bluuebunny/crossref_metadata_2025 huggingface dataset:
ML-15 The future direction of treatment development for primary central nervous system lymphoma (PCNSL)
Authors: Shinojima Naoki , Fujimoto Kenji , Yamamoto Takahiro , Ohta Kazutaka , Takezaki Tatsuya , Kuroda Jun-ichiro , Makino Keishi , Mukasa Akitake
Published: November 2020

Purpose: We found that the combination of high-dose Methotrexate (HD-MTX)-based therapy and histone deacetylase inhibitor (HDACI) had a therapeutic effect on PCNSL. In addition, this year, tirabrutinib, a Bruton’s tyrosine kinase inhibitor, was approved for marketing as a single agent for relapsed/refractory PCNSL, and new therapeutic development is expected. We will examine the treatment results of PCNSL in our department retrospectively and discuss the future direction of treatment development. METHODS: From 2001 to 2014, 82 newly diagnosed PCNSL patients treated with HD-MTX/Procarbazine (MP) as initial remission induction chemotherapy were retrospectively analyzed. RESULTS: Complete response (CR) was obtained in 38 patients (46.3%) after initial chemotherapy, and the median overall survival (OS) in the CR and non-CR groups was 2636 days and 728 days, respectively, and significantly shorter in the non-CR group (p<0.01). In the CR group, 27 cases (71.1%) recurred and 12 cases received HD-MTX re-challenge (M-re), 14 cases received treatment other than M-re (1 case did not receive treatment), the median OS after relapse was 590 days. The median post-relapse progression-free survival (PFS) of the 10 patients undergoing M-re at the first relapse was 116 days, the median OS after relapse was 590 days. The median post-relapse PFS of 16 patients receiving other treatments was 428 days, the median OS after relapse was 532 days. There was no difference in PFS and OS after recurrence in treatment at the first recurrence (p=0.15, p=0.55). Conclusion: The OS of non-CR patients in the initial chemotherapy and the OS after recurrence after CR were short. The possible directions of PCNSL treatment development include 1) increasing the CR rate with initial chemotherapy and maintaining CR for a long time for newly diagnosed PCNSL, and 2) finding an effective treatment for recurrence. New drugs such as tirabrutinib and HDACIs may be breakthroughs.
MET-01 Linac-based fractionated stereotactic radiotherapy with micro-multileaf collimeter for large brain metastasis unsuitable for surgical resection
Authors: Matsuda Ryosuke , Tamamoto Tetsuro , Morimoto Takayuki , Takeshima Yasuhiro , Tamura Kentaro , Yamada Shuichi , Nishimura Fumihiko , Nakagawa Ichiro , Motoyama Yasushi , Park Young-Su , Nakase Hiroyuki
Published: November 2020

To assess clinical outcomes using linac-based, fractionated, stereotactic radiotherapy (fSRT) with a micro-multileaf collimator for large brain metastasis (LBM) unsuitable for surgical resection. Between January 2009 and October 2018, we treated 21 patients with LBM using linac-based fSRT. LBM was defined as a tumor >30mm maximal diameter in gadolinium-enhanced magnetic resonance images. LBMs originated from the lung (n=17, 81%), ovary (n=2, 9.5%), rectum (n =1, 4.8%), and esophagus (n=1, 4.8%). The median pretreatment Karnofsky Performance Status was 50 (range: 50~80). Recursive partition analysis (RPA) was as follows: Classes 2 and 3 were 7 and 14 patients, respectively. The median follow-up was 5 months (range: 1~86 months). The range of tumor volume was 8.7~26.5 cm3 (median: 17.1 cm3). All patients were basically treated with fSRT ranged from 35 Gy with 7 Gy daily fractions, except in three cases. The progression-free survival was 3.0 months. The median survival time was 7.0 months. There was no permanent radiation injury in any of the patients. Radiation-caused central nervous system necrosis, according to the Common Terminology Criteria for Adverse Events version 4.0, occurred in one patient (grade 3). One patients received bevacizumab for radiation necrosis. Two patients underwent additional surgical resection due to local progression and cyst formation. For patients with LBM unsuitable for surgical resection, linac-based fSRT is a promising therapeutic alternative.
MET-02 Neoadjuvant fractionated stereotactic radiotherapy followed by surgery for large brain metastasis with difficulty in en-block resection
Authors: Mitsuya Koichi , Deguchi Shoichi , Onoe Tsuyoshi , Yasui Kazuaki , Ogawa Hirofumi , Asakura Hirofumi , Harada Hideyuki , Hayashi Nakamasa
Published: November 2020

BACKGROUND: Large brain metastases which require resection are treated with surgery followed by whole brain radiation therapy or postoperative stereotactic radiosurgery (SRS). Recently a novel strategy using neoadjuvant stereotactic radiosurgery (Na-SRS) followed by surgery was reported, demonstrating lower rates of postoperative leptomeningeal dissemination (LMD) and symptomatic radiation necrosis (sRN). However, local control rate was not significantly improved. We treated with neoadjuvant fractionated stereotactic radiotherapy (Na-frSRT) followed by surgery for large brain metastasis with difficulty in en-block resection.

METHODS: Nine patients received Na-frSRT followed by surgery between July 2019 and June 2020. Na-frSRT dose was based on lesion size and was standard dosing. Surgery generally followed within 7 days after radiotherapy.

RESULTS: The mean age was 64 years (55–78). Eight men and one woman. Median follow-up period was 5.3 months (1.7–12.5). Primary cancers were non-small cell lung cancer 2, esophageal cancer 2, colon cancer 1, melanoma 1, hepato-cellular carcinoma 1 and recurrence of BM from small cell lung cancer and renal cell cancer. The median maximum tumor diameter was 4.3cm (2.6–4.9). The median SRT dose was 30Gy/5fr, and the median time from SRT to surgery was 4 days (1–7). Median PTV was 15.4ml (5.6–49.7), and median GTV was 21.7ml (8.6–61.4). As preoperative adverse event, intracranial hypertension grade2 (CTCAE ver.4.0) was occurred one patient, but controlled with steroid and osmotic diuretics. Grade 3 and more adverse events were not occurred. Gross total resection with intra-tumoral decompression and piece-meal technique was performed in all cases as planning. Event cumulative incidence as follows: surgical site recurrence 0%; local recurrence 11.1%; distant brain failure 11.1%; LMD 0%; and sRN 0%. The median overall survival was not reached.

CONCLUSIONS: Na-frSRT followed by surgery is safety and feasible, and may have therapeutic value for large brain metastasis. Further prospective investigations in multi-institutional settings are warranted.
MET-04 A case of Brain Metastases with repeated bleeding from Esophageal carcinoma
Authors: Mikai Masataka , Abe Mitsuyoshi , watanabe Yo , Nakada Chie , Huchinoue Yutaka , Terazono Sayaka , Uchino Kei , Ando Syunpei , Masuda Hiroyuki , Kondo Kosuke , Harada Naoyuki , Miyazaki Chikao , Onagi Atsuo , Sugo Nobuo
Published: November 2020

Brain metastases from esophageal cancer is rare and the incidence has been reported at approximately 5%. We report a case of brain metastases with repeated bleeding from Esophageal carcinoma. The case is a 76-year-old man. Three years ago he was diagnosed with small cell carcinoma of the esophagus by endoscopic biopsy. Metastasis was found only in the cervical lymph node, but the condition was stable by chemoradiotherapy and no metastases were found throughout the body before 1 month. He was admitted to the hospital because of a sudden convulsion, and CT scan revealed cerebral hemorrhage in the right frontal lobe. We performed conservative treatment, but rebleeding was observed from the same site repeatedly after 1 month and 2 months. Due to the influence of bleeding, it was difficult to distinguish cerebral hemorrhage from brain tumor by contrast MRI. After surgery, the cause of bleeding was diagnosed as metastatic brain tumor of esophageal small cell carcinoma. Postoperative radiation therapy was performed in another hospital, but rebleeding was observed 3 months after the operation. A reoperation was performed at another hospital, and a recurrence of metastatic brain tumor was diagnosed. In the case of highly malignant metastatic brain tumors, it was considered necessary to frequently follow the images.
MET-05 Clinical investigation of treatment results and recurrence patterns of metastatic brain tumors from the viewpoint of postoperative irradiation
Authors: Hashiba Tetsuo , Kawano Haruka , Ueno Katsuya , Lee Qiang , Isozaki Haruna , Lee Yi , Kamei Takamasa , Takeda Junnichi , Yoshimura Kunikazu , Nonaka Masahiro , Asai Akio
Published: November 2020

While whole brain radiation therapy (WBRT) had been the standard postoperative radiation therapy for metastatic brain tumors for long time, recently local radiation therapy (LRT) has be become to be a new standard due to the accumulation of clinical evidences. Treatment results and pattern of recurrence were retrospectively analyzed from view point of postoperative radiotherapy. In this study, totally 69 patients were included and they were divided into WBRT group or LRT group. We analyzed the number of lesions, treated era, overall survival after diagnosis of metastasis (OS), recurrence free survival after RT (RFS), and patterns of recurrences. The subjects consisted of 37males and 32 females and average age was 61.7 years old. There were 49 cases in the WBRT group and 20 cases in the LRT group. While all cases before November 2017 had WBRT performed, LRT was adopted mainly in cases with a small number of metastases since December 2017. Although there was a difference in the observation period between the two groups, OS tended to be longer in the LRT group (P=0.08), while RFS tended to be shorter in the LRT group (P=0.08). Radiological recurrence after RT was observed in 7 cases in both groups, and in WBRT group, all cases were local recurrence, whereas in LRT group, all cases were new lesions or disseminated recurrence. Although there are biases such as the difference in observation period between the two groups and the tendency to adopt WBRT in cases with a large number of metastases, there is a possibility that postoperative LRT is not inferior to WBRT, especially for cases with a small number of metastases. However, we have experienced some cases of disseminated recurrence, and so it is necessary to consider the resection fashion such as whether en-bloc resection or piece meal resection when selecting postoperative RT.
MET-08 Air in cistern or ventricle after brain metastasis surgery is a predictor of early postoperative intracranial recurrence
Authors: Ikeuchi Yusuke , Nishihara Masamitsu , Ashida Noriaki , Sasayama Takashi , Hosoda Kohkichi
Published: November 2020

INTRODUCTION: The operations of brain metastasis are on the increase as a result of more routine diagnostic imaging and improved extracranial systemic treatment strategies. Opening of the cistern or ventricle during tumor resection may promote local recurrence and cerebrospinal fluid dissemination. We investigated whether the air found in the cistern/ventricle on postoperative Computed tomography (CT) was a predictor of postoperative recurrence.

METHODS: Between 2012 and 2019, 27 patients with single brain metastasis were treated with gross total resection at our hospital. The patients in which air was found in the cistern or ventricle of the head CT on the day after surgery was designated as air(+) group, and the patients without air was designated as air(-) group. The primary outcome was the local recurrence, as diagnosed with neuroimaging. The death due to other than brain metastasis was defined as competing risk.

RESULTS: CT air(+) group was 17 patients, whereas CT air(-) group was 10 patients. There was no significant difference between the two groups, such as age and sex. Estimated 1-year brain tumor recurrence rate was 70% in the air(+) group and 5.9% in the air(-) group. (p = 0.004). On the other hand, no significant difference was observed in estimated 1-year competing risk between in the air(+) group (10%) and in the air(-) group (2.4%).

CONCLUSION: En bloc resection of brain metastasis is effective, but there was no report on the risk of opening the cistern or ventricle. Our results indicate that postoperative air presence in the cistern or ventricle could be a predictor of early postoperative recurrence. In metastatic brain tumor removal, the cistern and ventricle should not be opened, and close follow-up should be done if air in the cistern or ventricle is detected on postoperative CT.
MET-09 Prognosis prediction study of using Susceptibility-weighted imaging in metastatic brain tumors
Authors: Iida Tomoko , Sakamoto Daisuke , Uchida Kazutaka , Yoshimura Shinichi
Published: November 2020

Background and purpose: MRI is a very useful tool especially for metastatic brain tumor. It can grasp the status of treatment and progress of primary lesion. In this study, we investigated the prognosis by using SWI (Susceptibility-weighted imaging) or T2 *sequences in MRI. Materials and methods: The study includes 69 patients who took a surgical treatment at our hospital from March 2014 to June 2020. Grade ranged from 0 to 2, with 0 defined as high signal intratumor, 1 defined as within 10 dark spots, 2 as almost consists with dark spot intratumor. Results: The median age of the patients was 66 years and 38 males (55%). The primary tumors were lung cancer in 28 cases (40.7%), breast cancer in 12 cases (17.4%), gastrointestinal cancer in 11 cases (15.9%), kidney cancer in 5 cases (7.2%), and others in 13 cases (18.8%). The SWI or T2 star images showed that grade 0 was 23 cases (33%), grade 1 was 18 cases (26%), grade 2 was 28 cases (41%). There were 16 deaths in grade 0 (69.6%), 10 deaths in grade 1 (55.6%), 15 deaths in grade 2 (53.5%). Conclusions: In this study, there was no statistically significant difference in the SWI or T2*-positive group. However, there was a tendency for many long-term survivors in the SWI or T2*-positive group.
MET-10 Preliminary report of radiotherapy for brain metastases from breast and kidney using mask system of Leksell Gamma Knife Icon
Authors: Kawabe Takuya , Sato Manabu
Published: November 2020

Object: Leksell Gamma Knife Icon enables us to apply new methods of immobilization using mask fixation and the option of fractionated treatment. This provides exceptional accuracy and precision of radiosurgery, making it a possibility for many more disease types and many more patients to be treated.

Methods: We retrospectively analyzed 97 patients (140 times) with brain metastases from breast (B group) and 26 patients (33 times) with brain metastases from kidney (K group) and who underwent Gamma Knife Icon using mask fixation between September 25th, 2017 and June 30th, 2020 at Rakusai Shimizu Hospital. Patients with small, few, newly diagnosed, and non-eloquent area tumors were treated in a single session. If the tumor volume was larger than 5.0 ml, recurrence, or the location was in an eloquent area, we applied a fractionated schedule. If the tumor number was large, we selected a multisession schedule. Median tumor number was three (1–64) in B group and two (1–31) in K group. Median tumor size was 2.7 (0. 01-58.8) ml in B group and 2.8 (0.02–123.5) ml in K group. We selected fractionated schedules as follows; 7.0 Gy x 5Fr (5–10 ml), 4.2Gy x 10Fr (10-20ml), 3.7Gy x 10Fr (20-30ml), 3.2Gy x 10Fr (30ml-).

Results: 32 (B) and 14 (K) cases were treated in a single session, 80 (B) and 17 (K) with fractionation, and 28 (B) and 2 (K) with multiple sessions. Median survival times after Icon treatment was 28.2 (B) and 15.5 (K) months. Local control rates were 89 % (B) and 85% after 12-month Icon treatment. Qualitative survival rates were 91% (B) and 86% (K) after 12-month Icon treatment. There were no statistically differences between two groups.

Conclusions: Although these results are limited to short periods, survival rates, local control rates and qualitative survival rates were within the acceptable ranges.
CS-03 BRAF V600E mutation mediates FDG-methionine uptake mismatch in polymorphous low-grade neuroepithelial tumor of the young
Authors: Hayashi Takahiro , Tateishi Kensuke , Ikegaya Naoki , Udaka Naoko , Sasame Jo , Miyake Yohei , Okabe Tetsuhiko , Minamimoto Ryogo , Murata Hidetoshi , Utsunomiya Daisuke , Yamanaka Syoji , Yamamoto Tetsuya
Published: November 2020

We present a case of a 14-year old boy with tumor-associated refractory epilepsy. Positron emission tomography imaging demonstrated a region with heterogeneous high 11 C-methionine uptake and a region with homogenous low 18 F- fluorodeoxyglucose uptake within the tumor. Histopathological and genomic analyses confirmed the tumor as BRAF V600E-mutated PLNTY (polymorphous low-grade neuroepithelial tumor of the young). Within the high-methionine-uptake region, we observed increased protein levels of L-type amino acid transporter 1 (LAT1) and constituents of the mitogen-activated protein kinase (MAPK) pathway. We also found that LAT1 expression was linked to BRAF V600E mutation and subsequent activation of MAPK signaling. Pharmacological inhibition of the MAPK pathway suppressed LAT1 expression and cell viability in PLNTY cells. Collectively, our results indicate that BRAF V600E mutation-activated MAPK signaling induces specific metabolic alterations in PLNTY, and may represent an attractive target in the treatment of the disease.
CS-09 Extra-parenchymal (Peripheral) Atypical Teratoid / Rhabdoid Tumors
Authors: Oka Hidehiro , Kusumi Mari , Koremura Masafumi , Kondo Koji
Published: November 2020

AT/RT is a malignant embryonal tumor reported by Rorke in 1996. Authors reported first AT/RT in Japan in 1998. This tumor entity was included as new malignant embryonal tumor in WHO 2000, and tumors of Japanese patients has been reported more than 80 cases in the past. This AT/RT is a tumor in the brain parenchyma that a medulloblastoma and PNET and the possibility that it has been misdiagnosed have had pointed out. On the other hand, it is reported that there is the type that we should call peripheral AT/RT which rarely occurs in extra-parenchyma. We want to propose that there is such special tumor group. In the results, age: 17 infants were main (2nd - 14 years old after birth). tumor location: 22 sellar or parasellar regions, 8 CP angles, 7 oculomoter nerves, and 3 petrous bone, treatment: duration of survival significantly improved all macroscopic tumor resection by the operation, but, in small pontine part AT/RT, an outcome tended to be poor. On the other hand, in AT/RT which occurred in the sellar region, all cases adult woman tended to have good prognosis. It is necessary for AT/RT (central AT/RT) in the brain to recognize that there is extra-parenchymal AT/RT (peripheral AT/RT) tumor which we reported this time which came to be recognized widely.
COT-07 Cerebrovascular complications in adult patients with malignant brain tumor
Authors: Mineharu Yohei , Arakawa Yoshiki , Tanji Masahiro , Nakajima Kohei , Terada Yukinori , Miyamoto Susumu
Published: November 2020

Background: According to the development of new treatment modalities, patients with malignant brain tumor have longer survival and they have more chances to have stroke.

Study Population: We retrospectively reviewed 509 patients with ischemic stroke and 445 patients with hemorrhagic stroke who visited Kyoto University Hospital between January 2010 and December 2019 and the association with malignant brain tumor was analyzed. The frequency of stroke in 287 patients with primary glioblastoma and 217 patients with metastatic brain tumor was also analyzed.

Results: Twenty one (4.1%) patients with ischemic stroke and 26 (5.1%) patients with hemorrhagic stroke patients had malignant brain tumor, and most tumors were either malignant glioma or metastatic brain tumor. A medical history of cranial irradiation was seen in 66.7% of patients with ischemic stroke, and 80% of hemorrhagic stroke occurred within the tumor before starting the treatments. Either ischemic or hemorrhagic stroke occurred in 9.1% of patients with glioblastoma and 4.1% of patients with metastatic brain tumor, and the number of ischemic and hemorrhagic were almost the same. In patients with glioblastoma, nearly half of the stroke cases were associated with bevacizumab. Half of the cases of bevacizumab-related stroke were asymptomatic, while asymptomatic cases were seen in 21.4% for non-bevacizumab cases.

Discussion: Stroke is not an uncommon complication in patients with malignant brain tumor but only a restricted number of cases were preventable. Including the cases of bevacizumab-related stroke, which is often asymptomatic, accurate diagnosis and the second prevention would be important.
COT-13 Current situation and problems of cancer genomic profiling test in Kyoto University Hospital
Authors: Arakawa Yoshiki , Suga Junko , Terada Yukinori , Nakajima Kohei , Tanji Masahiro , Mineharu Yohei , Muto Manabu , Miyamoto Susumu
Published: November 2020

Objective: Kyoto University Hospital has introduced the cancer genomic profiling tests, Oncoprime in 2015, Guardant360 in 2018, which are not under insurance coverage, FoundationOne CDx(F1CDx) and OncoGuide NCC Oncopanel system(NCC OP) in 2019, which received approval for insurance coverage for the first time in Japan. We investigated the results of cancer genomic profiling test under insurance coverage in our hospital. Methods: A special facility for the cancer genomic profiling tests was produced. To perform the cancer genomic profiling test, an outpatient must visit the facility three times (learning, ordering of the test, and getting the results). The expert panels decide the final test results and treatment options with the all information of the patients. Results: From November 2019 to March 2020, 51 and 9 patients were tested with F1CDx and NCC OP, respectively. 16 patients (31%) of F1CDX and 2 patients (22%) of NCC OP got treatment recommendations from the expert panels. However, only 5 patients (9.8%) of F1CDX and 1 patient (11%) of NCC OP received the treatments. The secondary finding suspecting germline mutations was found in 8 patients of F1CDX. Conclusion: After the approval the cancer genomic profiling tests with insurance coverage in Japan, it becomes easy for the patients to perform the test and get the genetic information of the tumor. However, it remains not easy to receive the recommended drugs because of several limitations of their usages.
COT-17 Cancer genomic medicine at Kobe University Hospital
Authors: Tanaka Kazuhiro , Toyoda Masanori , Kimbara Shiro , Hashiguchi Mitsuru , Fujita Yuichi , Minami Hironobu , Sasayama Takashi
Published: November 2020

Approximately one year has passed since the Japanese government approved a new plan to fight cancer by promoting the use of genomic medicine in June 2019. Our hospital plays an important role among 6 hospitals to serve cancer genomic medicine for cancer patients in Hyogo Prefecture. Here, we evaluated the system and the current status of cancer genomic medicine in our hospital, and examined future issues and problems. Consecutive 145 patients, who received outpatient treatment for cancer genomic medicine from July 2019 to June 2020 in Kobe University Hospital, were analyzed to examine patients’ background, implementation status, gene profile, and the number of subjects for treatment and clinical trials. The final result of gene profile was obtained in 93 cases, of which 49 cases (52.7%) showed the actionable gene changes to be treated. Six cases of brain tumor were 2 cases of glioblastoma, 2 cases of oligodendroglioma (recurrence), and 2 cases of AT/RT and CNS embryonal tumor. In one case the test was cancelled because Performance Status (PS) of the patient decreased. In another case the actionable gene mutation (PTEN, CDKN2A) was obtained, but the patient lived too far to visit clinical trial site. Almost half of genetic panel tests revealed genomic changes related to treatment, but the number of patients actually targeted for treatment or clinical trials was extremely small. It is necessary to consider the rapid progression of illness and access to facilities conducting clinical trials.
COT-18 Prognosis and problems about secondary intracranial neoplasm in childhood cancer survivors: a single-institution retrospective cohort study
Authors: Kagawa Naoki , Yokota Chisato , Hirayama Ryuichi , Kijima Noriyuki , Nakagawa Tomoyoshi , Miyamura Takako , Kinoshita Manabu , Kishima Haruhiko
Published: November 2020

Objective: As childhood cancer survivors gradually increased, late complications of treatment have been at issue and risk of secondary neoplasm is increasing cumulatively. We retrospectively analyzed clinical outcome and problems of treatment for secondary intracranial neoplasm. Patients and Methods: 497 patients (children, adolescents and young adults) with malignant central nervous system neoplasm were treated in our institution from 1971 to 2015. 188 cases (37.8%) were enrolled in this follow-up study. Diagnosis of primary neoplasm included low grade glioma (29%), embryonal tumor (23.5%), germ cell tumor (24.5%), ependymoma (8%), other (15%). Results: Fourteen cases of them were diagnosed as secondary intracranial neoplasm. Twelve cases were operated and histopathological diagnosis included 6 glioblastomas, 1 anaplastic astrocytoma, 1 anaplastic ependymoma, 4 meningiomas. In all cases, histopathological finding and molecular profile of secondary intracranial neoplasm differed from that of primary malignant brain tumors. Duration from the first operation of primary tumors to diagnosis of secondary intracranial neoplasm ranged from 5 to 36 years (average: 29.3). In malignant glioma cases except meningioma cases, origin of them was contained in high irradiation field (>40Gy). In malignant glioma cases, Chemotherapies using temozolomide and bevacizumab were selected after tumor removal. In 3 cases of them, reirradiation was performed. Response for treatment was poor or transient in most cases, median survival time was 12 months. Of late complications, such as endocrinological problem needed replacement (55%), cerebrovascular event (15.9%), secondary neoplasm (7.4%), secondary neoplasm was importantly related with prognosis. Conclusion: It is difficult to plan therapeutic strategies against second malignant neoplasm because of lack of information in case of long-term survivors and restriction for first radiation. Clinical outcome of them is poor and new treatment targets should be developed. It is important to plan clinical trials to reduce treatment intensity and usable long-term follow-up system.
COT-20 Clinical experience with tumor-treating fields therapy for newly diagnosed glioblastoma
Authors: Saito Norihiko , Hirai Nozomi , Sato Sho , Hiramoto Yu , Fujita Satoshi , Nakayama Haruo , Hayashi Morito , Sakurai Takatoshi , Yagihashi Akinori , Takahagi Shusaku , Iwabuchi Satoshi
Published: November 2020

Introduction: Tumor-treating fields (TTF) is an established modality for glioblastoma (GBM) treatment administered through the portable Optune system. The efficacy of Optune for newly diagnosed GBM was demonstrated in the EF-14 phase 3 trial. Although TTF is now included as part of initial treatment in the Japan GBM guideline, it is not yet a standard therapy because the procedures are cumbersome and may impose unnecessary psychological burdens on patients with dire prognoses. In our institution, TTF therapy has been offered as a treatment option for GBM patients since January 2018. This report summarizes our initial experience with this novel treatment.

Methods: The medical records of the first eight patients with newly diagnosed glioblastoma who underwent TTF were retrospectively reviewed.

Results: The eight patients with newly diagnosed glioblastoma treated with TTF comprised five men and three women (median age, 68 years; range 34–83 years). Nine patients were offered TTF therapy, but one declined because of the need for a shaved head. The patients continued TTF for 1–7 months, without major complications. Skin reaction was the most prevalent adverse event (n = 5). One patient could not continue TTF treatment after femoral neck fracture due to the weight of the mobile battery. One patient who did not have a helper at home received TTF treatment from a nurse visiting his home.

Conclusions: Patients should be provided with information on TTF, such as the timing of informed consent during and after chemoradiotherapy, to help them better understand this new modality and secure their consent.
Premalignant and malignant lesions of oral cavity in eastern India: a hospital-based study
Authors: Sahoo Pranab Kumar , Sarkar Sinjini , Ghosh Dipanwita , Mahata Sutapa , Pal Ranita , Mistry Tanuma , Ghosh Sushmita , Roy Asoke , Bucha Hitesh , Mandal Syamsundar , Nasare Vilas D.
Published: November 2020

Background

Oral carcinoma and precancers are major public health challenges in India and other developing countries.

Objectives

Aim of the study was to assess the associations of demographic characteristics, addictions, chief complaints of mouth/oral and clinical diagnosis by cytology smear and punch biopsy in early detection of oral premalignant and malignant lesions. Methods Study was designed on retrospective data of case files of CDC, CNCI, Kolkata, from patients attended from January 1996 to September 2016. History was taken, histopathology and Pap smear were performed. Descriptive statistical analysis, cross-tabulation and Pearson’s Chi-square test were done.

Results

Total participants (n = 692); 110 (15.9%) having history of swallowing betel leaf, nut lime, dokta, jarda, catecheu with an average of 11 years. Three hundred twenty-five (46.9%) had multiple addiction (cigarette/bidi/tobacco/all). Ninety-eight (12.1%), 99 (12.2%) and 68 (8.4%) were addicted to cigarette, bidi and chewing tobacco, respectively. Twenty-nine participants were addicted to alcohol; 18 (2.6%) and 11 (1.5%) took country and foreign alcohol correspondingly. Clinicians thoroughly examined lips (4.1%), buccal mucosa (27.3%), gingival (2.8%), tongue (23.1%), hard and soft palate (4.9%), mouth loor (5.2%) and other parts (32.3%); diagnosed participants as normal (22.8%)/benign (23.1%)/premalignant (39.1%)/malignant (14.8%). Smears confirmed 60, 131, 42, 9 and 8 cases as carcinoma, mild, moderate, severe dysplasia and inflammation, respectively. The punch biopsy identified 11 carcinomas, two severe, two moderate and seveeen mild dysplasia’s. Chi-square test showed significant association between smear and examination (P = 0.022), diagnosis and examinations of the oral cancer patients (P = 0.0001).

Conclusion

The study provided strong evidence that betel leaf, chewing tobacco, smoking and alcohol are independent risk factors for oral cancer. Cytological smear and biopsy are cost-effective approaches for early detection.
Validation of ICD-10 Codes for Gestational and Pregestational Diabetes During Pregnancy in a Large, Public Hospital
Authors: Stanhope Kaitlyn K. , Joseph Naima T. , Platner Marissa , Hutchison Ciara , Wen Shawn , Laboe Adrienne , Labgold Katie , Jamieson Denise J. , Boulet Sheree L.
Published: November 2020

Background:

The use of billing codes (ICD-10) to identify and track cases of gestational and pregestational diabetes during pregnancy is common in clinical quality improvement, research, and surveillance. However, specific diagnoses may be misclassified using ICD-10 codes, potentially biasing estimates. The goal of this study is to provide estimates of validation parameters (sensitivity, specificity, positive predictive value, and negative predictive value) for pregestational and gestational diabetes diagnosis using ICD-10 diagnosis codes compared with medical record abstraction at a large public hospital in Atlanta, Georgia.

Methods:

This study includes 3,654 deliveries to Emory physicians at Grady Memorial Hospital in Atlanta, Georgia, between 2016 and 2018. We linked information abstracted from the medical record to ICD-10 diagnosis codes for gestational and pregestational diabetes during the delivery hospitalization. Using the medical record as the gold standard, we calculated sensitivity, specificity, positive predictive value, and negative predictive value for each.

Results:

For both pregestational and gestational diabetes, ICD-10 codes had a high-negative predictive value (>99%, Table 3) and specificity (>99%). For pregestational diabetes, the sensitivity was 85.9% (95% CI = 78.8, 93.0) and positive predictive value 90.8% (95% CI = 85, 97). For gestational diabetes, the sensitivity was 95% (95% CI = 92, 98) and positive predictive value 86% (95% CI = 81, 90).

Conclusions:

In a large public hospital, ICD-10 codes accurately identified cases of pregestational and gestational diabetes with low numbers of false positives.
Assessing the Efficacy of Certificate of Need Laws Through Total Joint Arthroplasty
Authors: Schultz Olivia A. , Shi Lewis , Lee Michael
Published: November 2020

Lawmakers suggest Certificate of Need (CON) laws' main goals are increasing access to healthcare, increasing quality of healthcare, and decreasing healthcare costs. This retrospective database study aims to evaluate the effectiveness of CON through analysis of total knee, hip, and shoulder arthroplasty (TKA, THA, and TSA, respectively). A review was performed using the Humana Insurance PearlDiver national database from 2007 to 2015. Access to care was approximated by the rates of total joint arthroplasty (TJA) in patients diagnosed with arthritis to the corresponding joint. The quality of care was assessed using complication rates after TJA. The total cost of TJA was approximated from average reimbursement to the healthcare facility per procedure. Patients in states without CON programs received TKA, THA, and TSA more frequently (p < .0001, p = .250, p = .019). No significant difference was found in studied complication rates between CON and non-CON states. Similarly, there was no trend found when comparing the cost of each procedure in CON versus non-CON states. These findings are consistent with other recent studies detailing the impact of CON regulation on THA and TKA. The apparent nonsuperiority of CON states in achieving their purported goals may call into question the effectiveness of additional bureaucracy and regulation, suggesting a need for further examination.
The Experiences and Evaluation of a Complex Intervention for Couples Coping With Stroke
Authors: Ramazanu Sheena , Lim Chiang Vico Chung , Valimaki Maritta
Published: November 2020

BACKGROUND: Globally, stroke is a leading cause of death and disability. With a strong sense of filial responsibility, Asian caregivers are committed to caring for their ill family members. In response, the 3H (Head, Heart, Hands) intervention was developed and implemented in Singapore to support couples in their coping after a stroke. The purpose of this study is to explore the experiences of the participants taking part in the 3H intervention and evaluate the intervention after they had participated in it. METHODS: An interpretive descriptive design was used. Semistructured qualitative interviews were conducted with 7 patients and 7 spousal caregivers. Data were analyzed using conventional content analysis. RESULTS: The participants' experience was described as one of becoming more prepared to face the storm. The “storm” resulted from a stroke, where the participants were worried and uncertain about their future. After participating in the intervention, the couples' coping processes had improved. They coped by breaking the silence and engaging in conversations, cultivating a sense of support, and conveniently fulfilling their educational needs. It was evaluated that extending the 3H intervention for community nursing is necessary to strengthen the care transition of couples from the hospital to home. CONCLUSION: New knowledge has been gained that the 3H intervention is useful and may be implemented in a clinical context before a patient's discharge from hospital. As a result of participating in the 3H intervention, effective coping was evident where participants engaged in conversations, cultivated a sense of support, and fulfilled their educational needs. Primary healthcare professionals should pay more attention to the difficulties and needs of this group of people, provide more resources to support them, and improve their quality of life.
AIMS65 predicts prognosis of patients with duodenal ulcer bleeding; a comparison with other risk-scoring systems
Authors: Hirai Ryosuke , Shimodate Yuichi , Minami Mariko , Ishikawa Sho , Kanadani Takafumi , Takezawa Rio , Doi Akira , Nishimura Naoyuki , Mouri Hirokazu , Matsueda Kazuhiro , Yamamoto Hiroshi , Mizuno Motowo
Published: November 2020

Background and aim

Duodenal ulcer bleeding has a higher risk of mortality than bleeding from other portions of the gastrointestinal tract. AIMS65 is an effective risk-scoring system to predict prognosis of upper gastrointestinal bleeding and can be easily calculated without endoscopic findings. In this study, we investigate the usefulness of AIMS65 to predict prognosis of patients with duodenal ulcer bleeding.

Methods

Two hundred and fifty-five patients with endoscopically diagnosed duodenal ulcer bleeding at Kurashiki Central hospital from July 2007 to June 2017 were studied. We compared AIMS65, Glasgow Blatchford score (GBS), admission Rockall, and full Rockall scoring systems for predicting in-hospital mortality by calculating area under the receiver operating characteristic curve (AUROC).

Results

In-hospital mortality due to duodenal ulcer bleeding occurred in 17 (6.7%). Scores of all scoring systems were significantly higher in patients with in-hospital mortality than in patients without it. AUROC values for predicting in-hospital mortality was 0.83 in AIMS65, 0.74 in GBS, 0.76 in admission Rockall score, and 0.82 in full Rockall score, a statistically insignificant difference among the systems. In AIMS65, score more than or equal to 2 was an optimal value to predict in-hospital mortality, with sensitivities of 88.2% and specificities of 59.7%, respectively.

Conclusions

AIMS65 predicted in-hospital mortality of patients with duodenal ulcer bleeding as accurately as did other scoring systems. Given its simplicity of calculation, AIMS65 may be a more clinically practical system in the management of bleeding duodenal ulcer patients.
Pre-hospitalization proton pump inhibitor use and clinical outcomes in COVID-19
Authors: Ramachandran Preethi , Perisetti Abhilash , Gajendran Mahesh , Jean-Louis Farla , Bansal Pardeep , Dwivedi Alok Kumar , Goyal Hemant
Published: November 2020

Introduction

Severe acute respiratory syndrome coronavirus-2 may escape the inactivation by gastric acid because of hypochlorhydria caused by proton pump inhibitors (PPIs), which could predispose the patients to severe COVID-19.

Methods

We studied the association between prehospitalization PPI exposure and clinical outcomes among hospitalized COVID-19 patients.

Results

A total of 295 hospitalized COVID-19 patients were included in the study. 15.6% of hospitalized COVID-19 patients were on PPIs at home. Mortality among PPI-users was 2.3 times higher than non-users, along with 2.3 times higher risk of acute respiratory distress syndrome after adjusting for confounding variables.

Conclusion

We found that prehospitalization PPI-exposure is independently associated with worse clinical outcomes, including mortality in COVID-19 patients, regardless of the presence of cardiovascular comorbidities.
Assessment of the mass casualty triage during the November 2015 Paris area terrorist attacks: towards a simple triage rule
Authors: James Arthur , Yordanov Youri , Ausset Sylvain , Langlois Matthieu , Tourtier Jean-Pierre , Carli Pierre , Riou Bruno , Raux Mathieu
Published: November 2020

Backround

Triage is key in the management of mass casualty incidents.

Objective

The objective of this study was to assess the prehospital triage performed during the 2015 Paris area terrorist attack.

Design setting and participant

This was a retrospective cohort study that included all casualties of the attacks on 13 November 2015 in Paris area, France, that were admitted alive at the hospital within the first 24 h after the events. Patients were triaged as absolute emergency or relative emergency by a prehospital physician or nurse. This triage was then compared to the one of an expert panel that had retrospectively access to all prehospital and hospital files.

Outcomes measures and analysis

The primary endpoints were the rate of overtriage and undertriage, defined as number of patients misclassified in one triage category, divided by the total number of patients in this triage category.

Main result

Among 337 casualties admitted to the hospital, 262 (78%) were triaged during prehospital care, with, respectively, 74 (28%) and 188 (72%) as absolute and relative emergencies. Among these casualties, the expert panel classified 96 (37%) patients as absolute emergencies and 166 (63%) as relative emergency. The rate of undertriage and overtriage was 36% [95% confidence interval (CI), 27–47%] and 8% (95% CI, 4–13%), respectively. Among undertriaged casualties, 8 (23%) were considered as being severely undertriaged. Among overtriaged casualties, 10 (77%) were considered as being severely overtriaged.

Conclusion

A simple prehospital triage for trauma casualties during the 13 November terrorist attack in Paris could have been performed triaged in 78% of casualties that were admitted to the hospital, with a 36% rate of undertriage and 8% of overtriage. Qualitative analysis of undertriage and overtriage indicate some possibilities for further improvement.
Radium-223 therapy for metastatic castration-resistant prostate cancer: survival benefit when used earlier in the treatment pathway
Authors: Jarvis Peter , Ho Adrian , Sundram Francis
Published: November 2020

Background

Radium-223 dichloride (Ra-223) therapy improves overall survival in bony metastatic castration-resistant prostate cancer (mCRPC) patients. Recent guidance change recommends Ra-223 following at least two prior therapies for mCRPC. We evaluated how this change affects overall survival and the optimal timing of Ra-223 in the mCRPC treatment pathway.

Methods

Retrospective analysis of all mCRPC patients receiving Ra-223 therapy at a single UK centre over a 70-month period. Overall survival, number of prior lines of therapy commenced before Ra-223 initiation and number of Ra-223 therapy cycles completed were identified.

Results

One hundred ninety-one mCRPC patients received Ra-223 therapy during the study period. One hundred twenty-one (63%) received one prior therapy (group 1) and 70 (37%) received two prior therapies (group 2). Median survival in group 1 was significantly improved, compared to group 2 (448 days vs. 341 days (P = 0.03). Subgroup analysis of 111/191 (58%) patients that completed the recommended six Ra-223 therapy cycles showed additional improved survival. Median survival in group 1 was incrementally significantly improved, compared to group 2 within these patients (665 days vs. 552 days; P = 0.05). There was no difference in the number of patients completing the recommenced six cycles of therapy between the groups [72/121 (59%) vs. 39/70 (56%); P = 0.61].

Conclusion

We found a significant survival benefit when Ra-223 was used earlier in the mCRPC treatment pathway, with additional survival advantage seen in those patients completing all six Ra-223 cycles. Our results support the use of Ra-223 earlier in the treatment pathway.
Health Professionals’ Views on Lifestyle Advice Delivery to Teenage and Young Adult Cancer Patients
Authors: Pugh Gemma , Petrella Anika , Pabary Akshay , Cross Aaron , Hough Rachael , Soanes Louise , Sabiston Catherine , Fisher Abigail
Published: November 2020

Background

Many health professionals working with teenage and young adult cancer patients (TYA-HPs) do not provide advice on physical activity, dietary intake, smoking cessation, and alcohol consumption as part of routine cancer care.

Objective

The aim of this study was to understand TYA-HPs’ perspectives on the provision of health behavior advice and preferences on an intervention to help develop their health promotion skills.

Methods

In-depth, semistructured interviews were conducted with 26 TYA-HPs (12 nurses, 8 clinicians, and 6 allied health professionals) whose average time working with teenage and young adult (TYA) cancer patients was 8 years. Each interview followed the same semistructured guide, which was based upon constructs of the COM-B model of behavior change (capability, physical opportunity, social opportunity, reflective motivation, and automatic motivation), transcribed verbatim, and analyzed using the Framework analysis.

Results

Overall, TYA-HPs recognized the value and importance of promoting health behaviors but felt that their capability to provide health behavior advice was limited by the availability of, and access to, good-quality evidence linking health behavior to cancer outcomes. The TYA-HPs expressed confusion over professional responsibility to provide choices.

Conclusions

The TYA-HPs recognize health behavior promotion to be a core part of TYA cancer care but feel ill-equipped to provide such advice to patients.

Implications for practice

Mapped to constructs of the COM-B model of behavior, these findings suggest that TYA-HPs would benefit from cross–multidisciplinary team support for improved access to TYA-specific resources covering key health behaviors and skills-based training on delivering lifestyle advice.
Magnetic Resonance Imaging of the Brain in the Pediatric Emergency Department
Authors: Lee-Jayaram Jannet J. , Goerner Lee N. , Yamamoto Loren G.
Published: November 2020

Emergent imaging of the brain is often required to diagnose and manage serious and life-threatening conditions for children presenting to the emergency department. In an effort to reduce children's exposure to ionizing radiation, the use of magnetic resonance imaging (MRI) as an alternative to computed tomography (CT) is increasing. In some conditions, an urgent MRI rather than CT is critical for making management decisions. The purpose of this review is to highlight 3 emergency medical conditions—acute stroke, traumatic brain injury, and hydrocephalus—in which timely MRI of the brain is required for diagnosis and management. Another aim will be to guide providers in determining when and what limited MRI sequences of the brain can be used in lieu of CT in these emergency medical conditions.
The utility of olfactory function in distinguishing early-stage Alzheimer's disease from HIV-associated neurocognitive disorders
Authors: Sundermann Erin E. , Fields Adam , Saloner Rowan , Gouaux Ben , Bharti Ajay , Murphy Claire , Moore David J.
Published: November 2020

Objectives:

Given the rising number of older people with HIV (PWH) and the overlap in cognitive dysfunction profiles in HIV-associated neurocognitive disorders (HAND) and Alzheimer's disease and its precursor, amnestic mild cognitive impairment (aMCI), methods are needed to distinguish aMCI/Alzheimer's disease from HAND. As an early indicator of Alzheimer's disease, we examined whether olfactory dysfunction could help to distinguish between aMCI/Alzheimer's disease and HAND among PWH.

Design:

An observational cohort study.

Methods:

Eighty-one older (≥50 years) PWH (83% men, 65% white) from the California NeuroAIDS Tissue Consortium completed the University of Pennsylvania Smell Identification Test (UPSIT; higher scores = better smell identification) and a comprehensive seven-domain neuropsychological test battery and neuromedical evaluation. HAND was classified via Frascati criteria. High aMCI risk was defined as impairment (>1.0 SD below normative mean) on two of four delayed recall or recognition outcomes (at least one recognition impairment required) from the Hopkins Verbal Learning Test-Revised and the Brief Visuospatial Memory Test-Revised. We examined UPSIT scores in relation to aMCI risk and HAND status, and continuous memory scores considering adjustments for demographics and relevant clinical or HIV disease characteristics.

Results:

Fifty-seven participants were classified with HAND (70%) and 35 participants were classified as high aMCI risk (43%). UPSIT scores were lower (worse) in the high versus low aMCI risk group [F (1,76) = 10.04, P = 0.002], but did not differ by HAND status [F (1,76) = 0.62, P = 0.43]. UPSIT scores positively correlated with all memory outcomes (Ps < 0.05).

Conclusion:

Olfactory assessments may help in detecting early aMCI/Alzheimer's disease among PWH and allow for appropriate and early disease intervention.