bluuebunny/crossref_metadata_2025 huggingface dataset:
NIMG-72. CONTRALATERAL PREDOMINANT BLOOD SUPPLY OF FALX AND PARASAGITTAL MENINGIOMA BASED ON ANGIOGRAPHIC ANALYSIS
Authors: Tamai Sho , Tanaka Shingo , Kamide Tomoya , Misaki Kouichi , Nakada Mitsutoshi
Published: November 2023

INTRODUCTION

Preoperative prediction of blood supply in meningiomas is important to avoid unexpected intraoperative bleeding. Herein, we investigated the relationship between the location of meningioma and the dominant side of feeding arteries. METHOD: Between January 2018 and December 2020, a total of 101 consecutive patients underwent craniotomy for meningioma at our hospital. Among them, 43 cases in which the lesions were clearly localized on the right or left sides received preoperative angiography including bilateral common or external carotid artery (ECA) imaging. A region of interest (ROI) was set at the most stained area in (X) meningioma and (Y) main trunk of the ECA. In each affected side (AS) and healthy side (HS), the ratio of ROI (X) value to ROI (Y) value; tumor / vessel ratio (TVR = 0 ~ 1) was calculated. Multivariate analysis was performed to compare TVR between AS and HS, and to analyze factors associated with TVR, such as site of origin (convexity, skull base and relating falx), age, gender, WHO grading, and tumor diameter.

RESULTS

TVR was significantly higher in AS (0.60; 0.41 - 0.91) than HS (0.47; 0.39 - 0.99) (p=0.0003). HS was superior to AS in 10 cases, all of which were falx (6 of 9 cases) or parasagittal (4 of 10 cases) meningioma. 53% of falx and parasagittal meningiomas showed HS predominant TVR. Concerning factors associated with the TVR of HS predominance, falx origin was extracted as an independent factor (p< 0.0001).

DISCUSSION

The vessels crossing in the falx, which consist with particular anatomical structure, fusing the meningeal layers in each side of dura mater would contribute to this finding.

CONCLUSION

Falx and parasagittal meningiomas should consider the predominant influx of tumor feeding vessels from HS.
NIMG-74. COMPARING VOLUMETRIC GROWTH-RATE AND RANO CRITERIA IN DETERMINING THE RESPONSE OF MENINGIOMA TO BEVACIZUMAB THERAPY
Authors: Borenstein Sara , Amiel Alexandra , Siegal Tali , Gal Omer , Limon Dror , Eliahu Ruth , Yust-Katz Shlomit
Published: November 2023

Meningioma is the most prevalent primary tumor in the central nervous system (CNS). Although mostly benign, 15- 20% are aggressive and tend to recur and progress despite surgery and adjuvant radiation. Recent publications show that bevacizumab, a vascular endothelial growth factor inhibitor, effectively treats these refractory meningiomas. The standard method to monitor treatment’s effect on imaging is Response Assessment in Neuro-Oncology criteria (RANO). Recently, an alternative tool called 3D volumetric growth rate (3DVGR) has emerged. Our aim is to compare the effectiveness of conventional RANO criteria and the 3DVGR measure in evaluating the response to bevacizumab treatment in patients with refractory meningiomas. We will also assess their correlation with clinical outcomes over a period of up to 9 months. 68 MRI scans of 20 patients with aggressive meningiomas treated with bevacizumab were evaluated. For each tumor both RANO and 3DVGR were conducted in two subsequent head MRI studies acquired prior to the initiation of bevacizumab treatment and then in at least one exam within 6 months post-treatment. Measurements were obtained using PACS and BRAIN LAB software by two radiologists. A total of 43 lesions derived from 20 patients were included in the analysis. The mean age was 65.5; mean number of radiation treatments was 2.66; mean number of pre-surgical treatments was 2.7 and mean number of bevacizumab cycles was 22.7. All lesions showed a decrease or stabilization in growth rate compared to baseline. More specifically, 34 out of 43 lesions (79%) showed a negative growth rate value indicating decrease in tumor size. Comparison of treatment response using RANO criteria was not always in concordance with the 3DVGR measurement and showed inaccurate correlation with clinical outcome. 3DVGR measure seems to be more precise compared to RANO criteria. Furthermore, our results show great promise for treatment of refractory meningiomas with bevacizumab.
NIMG-76. A DEEP LEARNING ALGORITHM FOR FULLY AUTOMATED VOLUMETRIC MEASUREMENT OF MENINGIOMA BURDEN
Authors: Cleveland Mason , Kim Albert , Patel Jay , McCall Owen , Liu William , Ahmed Syed , Bearce Benjamin , Chang Ken , De Sauvage Magali , Hoebel Katharina , Larson Juliana , Nayyar Naema , Pulido Dagoberto , Singh Praveer , Summers Elizabeth , Kalpathy-Cramer Jayashree , Plotkin Scott R , Brastianos Priscilla , Bridge Christopher , Gerstner Elizabeth
Published: November 2023

PURPOSE

Meningiomas are the most common primary central nervous system tumor. A subset of these tumors is multiply recurrent despite aggressive treatment with surgery or radiation and causes significant morbidity and mortality. Longitudinal measurement of meningioma burden on post-contrast MRI is the basis of treatment response assessment. As per Response Assessment in Neuro-Oncology (RANO), estimates of tumor size are based on the product of bidirectional diameters of enhancing tumor. However, these 2D segmentations as well as manual volumetric segmentations have high rates of intra- and inter-rater variability, which prohibits accurate longitudinal assessment of tumor size. A rapid and reproducible quantitative method for determining meningioma volume is needed to expedite response assessment in clinical trials. To address this unmet need, we developed a deep learning algorithm that enables fully automated 3D segmentation and volumetric assessment of meningioma burden.

METHODS

351 post-contrast T1-weighted brain MRIs from 86 patients with meningioma were obtained from Massachusetts General Hospital and Dana-Farber Cancer Institute. The cohort was unique compared to prior DL segmentation models as it encompassed diverse clinical scenarios (e.g., meningioma of all grades, post-operative and post-radiated meningioma). The MRIs were resampled to 1 mm isotropic resolution and preprocessed using N4 bias field correction and zero-mean intensity normalization. The dataset was split 70%/15%/15% for training/validation/testing on a per patient level. The training data were used with manually generated tumor segmentations to train a convolutional neural network (CNN) with a U-Net architecture and the Dice loss function.

RESULTS

The median Dice score was 0.6758 on the test set. Additional work is ongoing to optimize performance, with primary focus directed toward improved data preprocessing and ground truth segmentation as the variability in segmentation quality contributed to the lower Dice score, highlighting the need to develop a less biased and more reliable tool to segment meningiomas.
NIMG-77. EARLY DIAGNOSIS OF NEUROCUTANEOUS MELANOSIS MASQUERADING AS SUBARACHNOID HEMORRHAGE
Authors: Chen Hsien-Chung , Yang Shun-Tai
Published: November 2023

A 50-year-old male presented to the emergency room with a sudden onset right upper limb facial numbness and dysphasia, soon followed by full-recovery. Brain computed tomography revealed hyperdense lesions within the left frontal sulcus, highly suspicious of subarachnoid hemorrhage. T1-weighted magnetic resonance imaging showed multiple leptomeningeal enhancement in the left frontal area.The digital subtraction angiography indicated an absence of vascular lesions. One-month after, the lesions progressed in the occipital area, when left sixth nerve palsy developed. Multiple giant nevus over the legs, trunk, and scalp had attracted attention. Owing to the suspicious symptomatic leptomeningeal lesions, open biopsy was performed. Surprisingly, diffuse, thick, black-colored tissue infiltration of the subarachnoid space, involving prominent cortical vessels, was noted. Pathology confirmed meningeal melanocytosis. Neurocutaneous melanosis is characterized by giant congenital or multiple satellite nevi and melanocytic tumors of the leptomeninges. Early disease diagnosis is crucial. Once the patient develops neurological symptoms, prognosis could quickly worsen.
NIMG-79. DIFFERENTIATION OF SUBTYPES IN AFULLY AUTOMATED DEEP LEARN TUMORS USING PREOPERATIVEM RIMAGES ING APPROACH FOR ACCURATE PRIMARY INTRACRANIAL
Authors: Li Yanong
Published: November 2023

BACKGROUND

Intracranial germ cell tumors (iGCTs) are divided into germinomas (GEs) and nongerminomatous germ cell tumors (NGGCTs), each having distinct treatments and prognoses. However, predictive biomarkers for differentiation are limited. Here, we aim to develop a deep learning (DL) model that can automatically differentiate GEs from NGGCTs using preoperative magnetic resonance (MR) images and analyzing how our model improved clinical decision making among five physicians. METHODS: This multicenter study included patients with pathology-confirmed iGCTs for the developed set (total n = 280), which was split into training (n = 200) and testing datasets (n= 80), and three independent validation datasets (n = 64), respectively. We developed a DL model based on 3D nnU-Net and preoperative MR images to differentiate GEs from NGGCTs. To evaluate the clinical value of the DL model, five physicians' accuracy and level of consistency in identifying tumor types were compared in the testing and three validation datasets, with and without referring to the DL model’s output.

RESULTS

The DL model achieved AUCs of 0.950, 0.921, 0.869, and 0.905 in the testing and three validation datasets, respectively, which is superior to using conventional information including MR features and clinical information (AUC=0.768, P=0.009). The physicians’ diagnostic performance improved from an average AUC of 0.695 without reference to the DL output to 0.842 using the DL output in the testing and independent validation datasets (21.2% improvement, P=0.014).

CONCLUSIONS

We developed and validated a DL model using a large dataset to accurately differentiate GEs from NGGCTs using preoperative MR images.
NIMG-81. ASSOCIATION OF THE ORIGIN OF CRANIOPHARYNGIOMA WITH OPTIC TRACT EDEMA
Authors: Kodama Takuma , Akiyama Osamu , Shimizu Yuzaburo , Suzuki Mario , Teramoto Shinichiro , Kondo Akihide
Published: November 2023

OBJECTIVE

Optic tract edema (OTE) is a useful finding in the diagnosis of craniopharyngioma (CP). However, the pathogenesis of OTE is not fully understood. In this study, we investigated the presence of OTE depending on the site of origin of CP.

METHODS

We reviewed 48 patients with CP who underwent surgical treatment at Juntendo University Hospital between March 2010 and February 2023 and investigated their size, location, presence of OTE, pathological subtypes, and genetic abnormalities. Tumors were classified into four groups based on their origin: retrochiasmatic (RC) type, prechiasmatic (PC) type, intrasellar (IS) type, and intra-third-ventricle (ITV) type.

RESULTS

Forty-eight cases were included in this study. The number of cases of RC, PC, IS, and ITV types were 29, 8, 3, and 8, respectively. OTE was shown in 21 cases. Among them, RC type was the most common location (18 cases, 86%) with significant differences. The cystic component of the tumor was in contact with the optic tract in 15 cases, which was more common than the solid component.

DISCUSSION

Possible causes of OTE include cytotoxic edema associated with inflammation, angiogenic edema due to leakage of serum components from the tumor, leakage of fluid components from the cyst, and enlargement of the Virchow-Robin space in the optic disc. In this study, many of the cases with OTE have cystic components in contact with the optic tract, suggesting leakage of fluid components from the cyst as the pathogenesis of OTE. The presence of OTE can be a new factor to determine the surgical approach since CP with OTE is thought to extend posteriorly to the optic chiasm.

CONCLUSIONS

OTE is often associated with RC type CP and is thought to be caused by leakage of fluid from the cyst.
NIMG-83. ELUCIDATING INTRA-TUMORAL HETEROGENEITY AND DISTINCT RADIOMIC FEATURES IN GLIOBLASTOMA METHYLATION SUBCLASSES
Authors: Matsumoto Yuji , Garcia Jose , Kazerooni Anahita Fathi , Abdullaev Zied , Singh Omkar , Davatzikos Christos , Aldape Kenneth , Nasrallah MacLean P
Published: November 2023

Glioblastoma, IDH-wildtype (GBM), is characterized by the inter- and intra-tumoral molecular heterogeneity. Genome-wide DNA methylation profiling has recently emerged as a promising tool offering complementary value to the classification of central nervous system tumors. In adult GBM patients, the most common methylation subclasses comprise RTK I, RTK II, and MES. We hypothesize that quantification of intricate and spatially complex radiomic features extracted from multi-parametric MRI (mpMRI) is informative to non-invasively determining characteristics of GBM methylation subclasses and their heterogeneity. In this study, mpMRI scans (T1, T1-Gd, T2, T2-FLAIR, DSC, DTI) of newly diagnosed 23 GBM patients were retrospectively collected. We derived 6339 radiomic features, including histograms, morphologic and textural descriptors. For each case, 3-4 multiple samplings from different parts of the tumor were conducted. DNA was extracted from FFPE for each of sample and analyzed for genome-wide DNA methylation patterns using the Illumina EPIC array. Classification of methylation subclasses was performed using the MNP brain tumor classifier v12b6 of the DKFZ. Analysis of variance (ANOVA) with Bonferroni correction was employed to extract subclass-specific radiomic features. Of the 23 patients, 7 indicated intra-tumoral heterogeneity in methylation subclasses. We identified 68 radiomic features (p< 0.05) and 12 radiomic features (p< 0.01) that showed statistically significant differences among the methylation subclasses as determined by ANOVA with Bonferroni correction. A heatmap illustrating the relationships between subclasses and extracted radiomic features displayed distinct trends among subclasses and between heterogeneous and homogeneous cases within the same subclass. Our findings suggest the presence of heterogeneity within methylation subclasses and distinctive imaging patterns for each subclass. These findings potentially pave the way for a more personalized approach to glioblastoma management, highlighting the importance of further validation through the analysis of additional cases.
NIMG-85. EVALUATING THE PERFORMANCE OF A DEEP LEARNING GLIOMA SEGMENTATION MODEL USING COMBINED PRE- AND POST-TREATMENT MRI TRAINING DATA
Authors: Ranjbar Sara , Singleton Kyle , Curtin Lee , Paulson Lisa , Clark-swanson Kamala , Hawkins-daarud Andrea , Mitchell J Ross , Jackson Pamela , Swanson Kristin
Published: November 2023

Identification of key phenotypic regions such as necrosis, contrast enhancement, and edema on magnetic resonance imaging (MRI) is important for understanding disease evolution and treatment response in patients with glioma. Manual delineation is time intensive and not feasible for a clinical workflow. Automating phenotypic region segmentation overcomes many issues with manual segmentation, however, current glioma segmentation datasets focus on pre-treatment, diagnostic scans, where treat-ment effects and surgical cavities are not present. Thus, existing automatic segmenta-tion models are not applicable to post-treatment imaging that is used for longitudinal evaluation of care. Here, we present a comparison of three-dimensional convolutional neural networks (nnU-Net architecture) trained on large temporally defined pre-treatment, post-treatment, and mixed cohorts. We used a total of 1563 imaging timepoints from 854 patients curated from 13 different institutions as well as diverse public data sets to understand the capabilities and limitations of automatic segmenta-tion on glioma images with different phenotypic and treatment appearance. We as-sessed the performance of models using Dice coefficients on test cases from each group comparing predictions with manual segmentations generated by trained techni-cians. We demonstrate that training a combined model can be as effective as models trained on just one temporal group. The results highlight the importance of a diverse training set, that includes images from the course of disease and with effects from treatment, in the creation of a model that can accurately segment glioma MRIs at multiple treatment time points.
NIMG-89. CNS-ISOLATED RICHTER’S TRANSFORMATION: THE FALLIBILITY OF NEURO-IMAGING AND THE CRITICAL ROLE OF BRAIN BIOPSY IN A CHALLENGING DIAGNOSIS
Authors: Lee Sean , Hurbon Audriana , Aboul-Nasr Ahmed , Salazar Dory Arevalo , Wakefield Chelby , Halder Ritika , Krishnadasan Ravitharan
Published: November 2023

INTRODUCTION

An 81-year-old male was admitted for acute encephalopathy and failure to thrive. Workup revealed a lymphocyte-predominant leukocytosis, prominent axillary and mediastinal lymphadenopathy on CT, and multiple supra-tentorial FLAIR-hyperintense lesions that were homogenously contrast-enhancing. Axillary lymph node biopsy demonstrated small lymphocytic lymphoma (SLL), a variant of CLL. Despite concern for CNS malignancy, brain biopsy was initially deferred since the patient’s brain lesions were attributed to SLL metastasis. However on hospital day 15, he developed partial seizures, prompting stereotactic biopsy which revealed DLBCL.

DATA/DISCUSSION

Our case highlights the pitfalls of relying solely upon neuro-imaging to diagnose Richter’s transformation (RT) isolated to the CNS. First, MRI does not differentiate CNS metastasis of systemic lymphoma from CNS RT. A review of 35 biopsy or LP-proven cases of CNS-isolated RT showed imaging characteristics consistent with primary and metastatic CNS lymphoma. When parenchymal lesions are present, all are T2/FLAIR hyper-intense; 60% are unifocal (40% multifocal); and 95% homogenously enhance. Second, CNS-isolated RT is at least 3 times rarer than CNS metastases of CLL. Among patients with CLL, ~1% will eventually exhibit CNS metastasis but < 0.3% will develop CNS-isolated RT. In patients with known CLL and no evidence of high-grade transformation, it is reasonable to attribute brain lesions to CNS metastasis of CLL as opposed to RT, absent a definitive tissue diagnosis.

CONCLUSION

These data emphasize the importance of biopsy in the workup of CNS lymphoma, especially since treatment differs based on histopathological subtype. Given its chronic indolent course, SLL is typically managed expectantly, whereas the aggressive nature of DLBCL warrants more intensive chemotherapy. Our case also shows that in patients with suspicious CNS lesions, presence of systemic malignancy does not eliminate the need for brain biopsy, and that clinical deterioration should prompt biopsy if not already performed.
NCMP-02. BIOPSY OUTCOMES OF PATIENTS WITH SUSPECTED LEPTOMENINGEAL CARCINOMATOSIS: A RETROSPECTIVE CASE SERIES
Authors: Blazek Audrey , Carabenciov Ivan
Published: November 2023

BACKGROUND

Leptomeningeal carcinomatosis is commonly considered when patients present with meningeal enhancement on magnetic resonance imaging (MRI), even without a known primary malignancy. In practice, some clinicians advocate for early meningeal biopsy to expedite diagnosis, citing lack of specificity of other testing, such as cerebrospinal fluid (CSF) analysis.

METHODS

We identified a cohort of patients with meningeal enhancement that underwent biopsy for diagnostic purposes between 2010 and 2022. Presenting symptoms, physical exam, enhancement pattern on MRI, other imaging findings, CSF parameters, other laboratory results, final diagnosis, and recommended treatment were recorded when available.

RESULTS

Out of nearly 100 cases included, the majority were autoimmune or inflammatory in etiology. Only 13 patients were diagnosed with malignancy-related enhancement, and 10 of these cases were felt to be true carcinomatosis. Nine out of the 13 patients were diagnosed with lymphoma. Four of these lymphomas were diagnosed on systemic biopsy, with meningeal biopsies negative for malignant cells. The other malignancies included systemic adenocarcinoma, oligodendroglioma, and a rare hematologic cancer. Nearly all 13 patients had abnormal CSF parameters, notably pleocytosis, but none had malignant cells in the fluid. Most frequent presenting symptoms were encephalopathy, vision changes, and strength/sensory changes. MRI often showed cranial nerve or general cerebral and cerebellar involvement, and physical exam often showed cranial nerve, strength, and sensory deficits. All patients proceeded with chemotherapy after diagnosis.

CONCLUSIONS

When leptomeningeal carcinomatosis is considered based on MRI enhancement, the clinical approach should continue to revolve around indirect testing such as CSF analysis, serum studies, and other imaging techniques to consider alternative biopsy sites before pursuing direct sampling with meningeal biopsy. With this approach, many patients with suspected carcinomatosis can avoid undergoing meningeal biopsy and decrease the chance of treatment delay.
NCMP-05. INTRACTABLE HEADACHE IN NEWLY DIAGNOSED AML WITH MIGRAINES AND CHIARI MALFORMATION- UNVEILING A COMPLEX SYMPTOM
Authors: Austin Hannah , Singla Laveena
Published: November 2023

Acute Myeloid Leukemia (AML) involvement in central nervous system (CNS) is poorly understood in pathophysiology, with reported incidence rates ranging from 1-33% of patients with relapsed AML. CNS involvement is uncommon in the early stages of AML. FLT3-ITD, chromosome 11 abnormalities, and inv(16) cytogenetics are known to have more potential to invade the CNS. A 28-year-old woman with recently diagnosed AML (FLT D835 mutation with deletion in the long arm of chromosome 11) and migraines was admitted for HIDAC consolidation #3. On day two, she started experiencing headaches in the bifrontal and bitemporal regions associated with photophobia, phonophobia, and nausea. Treatment for status migrainous provided little relief. MRI brain showed progression of Chiari malformation (CM) with tonsillar herniation from 16 to 19 mm, which precluded a lumbar puncture. On day 4, she was noted to have grade III papilledema and bilateral cranial nerve IV palsy with non-enhancing patchy increased FLAIR signal in dorsal pons, bilateral cerebral and middle cerebellar peduncles, without diffuse restriction on imaging. The patient underwent sub-occipital craniotomy and C1 laminectomy for decompression for chiari. On day 5, she developed cranial nerve palsies involving nerves VII, IV, and XII. Lumbar puncture (LP) performed after decompression demonstrated elevated opening pressure and 98% abnormal myeloid blast population, confirming CNS involvement of AML. 4 days before starting intrathecal chemotherapy, the patient was found to be in asystole (unclear etiology). This case highlights the range of differential diagnoses for headaches in a patient with multiple comorbidities, including obesity, migraine, Chiari malformation with tonsillar herniation, and cancer. It underscores the necessity for proactive screening of CNS invasion in AML patients with high-risk mutations and neurological symptoms. Moreover, it emphasizes the need to consider CNS involvement in AML patients with headaches, even if standard imaging does not show typical signs of leptomeningeal spread.
NCMP-07. HEADACHE PRESENTATION AND MANAGEMENT IN VON HIPPEL-LINDAU (VHL)-ASSOCIATED HEMANGIOBLASTOMAS
Authors: Vohra Sanah , Malkhasyan Yelena , Chandla Anubhav , Gordon Michael , Shuch Brian , Graber Jerome , Yang Isaac
Published: November 2023

BACKGROUND

Hemangioblastomas are the most common brain tumors among patients with Von Hippel-Lindau (VHL) disease. Common characteristics of these benign tumors, such as tumor growth, peritumoral edema, and cystic expansion, may lead to neurologic morbidity and/or mortality. Thus, early diagnosis based on symptom presentation and appropriate treatment is paramount to VHL-associated hemangioblastoma management.

METHODS

We conducted a systematic review of PubMed, Scopus, Cochrane, Embase, and Web of Science databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified studies reporting pre-diagnostic symptoms and post-diagnostic treatments among patients with VHL-associated hemangioblastomas.

RESULTS

Data from 150 patients were analyzed. The average age at presentation was 35.3 years (range: 18-75) and 52.7% of patients were female. Headache was the most common presenting symptom (73.3%). Other presenting symptoms included balance or gait disturbances (42%), ataxia (41.3%), nausea (24.3%), emesis (24.3%), dysmetria (15.5%), swallowing difficulties (11.3%), and singultus (10.7%). Anatomically, 98.7% of tumors were in the posterior fossa, specifically 69% in the cerebellum and 30% in the brainstem. Approximately 62.8% of patients had tumor associated cysts. A majority of the patients (98.7%) underwent gross-total resection of the tumor and cyst drainage as needed. Other common treatments included radiotherapy, gamma-knife surgery, and ventriculoperitoneal shunt placement.

CONCLUSION

Patients with VHL-associated hemangioblastomas commonly presented with headaches, balance or gait difficulties, and ataxia. Tumors were generally found in the posterior fossa and were associated with cysts. Gross-total resection was the main treatment offered to patients with these tumors.
NCMP-12. PREVALENCE OF RADIONECROSIS IN RECURRENT GLIOBLASTOMA
Authors: Morin Nicolas , Cottin Sylvine Carrondo , Saikali Stephan , Michaud Karine , D’Astous Myreille
Published: November 2023

INTRODUCTION

Glioblastoma (GBM) standard treatment consists of maximum and safe surgical resection, followed by radiation therapy in combination with temozolomide. Some patients show radiological and/or clinical deterioration soon after radiotherapy treatment. Early MRI changes, in the first 3 months following radiation is considered pseudo-progression. After this initial period, changes are considered as tumor recurrence. However, cases of early radiological deterioration have been related to radionecrosis. When tumor progression is suspected on imaging, it may causes treatment withdrawal or change. Therefore, for a certain percentage of patients, effective treatment could be abandoned in the presence of radionecrosis.

METHODS

The aim of the study is to assess the prevalence of radionecrosis at the Hôpital de l'Enfant-Jésus. This is a retrospective, observational case-control study evaluating recurrent GBM patients who underwent a second resection surgery.

RESULTS

The charts of 110 GBM patients with second resection were retrospectively reviewed (men: 62%, mean age: 58.3 years). Among these patients, we observed 87 cases of GBM recurrence as compared to 23 cases of radionecrosis (21%). No statistically significant difference was observed between the two groups regarding demographics, survival, Karnofsky performance status, type of surgery and treatments received. However, in the radionecrosis group, decreases in time between the 2 surgeries (55.3 vs. 24.3 weeks, p = 0.006) and in the number of cycles of chemotherapy received (5.7 vs. 3.7 weeks, p = 0.004) were observed as compared to GBM group.

CONCLUSIONS

This study characterizes demographically the patients with second surgery for suspicion of GBM in order to better adapt the treatments. Clinical and radiological data could not differentiate radionecrosis from true tumor recurrence or progression. A prospective study will be carried out as a second step, in order to determine radiological or molecular factors that could predict the presence of radionecrosis.
NCMP-16. A CASE OF WIDESPREAD EXTRACRANIAL METASTASES FROM A GLIOSARCOMA
Authors: Mohamadpour Maliheh , Budhu Joshua
Published: November 2023

BACKGROUND: Glioblastoma (GBM) with sarcomatous features (gliosarcoma) accounts for 2-8% of all glioblastomas1,2, characterized by a biphasic histopathology pattern consisting of glial and sarcomatous components. While GBMs generally do not metastasize outside the central nervous system (CNS), GS has been associated with extracranial metastases in up to 11% of cases3. Case presentation: A 58-year-old right-handed woman with a GBM presented to our institution for a second opinion. She was initially diagnosed 18 months prior and had received radiotherapy with concurrent temozolomide. Her adjuvant temozolomide was discontinued due to rash, and she started on bevacizumab. Her tumor progressed and she sought additional treatment options. On her initial presentation, she was tachycardic with leukocytosis, prompting admission. A chest CT showed thoracic adenopathy, multiple bilateral pulmonary nodules, and a large left malignant pleural effusion. Bronchoscopy revealed spindle cell sarcomatoid neoplasm raising the possibility of metastasis from a CNS primary tumor. Additionally, the patient endorsed development of subacute radicular pain in her bilateral lower extremities as well as weakness. MRI of total spine revealed multilevel osseous and epidural lesions, infiltrating the paraspinal muscles and thickening of cauda roots with concern for leptomeningeal disease. A subsequent PET-CT showed increased FDG avidity in these lesions. Reevaluation of the initial CNS pathology confirmed the presence of mesenchymal/sarcomatous differentiation, consistent with a diagnosis of GS. As confirmed by autopsy, the patient eventually passed away due to widespread and metastatic disease. Discussion: While GBM rarely metastasizes outside the CNS, GBM with sarcomatous features are more likely to exhibit extracranial metastasis. Our patient had widespread involvement, including the lungs, heart, liver, omentum, and bone. Metastasis was thought most likely once EBUS of the lung returned with sarcomatous features. Clinicians should therefore maintain a high suspicion for metastases when dealing with patients diagnosed with GS.
NCMP-18. ENDOVASCULAR TREATMENT OF SYMPTOMATIC TUMORAL VENOUS SINUS STENOSIS: COMPARATIVE ANALYSIS OF CORONARY BALLOON-MOUNTED STENTS AND CONVENTIONAL TECHNIQUES
Authors: Chen Adrian , Begley Sabrina , White Timothy G
Published: November 2023

Meningiomas may lead to symptomatic papilledema due to elevated intracranial pressure (ICP) from venous sinus compression. While venous sinus stenting has proven effective for treating elevated intracranial pressure, evidence for its application in tumoral-induced stenosis and acquired intracranial hypertension is limited. This study presents an institutional series of symptomatic tumoral venous sinus stenosis cases and compares the technical considerations of endovascular treatment using a coronary balloon-mounted stent to conventional venous sinus stenting. Three patients with meningioma-induced, bilateral papilledema received treatment with venous sinus stenting between 2019-2022. Presentation, stenosis severity, venous manometry, ophthalmologic findings, procedural techniques, and post-operative outcomes were retrospectively analyzed. Three patients (mean age: 59 years, 2 out of 3 male) presented with worsening blurry vision, diplopia, and persistent headaches. Bilateral papilledema was observed (median optic nerve sheath distension=0.48mm). Pre-procedure measurements showed elevated ICP with opening pressures ranging from 37-38 cmH2O. Imaging revealed extra-axial parieto-occipital lesions with significant mass effect, and MR venograms confirmed severe stenosis of the superior sagittal sinus (SSS). Venous angiography (DSV) demonstrated median venous sinus pressures of 32-mmHg proximal to the stenosis with a 4-mmHg pressure gradient across the stenosis. During the procedure, balloon-mounted Onyx coronary stents or a self-expanding PrecisePro carotid stent were deployed successfully. Post-stenting, papilledema resolved completely in two patients, while one patient experienced partial symptom resolution. Proximal SSS pressures decreased by a mean of 46.8%, and trans-stenotic pressure gradients were reduced to ≤1 mmHg. Stent patency without complications was maintained throughout the 2 to 5-month follow-up in all patients. Adjacent meningiomas were subsequently monitored for observation or stereotactic radiosurgery. Small extra-axial lesions causing symptomatic venous sinus compression can be endovascularly treated using balloon-mounted cardiac stents. Non-surgical meningioma patients, symptomatic for intracranial hypertension and lesions proximal to venous sinuses, should be assessed with DSV for potential management with endovascular interventions.
NCMP-20. ASSESSING THE IMPACT OF DRIVER MUTATIONS AND ANTINEOPLASTIC TREATMENTS ON RISK FOR STROKE RECURRENCE IN PATIENTS WITH LUNG ADENOCARCINOMA
Authors: Lim Sanghee , Keser Zafer , Carabenciov Ivan , Sener Ugur
Published: November 2023

BACKGROUND

Hypercoagulability is a well-described paraneoplastic phenomenon associated with strokes in cancer patients, but whether driver mutations or antineoplastic treatments contribute in a significant way to recurrent stroke risk are not well understood.

METHODS

As part of a larger study focusing on lung cancer and stroke, we retrospectively identified 103 patients with tissue-confirmed adenocarcinoma and prior diagnosis of stroke treated at the Mayo Clinic between 2000-2022. We collected data regarding demographics, performance status, cerebrovascular risk factors, antithrombotic use, chemotherapy, radiation, and genetic testing data, which were assessed for impact on recurrent stroke risk.

RESULTS

71.8% of patients had recurrent strokes (74/103). No class of chemotherapeutics was significantly associated with increased risk for recurrent strokes, including immune checkpoint inhibitors and thrombogenic chemotherapeutics (Gemcitabine, Cisplatin, Carboplatin, anti-VEGF therapies). 78 patients had genetic testing data available. Driver mutations in KRAS, EGFR, MET, and BRAF were not associated with increased risk for recurrent stroke. There was a signal towards increased risk for stroke recurrence in patients with ALK mutations (OR 2.647, p=0.4056). There was a trend towards increased risk for stroke recurrence in patients with advanced staging (Stage III/IV) at diagnosis (OR 2.125, p=0.09). Stroke recurrence risk was higher in patients treated with single antiplatelet agents compared to anticoagulation or dual antiplatelet therapy (OR 3.385, p=0.0061) though risk of hemorrhagic complications was similar (OR 1.559, p=0.3376). Patients with recurrent stroke had longer overall survival compared to those without (Median OS 43.2 months vs 26.3 months, Mantel-Haenszel HR 0.5202, p=0.0367).

CONCLUSIONS

In patients with lung adenocarcinoma who experienced ischemic stroke, prolonged survival and single antiplatelet therapy compared to dual antiplatelet therapy or anticoagulation were associated with increased recurrent stroke risk. ALK mutations and higher stage at initial diagnosis trended towards higher risk for stroke recurrence. Larger retrospective analyses are under way to confirm these findings.
NCMP-28. CIRCADIAN REGULATION OF NEUROINFLAMMATION DRIVING CANCER THERAPY-RELATED COGNITIVE IMPAIRMENT
Authors: Mehl Lindsey , Gibson Erin
Published: November 2023

More than 18 million cancer survivors were estimated to live in the United States as of January 2022. While advances in cancer detection and treatment have substantially improved survivorship, as many as 65% of patients treated for non-central nervous system tumors may develop cancer therapy-related cognitive impairment (CRCI), a neurological disorder which includes deficits in memory, attention, multitasking, fine motor function, and information processing. Our previous work found that methotrexate (MTX) chemotherapy induces persistent neuroinflammation driving CRCI in a pediatric mouse model. We now demonstrate that the time of MTX administration, called MTX chronotherapy, induces differential microglial activation and oligodendroglial dysregulation. Furthermore, we show that MTX chronotherapy alters the amount of chemotherapy that crosses the blood-brain barrier (BBB). Current experiments are elucidating the effect of various chemotherapeutics and chronotherapy on microglial activation and crosstalk with other glia. This work will reveal crucial factors regulating CRCI-associated neuroinflammation and will define novel strategies to alleviate CRCI to prioritize quality of life for cancer survivors.
NCOG-01. BASELINE PATIENT-REPORTED OUTCOMES IN AN ONGOING PHASE III TRIAL OF PRE-OPERATIVE SRS VERSUS POST-OPERATIVE SRS FOR BRAIN METASTASES
Authors: Bradshaw Mariana , Wefel Jeffrey , Noll Kyle , Rao Ganesh , Ferguson Sherise , Tawbi Hussein , Huse Jason , Johnson Jason , Court Laurence , O'Brien Barbara , Lang Frederick , Ejezie Lynette , Sullaway Catherine , Thomas Ashley , Suki Dima , Nana Yeboa D
Published: November 2023

In ongoing phase III randomized trial (NCT03741673) evaluating risk of LMD in patients with brain metastasis, patients are stratified by tumor size, location, and histology, and randomized to pre- versus post-operative SRS. Exploratory endpoints include patient reported outcomes (PROs) assessing symptoms (MDASI-BT) and health status (EQ-5D-5L). Characteristics of patients (N=40) with pre-treatment baseline include: mean (SD): age 59.3(11.4) years; 2.6(2.2) mets; 15.2(10.3) cc brain met volume; median KPS: 90 (range: 70-100). On the MDASI-BT, 22.5%, 47.5%, 27.5%, 12.5%, and 80% reported no symptoms on the Cognitive, Neurologic, Affective, Constitutional, and Gastrointestinal Factors, respectively. The median factor score was <1 on all factors. Neurologic (r=-.35, p=.03) and Constitutional Factors (r=-0.34, p=.03) correlated with KPS. There was no correlation between MDASI-BT Factors and number/volume of metastases. On the EQ-5D-5L, patients reported no problems with Mobility (45%), Self-Care (72.5%), Usual Activities (62.5%), Pain/Discomfort (55%), and Anxiety/Depression (52.5%). Nearly twenty-eight percent reported no problems in any domain. KPS correlated with Mobility (r=-.48, p< 0.01), Self-Care (r=-.49, p< 0.01), and Usual Activities (r=-.44, p< 0.01). There was no association between EQ-5D-5L items and number/volume of metastases. Patients’ baseline rating of current health on a 0-100 scale (VAS) ranged from 30-100 (mean (SD)=72.25 (19.18)). VAS correlated most with Anxiety/Depression (r=-.40, p=.01). VAS also correlated significantly with MDASI-BT Affective Factor (r=-.541, p< .001) but not with Cognitive or Neurologic Factors. There was no correlation between VAS and KPS or number/volume of metastases. As previously reported, objective measures of cognitive function are associated with disease characteristics. PROs were associated with performance status but not disease characteristics. Mood was more strongly associated with patients’ self-perception of overall health status than clinical or disease characteristics. At baseline, a high proportion of patients report no adverse symptoms, suggesting use of these outcomes is best suited to trials measuring worsening of symptoms.
NCOG-03. SURGICAL MANAGEMENT OF CRANIOSPINAL AXIS MALIGNANT PERIPHERAL NERVE SHEATH TUMORS: A SINGLE-INSTITUTION EXPERIENCE AND LITERATURE REVIEW
Authors: Chowdhury A J , Vivanco-Suarez Juan , Belzer Alex , Teferi Nahom , Hitchon Patrick
Published: November 2023

Malignant peripheral nerve sheath tumors (MPNSTs) are exceedingly rare and aggressive tumors with an overall incidence rate of 0.001%. The craniospinal axis is a rare location for primary MPNSTs with very few cases reported in the literature to date. Here-in, we present one of the larger series of single-institutional primary craniospinal MPNSTs, analyze patient outcomes, and extensively review the associated literature. All primary craniospinal axis MPNSTs managed at our institution between January 2005 to May 2023 were retrospectively reviewed. Patient demographics, tumor characteristics and radiographic features, treatment, and clinical outcomes were collected and analyzed. Descriptive statistics and multivariate logistic regression were performed. A total of 8 patients satisfied inclusion criteria (4 male and 4 female patients). Median age at presentation was 40 years (range 34-80 years). Most of these tumors were localized to the spine (6, 75%) and 3 patients (37%) had neurofibromatosis type 1(NF-1). Most common presenting symptoms were paresthesia/numbness in 50% of cases, and vision changes in 13%. Median tumor size was 3 cm (range 1-20), and most tumors were oval-shaped (4, 50%), with well-defined borders (6, 75%). One spinal tumor (11%) had an intramedullary extension. Most tumors were high grade (6, 75%), and gross-total resection was achieved in 5 (63%) patients with subtotal resection performed in the remaining 3 (37%). Radiotherapy and chemotherapy after surgery were performed in 6 (75%) and 4 (50%) cases, respectively. Local recurrence was evidenced in 5 (63%) cases and distant metastatic disease in 2 (25%) cases. The median progression-free survival time was 26.0 months, and 5 (63%) patients died due to recurrent disease. Early diagnosis and initiation of treatment is key as these tumors are highly aggressive with increased local invasion and distant metastatic rates. Maximal safe gross total resection with negative margins with adjuvant radiation therapy is associated with improved survival.
NCOG-10. LONG-TERM SURVIVAL ANALYSIS OF PLEOMORPHIC XANTHOASTROCYTOMA: INSIGHTS INTO PROGNOSTIC FACTORS AND TREATMENT STRATEGIES
Authors: Lee Chaejin , Byeon Yukyeng , Kim Gung-Ju , Jeon Juhee , Kim Young-Hoon , Hong Chang-Ki , Kim Jeong Hoon , Song Sang Woo
Published: November 2023

PURPOSE

Pleomorphic xanthoastrocytoma (PXA) is rare, accounting for less than 1% of astrocytomas. Despite its pleomorphic histologic features, PXA generally carries a favorable prognosis. Limited research exists regarding the clinical course and treatment outcomes of PXA. This study aimed to identify prognostic factors and evaluate treatment strategies in PXA.

METHODS

We retrospectively analyzed PXA patients who underwent surgical resection at our institution from 2000 to 2021. Demographic data, radiologic characteristics, and treatment outcomes were collected. Tumors were classified as grade 2 or grade 3 based on the 2021 World Health Organization criteria.

RESULTS

Among the included patients, 40 were diagnosed with grade 2 PXA, while 9 had grade 3 PXA. Five-year progression-free survival (PFS) rates were 75.8% for grade 2 and 37.0% for grade 3 (p = 0.003). Multivariate Cox regression analysis revealed that both grade (p = 0.044) and tumor infiltration (p = 0.008) significantly influenced PFS. Factors such as hydrocephalus (p = 0.005) and tumor infiltration (p = 0.017) were found to affect overall survival (OS). Subgroup analysis in grade 2 PXA showed significantly better OS and PFS when gross total resection (GTR) was performed during the initial surgery, as opposed to subtotal resection (STR). Adjuvant radiation therapy did not significantly alter the prognosis of grade 2 PXA.

CONCLUSIONS

Tumor infiltration was associated with improved PFS and OS in grade 2 and 3 PXA cases. GTR had a significant positive impact on PFS in the overall group, and both PFS and OS in grade 2 PXA. Adjuvant radiation therapy did not significantly alter the prognosis of grade 2 PXA.
NCOG-14. EFFECT OF CHOLINE ALPHOSCERATE ON THE SURVIVAL OF GLIOBLASTOMA PATIENTS
Authors: Kim Yeong Jin
Published: November 2023

Cognitive impairment often occurs in glioblastoma (GBM) patients due to the tumor itself and treatment side effects. Choline alphoscerate (L-alpha-glycerylphosphorylcholine, GPC) is frequently used to compensate for cognitive impairment in GBM patients. This study was conducted to determine whether GPC affects the overall survival (OS) and progression-free survival (PFS) of GBM patients. From 2011 to 2020, 187 isocitrate dehydrongenase (IDH)-wild-type GBM patients were analyzed. The patients were classified based on whether GPC was continuously used for at least 3 or 12 months (mos) after GBM diagnosis. Although GPC usage (≥3 mos) did not make significant differences in survival extension, median OS in the long-term GPC group (≥12 mos) was longer with statistical significance, compared to the control group (< 12mos)(38.3 vs 24.0 mos, p=0.004). In addition to younger age, supratentorial location, complete resection, and MGMT promoter methylation, long-term use of GPC (≥12 mos) was significantly associated with longer OS in multivariate analysis (p = 0.019, hazard ratio [HR] 0.532, 95% confidence interval [CI] 0.314–0.900). Despite the limitations of this study, long-term GPC use was possibly associated with prolonged survival in GBM patients. Multi-center prospective randomized studies with a large number of patients are needed to validate these findings.
NCOG-16. VALIDATION OF EFFICACY OF CCRT FOLLOWED BY TEMOZOLOMIDE FOR NEWLY DIAGNOSED GBMS: 15-YEAR EXPERIENCE OF A SINGLE INSTITUTION
Authors: Ko Ka Hyen , Kang Ho , Hwang Kihwan , Choe Byung Se , Choe Gheeyoung , Kim Yu Jung , Kim Chag-Yong
Published: November 2023

PURPOSE

The authors have analyzed the long-term follow-up results of chemotherapy with temozolomide (TMZ) during and after radiotherapy in patients with newly diagnosed glioblastoma (GBM). This study self-validates the effect of a treatment protocol that has been applied at a single institute for more than 18 years.

MATERIALS AND METHODS

Total 229 patients of newly diagnosed GBM patients who were treated with TMZ during and after radiotherapy from 2004 to 2018 in the authors’ institute were enrolled and analyzed in this retrospective study. Primary outcome was overall survival (OS), and progression-free survival (PFS) was the second outcomes. Long term survivors (LTS) were also reviewed retrospectively. 2021 World Health organization (WHO) classification has been used for this study.

RESULTS

The median follow-up period was 16.4 months (range, 1.3-171.1). Younger age (< 70 years old), higher KPS score (≥80 and ≥60), gross total resection (GTR), completion of the Stupp protocol, and salvage treatment in patients with the progressive disease showed significantly longer OS times than the other subgroups. Subgroup analysis has been gone through comparing LTS to non-LTS. non-GTR (42% vs. 67.6%, p < 0.001), preop KPS ( >60, 100% vs. 91.1%, p = 0.026) ( >80, 94% vs. 81%, p = 0.027), MGMT promoter methylation (42% vs. 26.3%, p = 0.034) were statistically significant factors that differentiate LTS from non-LTS. In our study, salvage treatment was significantly associated with increased survival in patients with PD. More specifically, if standard treatment was aborted, salvage treatment improved overall survival

CONCLUSION

Concurrent chemoradiotherapy using TMZ might be still effective for newly diagnosed GBM. Completing the Stupp protocol in patients with newly diagnosed GBM and salvage treatment in patients with the progressive disease might help achieve better survival.