bluuebunny/crossref_metadata_2025 huggingface dataset:
STMO-17 USEFULNESS OF INTEGRATION OF PREOPERATIVE FUNCTIONAL IMAGING AND INTRAOPERATIVE MRI NAVIGATION SYSTEM IN GLIOMA SURGERY
Authors: Tamura Manabu , Sato Ikuma , Sito Taiichi , Nitta Masayuki , Tsuzuki Shunsuke , Koriyama Shunichi , Kuwano Atsushi , Masamune Ken , Kawamata Takakazu , Muragaki Yoshihiro
Published: December 2022

Purpose

Intraoperative magnetic resonance imaging (MRI) update navigation is performed in all cases to preserve neurological function and remove the tumor as much as possible, and to prevent recurrence and improve prognosis. And under awake craniotomy, we supported operators by integrating preoperative functional images with intraoperative MRI. We report our usefulness of image superimposition between medium magnetic field intraoperative MRI and preoperative position emission tomography (PET) and preoperative diffusion tensor imaging (DTI) color-map.

Method

Of more than 2,200 cases using intraoperative MRI since 2000, 58 preoperative PET (57 methionine and 1 FDG nuclides) superimposed cases (32 left-sided, 35 males, 15 under awake craniotomy, mean 44.8 y.o.) were evaluated. The tumor was located to 34 frontal-, 12 temporal-, 10 parietal lobes, 1 insular gyrus, 1 thalamus. Color-map image superimposition of preoperative DTI (3T, 6-axis application) anisotropic indices in 12 cases (localized in 8 frontal-, 2 insular-, 2 parietal lobes, 7 left-sided, 7 females, mean 35 y.o.). Neurophysiological monitoring was combined (5 under general, 7 awake anesthesia).

Results

The preoperative TN ratio was 3.8 (in 57 methionine-PET cases), and pathological results (Grade 3-4 in 15-31 cases respectively, out of 54 cases) were used for reliable and preferential removal of sites with higher malignancy and recurrence-prone sites. Recurrent cases (41/58) had altered brain structures that were too difficult to identify without the navigation. In the DTI cases, intraoperative MRI, DTI color-map, and microscopic surgical images were displayed on one screen, and white matter tracts information as a reference is quickly conveyed to operators, and helped to reduce perioperative neurological complications.

Conclusion

Co-registering an effective superimposition of medium magnetic field intraoperative MRI with high positional accuracy, and preoperative PET- and DTI- images according to the patient's characteristics is currently the most practical navigation application method for intraoperative prediction of important functional information.
RT-6 POTENTIAL AND PROSPECTS OF BORON NEUTRON CAPTURE THERAPY USING A COMBINATION OF MULTIPLE BORON AGENTS
Authors: Kawabata Shinji , Tsujino Kohei , Kashiwagi Hideki , Yoshimura Kohei , Hiramatsu Ryo , Nonoguchi Naosuke , Furuse Motomasa , Takami Toshihiro , Hu Naonori , Ono Koji , Miyatake Shin-Ichi , Wanibuchi Masahiko
Published: December 2022

Boron neutron capture therapy (BNCT) is a particle therapy that can target tumors at the cellular level. BNCT has been developed for the treatment of malignant gliomas with widely infiltrated tumors, but as the indication for BNCT was expanded to include the whole body, the focus shifted to borophalan-10B (BPA), which is based on the essential amino acid phenylalanine, as a candidate agent. We started BNCT for brain tumors in 2002 with a protocol combining two compounds (BPA, BSH) that had been clinically used, but later, with the development of an accelerator-based system, we conducted a clinical study of a single agent of BPA with a modified administration protocol in a nuclear reactor. In this report, we analyze the clinical studies of BNCT for recurrent malignant glioma using the reactor as a neutron source, and discuss the possibility of BNCT using multiple drugs in combination. The median survival with BSH+BPA was 11.0 months (n=29) overall, and the MST with BPA alone was 11.1 months (n=24), with similar results for BPA alone. The blood boron levels at the time of irradiation were 46.3 and 27.3 μg/ml, respectively, which were higher with the addition of BSH. The irradiation doses converted to X-rays (Gy) equivalent were calculated to be 69 and 76 Gy-Eq for the maximum tumor, 37 and 40 Gy-Eq for the minimum, and 10.9 and 10.5 Gy-Eq for the normal brain, respectively. The biological effectiveness ratios for tumor and normal tissue from neutron capture reactions with boron compounds and tissue boron concentrations were factored into these calculations, and since BPA and BSH have different target systems (BPA in the infiltration zone and BSH in the contrast zone, respectively), we believe that their combined use may improve therapeutic efficacy and attenuate adverse events.
MPC-8 CLINICAL CHARACTERISTICS OF H3 K27-MUTATED GLIOMAS AT MIDLINE AND NEAR MIDLINE
Authors: Hayashi Nobuhide , Fukai Junya , Nakatogawa Hirokazu , Kawaji Hiroshi , Okita Yoshiko , Kijima Noriyuki , Shofuda Tomoko , Yoshioka Ema , Kanemastu Daisuke , Katsuma Asako , Sumida Miho , Nakao Naoyuki , Mori Kanji , Kanemura Yonehiro
Published: December 2022

Background and Purpose

Diffuse midline glioma(DMG),H3K27 alterd (WHO 2021, CNS grade 4) is a type of tumor that mainly develops in the CNS's median. However, owing to its rarity, few comprehensive reports have been published. This report conducted a retrospective study on H3p.K27M mutation cases via the Kansai Molecular Diagnosis Network for CNS tumors.

Materials and Methods

H3p.K27M mutation cases were analyzed out of 4128 total gene analysis specimens submitted for suspected glioma during the case accumulation period from May 2007 to July 2022.

Results

There were 109 cases with the H3p.K27M mutation, of which 107 had the H3F3A mutation, and 2 had the HIST1H3B mutation. Of the 93cases that developed a tumor on or around the lateral ventricles of the brain along the midline of the CNS, affected sites included the thalamus (37 cases), brainstem (19 cases), spinal cord (11 cases), and other areas (15 cases), while 7 cases were of multifocal origin and 4 cases were unclassifiable. The patients' ages ranged from 4 to 76 years, with a mean and median age of 32.8 and 30 years, respectively (n = 88). The male to female ratio was 52:36. All cases had IDH-wild type with pMGMT methylation (9.6%), pTERT mutation (3.2%), TP53 mutation (56.5%), BRAF V600E mutation (1.1%), FGFR1 mutation (14.3%), or EGFR mutation (3.3%). Histopathological examination revealed the existence of WHO CNS grade 2, 3, and 4 tumors. Overall survival (OS) was confirmed in 38 cases, with a mean and median age of 15.0 and 11.9 months, respectively. The results of 51 cases in which prognosis was followed up on, suggested that the factors that contributed to the prolongation of OS were female sex (p = 0.0335), thalamus location (p = 0.0366), and irradiation of 50 Gy or more (p = 0.0237).

Discussion/Conclusion

Based on a literature review, we report on the clinical characteristics of DMG in our cases, including the category of midline in DMG.
MPC-10 RECURRENT ASTROCYTOMA WITH SOMATIC IDH MOSAICISM: A CASE REPORT AND WARRANT FOR MOLECULAR DIAGNOSTICS
Authors: Masui Kenta , Onizuka Hiromi , Nitta Masayuki , Muragaki Yoshihiro , Kawamata Takakazu , Komori Takashi
Published: December 2022

Introduction

Acquisition of somatic mutations is essential for the development of malignant tumors such as diffuse gliomas. Recent single-cell analyses have pointed out the importance of somatic mosaicism in the pathogenesis of cancer. Here we report a case of IDH (isocitrate dehydrogenase)-mutant astrocytoma that has relapsed after intensive chemoradiation with somatic mosaicism for the IDH1 R132H mutation.

Clinical and Pathological Findings

A 36-year-old male presented with epileptic symptoms and a mass lesion in the right frontal lobe. A needle biopsy demonstrated IDH-mutant astrocytoma (grade 2). At the age of 41, relapsed tumor was completely resected, and the tumor cells were diffusely positive for IDH1 R132H with grade 4 morphology. Chemoradiotherapy (PAV + IMRT 60Gy/30fr) was added, but contrast-enhanced lesions reappeared 5 months after the initial surgery. The re-excised specimen was grade 4 astrocytoma, and the number of IDH1 R132H-positive tumor cells was very small compared to the total number of tumor cells, suggesting somatic mosaicism for IDH mutations.

Conclusion

It is imperative to clarify the induction mechanism and significance of somatic cell mosaicism in cancer, and molecular genetic assessment with sequencing and digital PCR would be necessary in addition to immunostaining for accurate molecular diagnoses of the brain tumors.
MPC-15 CLINICAL FEATURE OF NON-MIDLINE GLIOMA WITH H3F3A GENE MUTATION
Authors: Nakatogawa Hirokazu , Kawaji Hiroshi , Hayashi Nobuhide , Fukai Junya , Kijima Noriyuki , Shofuda Tomoko , Yoshioka Ema , Kanematsu Daisuke , Katsuma Asako , Sumida Miho , Inenaga Chikanori , Mori Kanji , Kanemura Yonehiro
Published: December 2022

Introduction

Diffuse midline glioma (DMG), H3K27-altered, is a CNS WHO grade 4 glioma that usually occurs mainly in the brainstem region in children and also in the thalamus and spinal cord in older children and adults. On the other hand, glioma with histone H3 p. G34R/V mutations in the cerebral hemispheres are defined in a new classification of Diffuse hemispheric glioma, H3G34-mutant (DHG), in the WHO 2021 classification. However, there are some reports of H3K27-altered non-midline gliomas (NDMG) that are not located in the midline, but the differences between these hemispheric tumors with mutations in different regions of histone H3 are unknown. In this study, we report a comparative study of the clinical characteristics between two groups of glioma, H3K27-altered NDMGs and H3G34-mutant DHGs.

Methods

Among 4128 brain tumor specimens collected in the Kansai Network for Molecular Diagnosis of Central Nervous System Tumors, 25 NDMG cases, excluding 93 cases defined as DMG, were included out of 118 cases with mutations in the H3F3A gene. Both 16 H3K27-altered NDMG cases and 9 H3G34-mutant DHG cases were examined for comparison of clinical characteristics.

Results

There were no differences in gender, tumor location, or pathology between NDMG and DHG. The median age was 47.3 years in NDMG and 26.2 years in DHG, and NDMG was significantly older than DHG (p=0.003). The rate of MGMT promoter methylation is no significant difference between 4 cases (25%) in NDMG and 6 cases (66.7%) in DHG (p=0.087). The Kaplan-Meier survival curve showed no significant difference, with a median survival of 495 days for NDMG and 587 days for DHG (p=0.765).

Discussion and Conclusion

We reported on gliomas with H3F3A mutations that occur in the cerebral hemispheres. We compared the clinical characteristics of NDMG with H3K27-altered and DHG with H3G34-mutant, which have similar tumor locations of occurrence.
MPC-16 CHARACTERISTICS AND PROGNOSTIC FACTORS OF H3K27M-MUTANT DIFFUSE MIDLINE GLIOMA
Authors: Tanaka Kazuhiro , Nagashima Hiroaki , Yamanishi Shunsuke , Iwahashi Hirofumi , Itoh Tomoo , Sasayama Takashi
Published: December 2022

H3 K27M-mutant diffuse midline gliomas (DMG) is a still challenging disease with no effective medical therapies. We analyzed the characteristics and prognostic factors of 64 patients with midline gliomas including 18 patients with H3 K27M-mutant DMG treated in Kobe University Hospital from 2006 to 2021. The median age at diagnosis in midline gliomas was 50.1 years (range: 14-82 y). All tumors were located in thalamus n=25, corpus callosum n=8, brainstem n=8, spinal cord n=6, cerebellum n=15, and pineal region n=2. Isocitrate dehydrogenase 1 (IDH1) and H3 K27 mutation was recognized in 6 and 18 patients, respectively, which was mutually exclusive. In all midline gliomas, the identification of an H3 K27M mutation was significantly a poor prognosis factor (median 19.8 months vs 27.9 months, p=0.042). Compared to midline gliomas without histone H3 and IDH1 mutations (IDH1/H3 wild type), however, H3 K27M-mutant DMG had no worse overall survival (median 19.8 months vs 15.9 months, p=0.51). H3 K27M-mutant DMG is considered as a distinct WHO Grade 4 regardless of histological features, but the biological properties of H3 K27M mutation is not yet defined in IDH1 wild-type midline gliomas.
MPC-19 DIAGNOSTIC APPROACH IN HISTOPATHOLOGICALLY CHALLENGING CASES IN KYOTO UNIVERSITY HOSPITAL
Authors: Takeuchi Yasuhide , Arakawa Yoshiki
Published: December 2022

In 2021, the WHO classification of tumors of the central nervous system (CNS) was published, which drastically changed the diagnostic approach to tumors in the CNS. In the diagnosis of most subtypes of CNS tumors, especially in gliomas, the genetic test became critical in the latest version of the classification, meanwhile analyzing genetic alterations in routine practice is still quite difficult in most of the hospitals in Japan because of the accessibility of the genetic analysis. In Kyoto University Hospital (KUHP), around 80 tumors in CNS are newly diagnosed every year, half of which are gliomas with a few challenging cases on the histopathological diagnosis. The diagnostic approach to CNS tumors in KUHP can be divided into two steps: the clinical phase and the academic phase. The clinical phase includes a pre-operative conference with neurosurgeons, radiologists, and pathologists, and classical histopathological analysis on formalin-fixed and paraffin-embedded tissues with H&E staining, immunohistochemistry on p53, IDH1 R132H, and ATRX, fluorescence in situ hybridization on 1p/19q co-deletion, and consultation to the experts of the CNS tumors. Some cases are further analyzed by clinical cancer genome sequencing. When the tumors are expected to be glioma during the pre-operative conference, after the surgery, the tumor tissue gets frozen to be submitted to the academic phase. The academic phase includes analysis of genetic alterations with Sanger sequencing and Multiplex Ligation-dependent Probe Amplification (MLPA) assay on the representative glioma-associated genes. In some cases, the tumors are further analyzed by methylome assay and/or mRNA sequencing (PMID: 35900258), to identify novel genetic alterations. Most of the neuropathologists in Japan today are suffering in diagnosing gliomas because of the novel, sophisticated, and complicated WHO classification. In this presentation, we want to share our diagnostic approach to the diagnosis of CNS tumors and shed light on it.
NI-1 METHYLTHIOADENOSINE PHOSPHOLYLASE STATUS CORRELATES WITH PROGNOSIS AND METHIONINE UPTAKE IN IDH MUTANT ASTROCYTOMA
Authors: Yamamura Toshihiro , Tamura Kaoru , Kobayashi Daisuke , Inaji Motoki , Toyama Yuka , Hara Shoko , Tanaka Yoji , Nariai Tadashi , Ishii Kenji , Maehara Taketoshi
Published: December 2022

Purpose

Methylthioadenosine phosphorylase (MTAP) immunohistochemistry staining has been proposed as a surrogate of Cyclin-dependent kinase inhibitor 2A homozygous deletion (CDKN2A HD) in various type of tumors. This study was designed to determine whether MTAP status correlates with clinical outcome and uptake of 11C-methionine in astrocytoma with IDH mutations.

Methods

We conducted a MTAP immunohistochemistry staining of 30 IDH-mutant astrocytoma patients who underwent 11C-methionine positron emission tomography scans prior to surgical resection from 2000 to 2020. The tumor-to-normal ratio (T/N) of 11C-methionine uptake was calculated by dividing the mean standardized uptake value (SUV) for the tumor by the mean SUV of the normal brain.

Results

Eight of the thirty astrocytomas harboring IDH mutations exhibited loss of cytoplasmic MTAP expression, which is accompanied with a poor prognosis. The median progression free survival (PFS) in IDH-mutant astrocytoma patients with loss of MTAP was 1.88 years, significantly shorter than that of those with MTAP retention (6.80 years, p=0.003). The median Overall survival (OS) in IDH-mutant astrocytoma patients with loss of MTAP was 5.23 years, again significantly shorter than that of those with MTAP retention (p=0.0191). Multivariate analysis revealed MTAP status to be an independent prognostic marker for PFS in IDH-mutant astrocytoma patients. The median T/N ratio in tumors with loss of cytoplasmic MTAP expression was 2.12 (IQR 1.92-2.50), i.e., significantly higher than that of tumors with MTAP retention (1.65, IQR 1.23-1.94, p=0.0116, U test).

Conclusion

Our study showed MTAP status to correlate with clinical outcome and T/N ratio of astrocytoma patients with IDH mutations.
NI-2 DUAL-ISOTOPE 123I-IMP/201TL SPECT FOR THE DIFFERENTIAL DIAGNOSIS OF PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA AND GLIOBLASTOMA
Authors: Osawa Sho , Tosaka Masahiko , Horiguchi Keishi , Tokue Azusa , Higuchi Tetsuya , Tsushima Yoshito , Yoshimoto Yuhei
Published: December 2022

Background

Preoperative differential diagnosis between primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM) is important because these tumors require different surgical strategies. This study investigated the usefulness of dual isotope, iodine-123-labeled N-isopropyl-p-iodoamphetamine (123I-IMP) and thallium-201 chloride single photon emission computed tomography (201Tl SPECT) for the differential diagnosis.

Methods

Sixteen PCNSL patients and 20 GBM patients who underwent dual isotope imaging, 123I-IMP and 201Tl SPECT, are included. Early and delayed SPECT images were obtained after 30 minutes and 4 hours, respectively. Tumor to normal (T/N) ratio was calculated from the ratio of maximum tracer counts in the lesion to the mean counts in the contralateral cerebral cortex. The mean and minimum apparent diffusion coefficient values (ADCmean and ADCmin, respectively) on magnetic resonance imaging were also analyzed for comparison of diagnostic accuracy.

Results

Delayed phase 123I-IMP SPECT was the most useful imaging examination for the differentiation between PCNSL and GBM compared with early phase 123I-IMP SPECT, early and delayed phase 201Tl SPECT, ADCmean and ADCmin. However, the median T/N ratios of PCNSL and GBM were 1.29 and 0.84, respectively, in the delayed phase 123I-IMP SPECT, and the tumor detection was inadequate. On the other hand, the median T/N ratios of PCNSL and GBM were 3.23 and 2.34, respectively, in the delayed phase 201Tl SPECT, with excellent tumor detection. Thirty-five of 36 patients (97.2%) showed a tracer retention rate of 201Tl SPECT 0.7 or higher, which indicates malignant property of brain tumors.

Conclusion

Delayed phase 123I-IMP SPECT could differentiate between PCNSL and GBM with high accuracy, but T/N ratio was low and tumor detection was poor. 201Tl SPECT was useful for estimation of the localization and the malignant property of the tumors. The combination of these isotopes was useful for the diagnosis of PCNSL and GBM.
NI-3 FEASIBILITY OF MRI PERFUSION IN DISCRIMINATING BETWEEN EDEMA AND INFILTRATIVE AREAS IN THE PERI-GBM NON-CONTRAST T2 WEIGHTED HIGH AREA
Authors: Kuroda Hideki , Okita Yoshiko , Arisawa Atsuko , Utugi Rena , Tachi Tetsuro , Hirayama Ryuichi , Kijima Noriyuki , Nakamura Hajime , Kagawa Naoki , Kishima Haruhiko
Published: December 2022

Background

Glioblastomas are highly infiltrative tumors, and differentiating between infiltrating tumors and vasogenic edema occurring in the non-enhancing T2-weighted hyperintense area is challenging. Here, we differentiated between infiltrating tumors and edemas in glioblastomas using dynamic perfusion-weighted MR imaging.

Methods

Data were collected from 33 patients with glioblastomas and 15 with meningioma as controls, who underwent resection at our institution between January 2019 and March 2022. The MRI data included T2 weighted images and contrast-enhanced T1 weighted images, and dynamic perfusion-weighted MR imaging. Two neurosurgeons manually assigned regions of interest (ROIs) to infiltrating tumors and vasogenic edema based on a previous report using conventional MRI features. The ratio of cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) in the ROIs to that contralateral normal regions were calculated. We also histological analysis using histological specimens obtained by stereotactic biopsy in each ROI.

Results

CBF and MTT ratios of infiltrating tumors and edemas differed significantly (p<0.01), while CBF and MTT ratios of edemas and controls showed similarities. MTT values of controls and infiltrating tumors differed significantly (p=0.02). Receiver operating characteristic curve analysis revealed that CBF (area under the curve [AUC]=0.81) and MTT(AUC=0.95) were effective in distinguishing between infiltrating tumors and edemas. Pathological analysis revealed that cell density, MIB1-index, and microvessel density were higher in infiltrating tumors than in edemas.

Conclusions

Using dynamic perfusion-weighted MR imaging may prove useful in differentiating infiltrating tumors from edemas in the non-contrast T2 hyperintensity region of glioblastomas.
NI-8 LATE-DELAYED MRI FINDINGS AFTER RADIOTHERAPY: DOT-LIKE ENHANCED LESION
Authors: Asano Kenichiro , Kakuta Kiyohide , Fujiwara Nozomi , Saito Atsushi , Kakeda Shingo
Published: December 2022

Introduction

Late-delayed radiation reactions after radiotherapy include brain atrophy, leukoencephalopathy, radiation necrosis, and cerebrovascular disease. We will discuss the contrast-enhanced SPGR to detect dot-like enhanced lesions that are considered to be late late-delayed radiation reactions.

Material and Methods

One hundred eleven patients (62 males and 49 females; median age at irradiation: 49 years) who had received radiotherapy since 1994 and were alive since 2010, had dot-like lesions by contrast-enhanced SPGR, and had a PFS OS of at least 24 months were included in the study. Of these, 64 had high-grade glioma, 4 had low-grade glioma, 15 had PCNSL, 7 had metastatic brain tumors, 9 had germ cell tumors, 5 had medulloblastoma, and 7 had other tumors, with a mean follow-up of 89.

Results

Contrast-enhanced SPGR showed dot-like or rod-like findings in 23/111 patients (20.7%). Contrast-enhanced FIESTA and Flair-Cube were also detectable in some cases. However, it was difficult to detect by contrast SE-T1WI, SE-T2WI, or contrast SE-Flair. The lesions appeared a median of 49 months after irradiation (IQR 34, 103. Range 25-298). There were no lesions that increased in size, and multiple lesions appeared during the course of the study in 8/23 (34.8%) of the patients. All lesions occurred within the irradiated field and were seen in patients receiving a total dose of 50 Gy or more, but not in patients receiving whole-brain irradiation alone or whole-brain irradiation plus boost at 50 Gy or less.

Discussion and Conclusion

It is difficult to elucidate the pathogenesis without pathological evidence, but it is one of the late-delayed radiation reactions that occur more than 2 years later, and it is presumed to be vasculopathy or granulation reaction in the Virchow-Robin space. It tends to increase over time and is not considered to be a condition that causes sudden clinical manifestations.
NI-10 CLINICAL BENEFITS FROM ONE-SHOT BEVACIZUMAB BEFORE A RESECTION OF GLIOBLASTOMA
Authors: Beppu Takaaki , Sato Yuichi , Nomura Jyun-ichi , Fujiwara Shunrou , Ogasawara Kuniaki
Published: December 2022

Purpose

We aimed to clarify of clinical impacts from preoperative administration of bevacizumab (BEV) in patients with newly diagnosed glioblastoma.

Methods

Subjects were 17 patients who met the entry criteria, and were administered with BEV (10 mg/kg) one time before surgery. Between phases before and after BEV administration, we compared KPS and volumes of hyperintense areas on FLAIR and enhanced areas on T1-weighted imaging with contrast media (Gd-T1WI). Tumor resection was carried out at least three weeks after BEV. Also between phases immediately before and after operation, volumes of hyperintense areas on FLAIR and enhanced areas on Gd-T1WI (= tumor removal rate) were compared. These were compared with those in the control group of patients who received tumor resection without BEV.

Results

One-shot BEV led to significant improvement of KPS and significant volume reductions of hyperintense areas on FLAIR (43.8±26.3%) and enhanced areas on Gd-T1WI (34.6±18.2%). No patients showed any adverse effects around surgery. On MRI after surgery, volume-reduction rates of hyperintense areas on FLAIR and enhanced areas on Gd-T1WI were 44.7±24.7% and 96.2±5.4%, respectively. Compared with control group, a significant difference was identified in the reduction rate of hyperintense areas, but not in that of enhanced areas.

Conclusions

One-shot administration with BEV reduced both volumes of hyperintense areas on FLAIR and enhanced areas on Gd-T1WI, thereby improved KPS before surgery. Preoperative BEV was safe for tumor resections but did not affect to tumor removal rate. We speculated a significant volume reduction of hyperintense areas on FLAIR might have been led by continuous effect from BEV rather than an increase of resected volume.
NI-11 USEFULNESS OF MRI ARTERIAL SPIN LABELING METHOD FOR DIAGNOSING BRAIN TUMOR
Authors: Hiu Takeshi , Shiozaki Eri , Ishikawa Ayano , Morikawa Minoru , Matsuo Ayaka , Yoshida Michiharu , Baba Shiro , Ujifuku Kenta , Yoshida Koichi , Morofuji Yoichi , Izumo Tsuyoshi , Matsuo Takayuki
Published: December 2022

Background

Diagnosis of hemangioblastoma by magnetic resonance imaging (MRI) can sometimes be difficult when the tumor is a solid mass in the posterior fossa. We therefore evaluated perfusion images and diffusion-weighted images as brain function images to diagnose hemangioblastoma in order to obtain the most useful quantitative features.

Methods

Forty-five posterior fossa tumors whose pathological diagnosis was confirmed by surgery were included in groups A (18 hemangioblastomas) and B (non-hemangioblastoma 27 cases: metastatic brain tumor 8 cases, pilocytic astrocytoma 6 cases, and other 13 cases). All cases were imaged by 3.0-Tesla MRI, with arterial spin labeling (ASL) as the relative value from the CBF map to the region of interest (ROI) in the contralateral hemisphere as perfusion image. Among 45 cases, 27 cases were evaluated with both ASL and dynamic susceptibility contrast (DSC) as rCBF, rCBV, corrected CBV, and K2. The ROI was set to match the contrast-enhanced part, and the two groups were compared and examined.

Results

The relative ASL value of group A and the corrected CBV in DSC were significantly higher than group B (p < 0.001). In contrast, the ADC showed no marked difference between the two groups. In the distinction between the two groups, the receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) of the relative ASL value was significantly higher than the other parameters (AUC 0.995, cut-off value 2.34, sensitivity 100%, specificity 99.5%).

Conclusions

The non-contrast ASL method was extremely useful for diagnosing hemangioblastoma in posterior fossa tumors. Non contrast ASL can be used instead of contrast-enhanced DSC in diagnosing posterior fossa hemangioblastoma.
NI-13 THE RATIO OF T1-WEIGHTED TO T2-WEIGHTED SIGNAL INTENSITY AND IDH MUTATION IN GLIOMA
Authors: Sanada Takahiro , Yamamoto Shota , Sakai Mio , Umehara Toru , Sato Hirotaka , Saito Masato , Mitsui Nobuyuki , Hiroshima Satoru , Anei Ryogo , Kanemura Yonehiro , Tanino Mishie , Nakanishi Katsuyuki , Kishima Haruhiko , Kinoshita Manabu
Published: December 2022

Purpose

The current study aims to test the hypothesis that the ratio of T1-weighted image to T2-weighted image signal intensity (T1w/T2w-Ratio: rT1/T2), an imaging surrogate developed for myelin integrity, is predictive of histologically lower-grade glioma's IDH mutation status.

Materials and Methods

25 histologically and molecularly confirmed lower-grade glioma patients with eight IDH-wildtype (IDHwt) and 17 IDH-mutant (IDHmt) tumors at Asahikawa Medical University Hospital (AMUH) were used as a test cohort. Twenty-nine patients (IDHwt: 13, IDHmt: 16) from Osaka International Cancer Institute (OICI) and 101 patients from the Cancer Imaging Archive (TCIA) / Cancer Genome Atlas (TCGA) dataset (IDHwt: 19, IDHmt: 82) were used as external cohorts. rT1/T2 images were calculated from T1- and T2-weighted images using a recommended signal correction. The relationship between the mean rT1/T2 (mrT1/T2) and the IDH mutation status was investigated. Moreover, t-Distributed Stochastic Neighbor Embedding (t-SNE) investigated the difference in MRI qualities and characteristics between the three cohorts.

Results

The test cohort at AMUH revealed that mrT1/T2 of IDHwt tumors was significantly higher than that of IDHmt tumors (p < 0.05) and that the optimal cut-off of mrT1/T2 for discriminating IDHmt was 0.666-0.677, (AUC = 0.75, p < 0.05), which finding was validated by the external domestic cohort at OICI (AUC = 0.75, p = 0.02). However, the external international cohort deriving from TCIA/TCGA could not validate this (AUC = 0.63, p = 0.08). t-SNE analysis revealed that the difference in image characteristics within the cohort was more diverse for the TCIA/TCGA than for the two domestic cohorts.

Conclusion

The current study revealed that mrT1/T2 was able to discriminate IDHwt and IDHmt tumors in two domestic cohorts significantly. This was not validated by the TCIA/TCGA cohort due to the wide variety in the original imaging characteristics of the TCIA/TCGA cohort.
NI-16 RESPONSE ASSESSMENT OF BEVACIZUMAB THERAPY FOR GLIOBLASTOMA BY USING MULTIPLE PET TRACERS
Authors: Miyake Keisuke , Fuke Tomono , Tatano Masaki , Kawai Nobuhiko , Ishikawa Momo , Mino Satoshi , Kanda Takahiro , Suzuki Kenta , Fujimori Takeshi , Toyota Yasunori , Ogawa Daisuke , Hatakeyama Tetsuhiro , Okauchi Masanobu , Kawanishi Masahiko
Published: December 2022

Objective

PET scans are useful for the diagnosis and treatment planning of glioma. Introduced in 2013, bevacizumab (Bev) treatment efficacy can be difficult to determine using MRI imaging. We instead performed PET scans to determine the efficacy of Bev-based glioblastoma treatment.

Methods

Eighty glioblastoma patients treated with Bev from July 2013 to December 2021 were included. The patients were divided into the following three groups: the first group received Bev added to the Stupp regimen after biopsy or subtotal resection (first-dose group), the second group received Bev added to the Stupp regimen after biopsy followed by tumor resection (neoadjuvant group), and the third group received the Stupp regimen after tumor resection followed by TMZ + Bev at recurrence (recurrent group). PET scans (FDG, MET, FLT, and FMISO) were performed before and 4 weeks after the start of the Bev treatment. FDG, MET, and FLT measured tumor-to-normal ratio (TNR), and FMISO measured tumor-to-blood ratio (TBR), as well as the percent change in SUVmax, TNR, TBR, and MTV before and after Bev treatment. Using the Cox proportional hazards model, we examined which of these rates of change were the prognostic factors.

Results

The median PFS (months) and median OS from Bev treatment were 8.87, 16.53, and 4.0 and 12.53, 22.13, and 8.0, respectively. Significant differences in the percent change in MTV for MET, FLT, and FMISO in the first-line group, the percent change in MTV for FDG and MET, the percent change in FDG TNR and FMISO TBR in the recurrent group, and the percent change in MTV for MET and FLT in the neoadjuvant group were shown in the Cox proportional hazards model.

Conclusion

Neoadjuvant treatment with Bev prolonged PFS and OS. The decrease in MET MTV change rate and FMISO TBR.
NI-17 NEW ASSESSMENT FOR FLAIR ABNORMALITY AREA OF GLIOMA USING APT IMAGING
Authors: Yamauchi Takahiro , Maatta Yuki , Kanamoto Masayuki , Tai Katsuhide , Tsukinowa Yu , Kawajiri Satoshi , Yomo Munetaka , Kidoguchi Masamune , Akazawa Ayumi , Higashino Yoshifumi , Isozkai Makoto , Arishima Hidetaka , Kimura Hirohiko , Okazawa Hidehiko , Kikuta Ken-Ichiro
Published: December 2022

Background

In glioma, decision of infiltrating margin in extensive FLAIR hyperintensity area around enhanced area and only FLAIR hyperintensity without enhanced is difficult. For deciding this margin, there are some useful reports using perfusion imaging, diffusion-weighted imaging and PET. Recently, there are some reports that amide proton transfer (APT) imaging is useful for assessment for tumor invasion. In this study, we assessed FLAIR hyperintensity area in gliomas using APT imaging and discussed about pattern of APT signal intensity (SI).

Methods

For patients with glioblastoma (GBM) and oligodendroglioma (OL: IDH-mutant and 1p/19q-codeleted), APT imaging was performed. Gadolinium T1WI, FLAIR and apparent diffusion coefficient (ADC) were performed for tumor invasion and edema. Areas of these sequences were compared with APT hyperintensity and APT and ADC were determined the quantity by SI.

Results

37 sections from 10 GBM and 5 OL patients were assessed. Areas of differences between FLAIR and APT hyperintensity was significantly different between GBM and OL (p = 0.0142). SIs of the hyperintensity area between GBM and OL were different on ADC and APT SIs (ADC: p = 0.0267 / APT: p = 0.055). On GBM, hyperintensity area of APT imaging showed a correlation with hyperintensity area of FLAIR (R2 = 0.600, p < 0.0001). On OL, hyperintensity area of APT imaging showed a strong correlation with hyperintensity area of FLAIR (R2 = 0.806, p < 0.0001), and ADC SI showed correlation with APT SI (R2 = 0.675, p = 0.0019).

Conclusions

FLAIR hyperintensity area of GBM and OL, APT imaging showed different distribution. In FLAIR hyperintensity area of GBM with various phenomenon, APT imaging may indicate increasing area of tumor cell and reactive cells. Furthermore, mismatch between FLAIR and APT hyperintensity area may be useful for differentiation for glioma subtypes.
NQPC-1 INSIGHTS FROM PREOPERATIVE FATIGUE ASSESSMENT IN GLIOMA PATIENTS
Authors: Sakurai Takuro , Nakashima Toshihisa , Horikawa Mayumi , Shimizu Yoichi , Inamura Naoko , Sumiyoshi Ai , Matsuoka Aiko , Oki Mami , Watanabe Noriko , Okita Yusuke , Yokota Shota , Abe Risa , Ichikawa Kaneyuki , Miyakita Yasuji , Takahashi Masamichi , Ohno Makoto , Yanagisawa Shunsuke , Kawai Akira , Narita Yoshitaka
Published: December 2022

Introduction

Glioma is a rare type of tumor, and the research on fatigue and QOL in glioma patients is limited. Research from other countries has reported patients with intense fatigue in the preoperative stage, but no similar studies could be found in Japan. In the present study, we report a retrospective investigation of fatigue assessment performed during preoperative rehabilitation evaluation.

Participants and Methods

Participants were 90 patients admitted to the hospital for glioma surgery between January 2016 and December 2020 who underwent five specific preoperative evaluations: KPS, MMSE, Motor-Functional Independence Measure (Motor FIM), Cancer Fatigue Scale (CFS), and grip strength. Participants were divided into a CFS-High(CFS-H) group (CFS>19 points) and a CFS-Low (CFS-L) group (CFS<18 points), and participant attributes, MMSE, Motor FIM, and grip strength compared. Between-group comparisons used the Mann-Whitney U test.

Results

Participants were 90 patients with high-grade glioma. Fifty-seven were men, and the median age was 45 (15-81). Thirty-three participants (37%) had intense fatigue before surgery (CFS-H group: 33 participants, CFS-L group: 57 participants). In the CFS-H group and CFS-L group respectively, age was 46.5/44 (p=0.36), MMSE was 24 points/29 points (p=0.00255), Motor FIM was 89 points/91 points (p=0.0383), and grip strength was 22.2kg/25.5kg (p=0.194).

Discussion

The present study suggests that some Japanese high-grade glioma patients also experience intense fatigue before surgery. Compared to patients with low fatigue, those with high fatigue were suggested to have significant declines in cognitive function and ADL.
NQPC-5 JAPAN BRAIN TUMOR ALLIANCE: ACHIEVEMENTS IN 2021-2022 AND PATIENT VOICE
Authors: Nomura Keiko , Tagawa Hisato , Yamaguchi Shuji , Gatellier Laureline
Published: December 2022

Brain tumors are a major shock at diagnosis for patients and families, and their journey is impacted in various and complex ways, not only physically but mentally, financially and socially. The Japan Brain Tumor Alliance is a non-profit organization, established in 2006 to support patients and their families. As our key activity, JBTA offers patient-gathering meetings on the regular basis so that patients and families could openly share their concerns and experience. As JBTA collaborates with healthcare professionals, the up-to-date information is provided to patients and families and their needs are shared to the healthcare professionals. JBTA's achievements in 2021-2022 include the review of clinical guidelines, information-sharing events with the Japan Clinical Oncology Group and a seminar by a certified specialist regarding the social support system in Japan. With the active collaboration with other patient advocate groups, multiple petitions have been submitted to pursue further development of drugs for brain tumors. JBTA is also focusing on to provide the information to community through its website and SNS, including the stories of personal journey described by patients and families.Each of brain tumor patients and families has their own needs. Through the discussion at JBTA's monthly meetings and our online communication, they could express their real voice to the peers. JBTA picks up these issues that patients and families are facing and presents the necessity of working on their unmet needs.
NQPC-6 CHANGE ON STANDING OF HEALTH RELATED QOL IN BRAIN TUMOR AND STROKE PATIENTS ON A VOCATIONAL REHABILITATION PROGRAM
Authors: Ideguchi Makoto , Matsutani Masao , Kitamura Takayuki , Sato Akira , Ito Syoichi , Muraya Syoichi , Imaizumi Yuki , Omata Akiko
Published: December 2022

Introduction

It is important for brain tumor and stroke patients to evaluate not only prognosis but also health related QOL (HRQoL). In this study, we have evaluated HRQoL and reviewed the related factors to improve HRQoL through in hospital to after discharge.

Methods

One hundred-eighteen brain tumor (n=21) and stroke patients (n=97) of one hundred-thirty-one patients in our vocational rehabilitation program were enrolled. We evaluated HRQoL using EORTC QLQ-C30/BN-20 on admission, pre- and six months after discharge and examined the influence factor.

Results

In QLQ-C30 assessment on admission, although physical functioning (F), role F, social F and financial difficulties were lower than borderline, improved up to the standard healthy level by discharge. While future uncertainty score in BN-20 improved from 40points (p) to 30p, that has averaged higher value of 49p to 47p in brain tumor patients. On an individual basis, the score of 30% of global health status cases, 9% of physical F, 37% of financial F and 18% of future uncertainty deteriorated during the course of hospitalization significantly. While scores of all categories in stroke patients were improved, those of emotional F (-15.4p), social F (-14.3%), pain (+10.5p) and insomnia (+21.2p) in brain tumor patients were deteriorated, the tendency of which was especially prominent in malignant brain tumor. KPS and motor FIM in brain tumor patients correlated to physical F, and mRS and motor FIM in stroke to functioning scale strongly, to symptom scale moderately.

Conclusion

QOL evaluation can reveal the HRQoL deterioration in patients hard to detect the symptom. Appropriate intervention is needed because some cases deteriorate on an individual basis, especially brain tumor patients while HRQoL has almost improved with time. Rehabilitation therapy could contribute to HRQoL improvement because that strongly correlates to examination data of motor function.
NQPC-8 UNMET NEEDS OF CANCER PATIENTS SURVEY 2022: INTERIM ANALYSIS RESULTS
Authors: Gatellier Laureline , Majima Yoshiyuki , Moue Yuko , Charvat Hadrien , Uchitomi Yosuke , Matsuda Tomohiro
Published: December 2022

Background

With the recent advances in genomic medicine, the unmet needs of cancer patients (unmet needs) may be changing. A large-scale unmet needs survey was launched in 2021 with the aim of understanding the latest unmet needs and sharing information with healthcare professionals and patients, thereby contributing to the improvement of cancer treatment in Japan. The Rare Cancer Patients' Network (RCJ) is conducting this survey in collaboration with the National Cancer Centre and the National Federation of Cancer Patients' Associations (Zenganren). This presentation will report on progress since the JSNO2021 publication.

Methods

A total of 38 questions were asked in six categories: (1) detection and diagnosis; (2) treatment; (3) genomic medicine (access to genetic mutation testing); (4) clinical trials; (5) necessary information, medical care and support systems; and (6) quality of life. A combination of free-text and multiple-choice questions were asked on these, with approval obtained from the Ethics Review Committee of the National Cancer Centre at the end of October 2021 to conduct the survey online via the RCJ and the All Cancer Federation network (response deadline: 08/2022).

Results

The survey is scheduled to complete response collection and final analysis in August 2022. The results of the interim analysis will be presented at the poster session.

Conclusions

Depending on the final response collection, it may be possible to make comparisons between cancer types and identify specific patient needs in individual cancer types, such as brain tumours. At JSNO2022, we will present the results of each of the 38 questions and discuss the unmet needs of brain tumour patients with healthcare professionals, hoping that results and discussions will improve healthcare with a focus on brain tumour patients.
NQPC-9 CHARACTERIZATION AND MANAGEMENT OF DERMATOLOGIC ADVERSE EVENTS WITH OPTUNE® IN WAKAYAMA MEDICAL UNIVERSITY HOSPITAL
Authors: Fukai Junya , Seki Kohei , Sasaki Takahiro , Koyama Yoshiki , Nakao Naoyuki
Published: December 2022

Introduction

The NovoTTF-100A System (NovoTTF™ Therapy, Optune®, Novocure Inc.) is approved for use as a combination therapy with adjuvant temozolomide after postoperative chemo-radiation for newly diagnosed supratentorial glioblastoma (GBM). In our experience, dermatologic adverse events (dAEs) due to the continuous contact between the array and the scalp is not infrequently occurred, and we believe that the addition of skincare strategy is vital to maximize adherence to the NovoTTF™ Therapy. In Wakayama Medical University Hospital (WMUH), “WOC nurses,” certified Nurses in Wound, Ostomy and Continence Nursing, cooperate with neurosurgeons for the skincare of the patients.In this presentation, we review our dAE experience and introduce our skincare strategy by WOC nurse.

Methods

We collected and analyzed clinical information of GBM patients treated with NovoTTF™ Therapy in WHUH and focused on the dAEs of the patients.

Results

Total 7 patients (Male, 6; Female, 1). Median age, 64.4 (38-78). dAEs occurred in 6/7 cases (86%). dAEs includes contact dermatitis 5 (71%), erosion 3 (43%), ulcers 0, foliiculitis 3 (43%). CTCAE grading of dAEs, 1 or 2. Two cases (29%) abandoned NovoTTF™ Therapy due to dAEs. Based on our skincare strategy, which consists of three essential rules of scalp care (cleansing, moisturization, protection), WOC nurses have close contact with the patients and their caregivers from the beginning of the therapy.

Conclusion

The addition of skincare strategies to the NovoTTF-100A System would be vital for the adherence to NovoTTF therapy, which contribute to the therapeutic benefit of the Therapy. Not only neurosurgeons and patients but also nurses and caregivers must cooperate in scalp care and dAE treatment.
NQPC-10 IMPACT OF HEALTH-RELATED QOL (HRQOL) IN THE FIRST SIX MONTHS AFTER SURGERY ON LONG-TERM POSTOPERATIVE GENERAL HEALTH STATUS IN GLIOMA PATIENTS
Authors: Kugasawa Kazuha , Tanaka Shota , Yanagisawa Shunsuke , Takayanagi Shunsaku , Takami Hirokazu , Ohno Makoto , Takahashi Masamichi , Miyakita Yasuji , Narita Yoshitaka , Saito Nobuhito
Published: December 2022

Purpose

Though prolonging survival is often the focus of brain tumor therapy, evaluation of health-related quality of life (HRQoL) is important in postoperative follow-up since treatment-induced side effects or tumor-induced functional impairment could affect HRQoL.In glioma treatment, we investigated the relationship between patient-reported HRQoL assessment from 1 month preoperatively to 6 months postoperatively and overall health status at 1 year and 1.5years postoperatively.

Methods

Thirty-one glioma patients who underwent surgical treatment at our hospital and the National Cancer Center Hospital from May 2011 to August 2022 were included in this study. HRQoL and KPS were evaluated at 1 month before surgery, 6 months, 1 year and 1.5 years after surgery, respectively. The median age was 47 years, 15 (48%) were men and 16 (52%) were women. Pathological results were GBM in 19 (61%), AA in 4 (13%), AO in 2 (6%), and others in 6 (19%). The EORTC QLQ-C30/BN20 was used as a measure of HRQoL, and eligible patients answered each of the 50 questions on a 4-point scale, with scores calculated for 26 QoL status items. Bivariate analysis (Wilcoxon test) was performed on the 26 HRQoL items and KPS.

Results/Consideration

High KPS(≥70)was seen in patients who perceived themselves at 6 months postoperatively, to be “good” in the following 10 items “Physical functioning,” “Role functioning,” “Cognitive functioning,” “Global health status,” “Fatigue,” “Constipation,” “Motor dysfunction,” Communication deficit,” “Itchy skin” and “Weakness of legs. “In addition, patients who perceived their HRQoL conditions of” Sleep disturbance,”“ Future Uncertain,”and “ Bladder control”to be “good” after 6 months had a KPS of 70 or higher at 1.5 years.

Conclusions

The results suggest that long-term systemic status can also be monitored by assessing HRQoL in the first six months after surgery. Patient evaluation including sequential HRQoL is important in the treatment of glioma.
NQPC-15 DEVELOPMENT OF BRAIN TUMOR SURVIVORSHIP PROGRAM
Authors: Saito Norihiko , Hirai Nozomi , Kushida Naoki , Sato Sho , Hiramoto Yu , Fujita Satoshi , Nakayama Haruo , Hayashi Morito , Ito Keisuke , Sakurai Takatoshi , Iwabuchi Satoshi
Published: December 2022

Introduction

Brain tumor patients suffer from psychological distress and various sequelae from the moment they are diagnosed with a brain tumor, during and after treatment. Although the number of brain tumor survivors is increasing as a result of improved treatment outcomes for brain tumors, the support system is not sufficient. We, in collaboration with the University of California San Francisco Brain Tumor Center, have established a multidisciplinary professional staff of physicians, nurses, pharmacists, rehabilitation therapists, nutritionists, and social workers to support brain tumor patients, their families, and care givers. The brain tumor survivorship program is designed to support brain tumor patients, their families, and caregivers. This report describes their efforts.

Methods

This program started in December 2021. We asked relevant departments in the hospital to cooperate with the program. In July 2022, the “Brain Tumor Survivorship Care Program 360” website was opened to the public.

Results

As of the end of August 2022, there were 9 participants, of which 7 were patients and 2 were care givers. Of these, two were patients being treated at other hospitals. Various information is provided on the website. Web meetings are also held to provide a place where participants can communicate directly with each other. When participants were asked about their requests for the program, many of them requested information on treatment, public services, and a place for communication among patients.

Discussion

Brain tumor patients face not only life-threatening but also painful symptoms associated with the impairment of their own physical motor and cognitive functions, which they had possessed until then. Through the survivorship program, we will continue to scientifically examine and develop a support system for the various survival-related issues that brain tumor patients and their families experience from diagnosis to the end of life.