bluuebunny/crossref_metadata_2025 huggingface dataset:
QOL-15. PATIENT-REPORTED PHYSICAL HEALTH-RELATED QUALITY OF LIFE PREDICTS SHORT-TERM POSTOPERATIVE OUTCOMES IN A HETEROGENEOUS COHORT OF BRAIN TUMOR PATIENTS
Authors: Chakravarti Sachiv , Kuo Cathleen , Kazemi Foad , Oak Atharv , Lucas Calixto-Hope , Croog Victoria , Kamson David , Schreck Karisa , Holdhoff Matthias , Bettegowda Chetan , Mukherjee Debraj
Published: November 2024

Patient-reported outcome measures (PROMs) are increasingly used to assess patients’ perioperative health. The PROM Information System 29 (PROMIS-29) is a well-validated global health assessment instrument for patient physical health, though its utility in cranial neurosurgery is unclear. To investigate the utility of preoperative PROMIS-29 physical health (PH) summary scores in predicting postoperative outcomes in brain tumor patients. Adult brain tumor patients undergoing resection at a single institution (January 2018-December 2021) were identified and prospectively received PROMIS-29 surveys during pre-operative visits. PH summary scores were constructed and optimum prediction thresholds for length of stay (LOS), discharge disposition (DD), and 30-day readmission were approximated by finding the Youden index of the associated receiver operating characteristic curves. Bivariate analyses were used to study the distribution of low (z-score≤-1) versus high (z-score>-1) PH scores according to baseline characteristics. Logistic regression models quantified the association between preoperative PH summary scores and post-operative outcomes. A total of 157 brain tumor patients were identified (mean age 55.4±15.4 years; 58.0% female; mean PH score 45.5 + 10.5). Outcomes included prolonged LOS (24.8%), non-routine discharge disposition (37.6%), and 30-day readmission (19.1%). On bivariate analysis, patients with low PH scores were significantly more likely to be diagnosed with a high-grade tumor (69.6% vs 38.85%, p=0.010) and less likely to have elective surgery (34.8% vs 70.9%, p=0.002). Low PH score was associated with prolonged LOS (26.1% vs 22%, p<0.001), nonroutine discharge (73.9% vs 31.3%, p<0.001) and 30-day readmission (43.5% vs 14.9%, p=0.003). In multivariate analysis, low PH scores predicted greater LOS (odds ratio [OR]=6.09, p=0.003), nonroutine discharge (OR=4.25, p=0.020), and 30-day readmission (OR=3.93, p=0.020). The PROMIS-29 PH summary score predicts short-term postoperative outcomes in brain tumor patients and may be incorporated into prospective clinical workflows.
QOL-24. NEUROLOGIC AND NEUROCOGNITIVE OUTCOMES AMONG SURVIVORS OF INFANT-TYPE HEMISPHERIC GLIOMA (IHG)
Authors: Bagchi Aditi , Hanzlik Emily , Chiang Jason , Lensing Shelly , Bryndziar Martina , Ashford Jason , Singh Anjali , Khan Raja B , Gajjar Amar , Robinson Giles W , Onar-Thomas Arzu , Conklin Heather M
Published: November 2024

IHGs are large, hemorrhagic cerebral tumors associated with hydrocephalus, increased intracranial pressure, and herniation. Commonly diagnosed during early infancy, children with IHGs have an approximately 90% chance of overall survival when treated with surgery, chemotherapy, and, more recently, molecularly targeted therapies. However, there is limited understanding of long-term quality-of-life following treatment. Our study investigated long-term neurological and neurocognitive outcomes among IHG survivors. The medical database was reviewed for neurological sequelae and neurocognitive outcomes (intelligence [IQ], adaptive function, academic readiness) for 21 survivors. Median age of diagnosis and last follow-up were 0.8 (0.0-4.4) and 10.3 (4.8-17.6) years, respectively. Sixteen patients (76%) experienced atleast one neurological sequelae: 38% (8/21) had paresis/plegia; 24% (5/21) had spasticity, 26% (5/19) had abnormal speech, and 57% (12/21) had a long-term seizure disorder. Nine patients diagnosed with IHG at < 0.5 years had significantly higher rates of dysarthria (p = 0.019) and seizure disorders (p = 0.035) in follow-up in comparison to patients diagnosed at 0.5-1 year (n=4) and >1 year (n=8). Neurocognitive outcomes were available for 19 patients at a median of 6 years after diagnosis. Median IQ for the entire cohort was 68.0 (47.0-114.0), compared to normative expectations of 100 (SD = 15), with younger age at diagnosis associated with lower IQ (r = 0.36). Ten survivors experiencing seizures particularly had worse IQ scores (median 69.4 [47-101]). Survivors also had inferior outcomes in school readiness (median 46.0 [40.0-98.0]), compared to normative expectations of 100 (SD = 15), and adaptive function (median 48.0 [34.0-67.0]), compared to normative expectations of 50 (SD= 10), with younger age at diagnosis associated with lower performance for adaptive function (r = 0.45).

CONCLUSION

Children diagnosed with IHG have a high survival rate but experience substantial tumor-associated and treatment-related long-term morbidity. Future clinical trials should aim for better long-term quality of life for survivors through scientifically driven treatment modification.
QOL-25. DIGITAL PHENOTYPING OF PERIOPERATIVE MOBILITY METRICS IN PATIENTS UNDERGOING SURGICAL RESECTION OF SKULL BASE TUMORS
Authors: Hong Christopher , Gudde Niels , Magnusson David , Gerstl Jakob , Kilgallon John , Onnela J P , Smith Timothy
Published: November 2024

Current methods to assess quality of life and recovery after surgery for skull base tumors are limited and often biased by subjective patient-reported assessments, while objective, in-situ assessments are lacking. Smartphone-based digital phenotyping has been increasingly studied across pathologies, utilizing built-in technologies to measure behavioral patterns pertaining to sleep, physical mobility, social interactions, and cognitive functioning, among others. Here, we report our initial experience with smartphone-based digital phenotyping in patients who underwent resection of skull base lesions. Patients seen at our multi-disciplinary skull base center were enrolled under an institutional board-approved protocol and installed the Beiwe application, which passively collected GPS data 20 days pre- and up to 140 days post-surgery. Variables measured included time spent at home, number of separate significant places visited outside home, daily walking time, and daily number of steps taken. 26 patients were enrolled, comprised of 14 pituitary adenomas, 8 meningiomas, and 4 vestibular schwannomas. All patients demonstrated increased time spent at home, fewer number of significant locations visited, decreased walking time, and decreased total steps in the immediate post-operative period. For pituitaries, mean return to baseline for these variables was 25.7, 24.3, 80.2, and 88.9 days, respectively. For meningiomas, return to baseline was 56.5, 214.4, 45.0, and 45.6 days, respectively. For vestibular schwannomas, return to baseline was 219, 39.9, 35.1, and 36.4 days, respectively. This study demonstrates initial efficacy of digital phenotyping for a cohort of patients undergoing surgical resection of skull base lesions, based on passively collected smartphone GPS data during the peri-operative period. This is part of a larger, ongoing study enrolling surgical patients as well as non-operative controls for comparison. Such peri-operative mobility metrics may potentially be refined to predict postoperative outcomes following surgery such as improvement of neurological symptoms, postoperative CSF leak, infection, dysnatremia, and hospital length of stay.
QOL-26. GLIOMA PATIENTS’ COGNITION AND THEIR CAREGIVERS: THE GOOD, THE BAD, AND THE BURDEN
Authors: Zarrella Giuliana , Fox Amber , Loughan Ashlee , Lanoye Autumn , Aslanzadeh Farah , Sherwood Paula , Braun Sarah
Published: November 2024

BACKGROUND

Cognitive decline, common in patients with gliomas, can contribute to reduced independence in daily functioning. Patients with gliomas often rely on informal caregivers for functional support, evidenced to cause distress in other caregiver populations (e.g., Alzheimer’s, terminal cancer, dementia). Few studies have investigated this relationship in neuro-oncology; thus, we explored whether patients’ neurocognitive function was associated with aspects of caregiver burden.

METHODS

Patients with glioma underwent neurocognitive testing including Auditory Verbal Learning Test-Delayed Recall (AVLT), Trail Making Test-Part B (TMT-B), Stroop Color-Word Interference (CWI), Controlled Oral Word Association Test (COWA), and the Grooved Pegboard (GPB). Caregiver burden was assessed using the schedule burden and self-esteem subscales of the Caregiver Reaction Assessment (CRA). Hierarchical regressions and independent samples t-tests evaluated whether neurocognitive performance predicted caregiver burden and differences in caregiver burden between patients with intact versus impaired (AVLT; ≥ -1.5 SD) memory.

RESULTS

Seventy-eight dyads were included for analyses (Patient: Mage=53.4, 65.4% male, 97.4% Non-Hispanic/White; Caregiver: Mage =52.5, 71.8% female, 96.2% Non-Hispanic/White). AVLT performance was significantly related to both caregiver schedule burden (β = -.63, p =.003) and self-esteem (β =.26, p =.046). Performance on TMT-B, COWA, GPB, and CWI and patient age were not related to caregiver burden in any model (ps>.05). There was a significant difference in caregiver schedule burden between those with (M=15.17, SD=5.84) and without memory impairment (M=18.50, SD=5.60) [t(72)=-2.44, p=.017] but not for self-esteem (p>.05).

CONCLUSIONS

Patient performance on verbal memory was sensitive to the changes that may contribute to increased caregiver burden. An amnestic profile may be the most salient cognitive predictor of strain on neuro-oncology caregivers. Our findings speak to the interdependence of patient outcomes and caregiver quality of life. Supporting patients’ neurocognitive capabilities, such as implementing individualized cognitive rehabilitation programs, may improve caregiver burden.
QOL-27. PATIENT REPORTED OUTCOME AND PREFERENCE AFTER CRANIOTOMY AND LASER THERMAL ABLATION: A PILOT STUDY
Authors: Pino Isabela Peña , Bartek Jiri , Chen Clark
Published: November 2024

BACKGROUND

Laser interstitial thermal therapy (LITT) is a minimally invasive procedure that allows cytoreduction in the treatment of brain tumors and can be considered by both surgeons and patients as an alternative to craniotomy.

OBJECTIVE

We surveyed 27 patients who underwent both craniotomy and LITT during distinct stages of their oncology journey to assess patient reported outcomes comparing both procedures.

METHODS

A nine question survey was developed and validated to assess patient reported post-operative recovery, pain level, narcotic use, and procedure preference. The survey was administered to patients with WHO II-IV gliomas who underwent both craniotomy and LITT.

RESULTS

The survey was reviewed by independent surgeons, patient advocates, and patients in terms of face validity and showed >90% correlation in test-retest reliability. Our cohort had a mean age of 57 (+/- 12 years), 78% had glioblastoma. There was no significant difference in symptomatic improvement post-craniotomy or post-LITT (30% versus 4%, p=0.17). Similarly, no significance was detected in patient-reported recovery time from craniotomy (time required to return to pre-operative state, 4.3 +/- 9.1 weeks, median 2 weeks) or LITT (2 ± 2.3 weeks, median 1 week)(p=0.21). Notably, post-surgical pain (1-10 pain scale) and need for narcotic use in the first week (yes/no) after the procedure were significantly lower post-LITT (average pain score 1.7 versus 5 points, narcotic use 4% versus 81%, p<0.0005 for both comparisons). When asked which procedure they would choose – having experienced both craniotomy and LITT, surveyed patients overwhelmingly chose LITT over craniotomy (89% versus 11%, p<0.0005). Of note, the patients who preferred craniotomy experienced improved neurologic function post-craniotomy or suffered new deficits post-LITT.

CONCLUSION

In this pilot study, patients reported less pain and narcotic use post-LITT relative to craniotomy and generally preferred the former procedure if given the choice. Validation of these results in future studies can help inform decision making in clinical scenarios where there is equipoise between LITT and craniotomy.
QOL-28. CANCER-RELATED DISTRESS IN NEURO-ONCOLOGY: PATIENTS INFORM PROGRAM DEVELOPMENT FOR ENHANCING QUALITY OF LIFE
Authors: Fox Amber , Zarrella Giuliana V , Loughan Ashlee R , Lanoye Autumn , Palesh Oxana , Moeller F Gerard , Braun Sarah E
Published: November 2024

BACKGROUND

Brain tumor diagnosis and treatment result in significant negative sequelae, including cognitive decline, fatigue, and psychosocial symptoms. This study aimed to identify brain tumor patients’ sources of cancer-related distress and examine their interest in various treatment modalities targeting cognitive decline to inform program development for this underserved population.

METHODS

In pursuit of program development, patients with both primary and secondary brain tumors completed an anonymous survey. They reported demographics, tumor characteristics, subjective cognitive functioning; and, rated sources of cancer-related symptom distress (i.e., cognitive changes, fatigue, physical symptoms, motor functioning, balance, mood, and relationship) and interest in treatments targeting cancer-related cognitive decline (i.e., cognitive rehabilitation, mindfulness-based practices, psychotherapy, and medication). Descriptive statistics, t-tests, chi-square, and linear regressions were conducted.

RESULTS

Among participants (N=137, Mage=49.6±15.8, 58.1% female, 84.8% White), 50.4% endorsed subjective cognitive functioning below the mean (MFACT-Br-CI=22.6±7.5). Nearly half reported significant distress due to cancer-related fatigue (49.6%) and cognitive change (48.9%). Patients’ mean severity of distress due to cognitive decline was significantly greater relative to all other cancer-related symptoms (ps<.001), except fatigue (p>.05). Age, gender, or time since diagnosis were not significant predictors (ps>.05) of distress due to cognitive decline. Most patients with distress due to cognitive change were interested in cognitive rehabilitation (63.6%) and mindfulness-based practices (61.6%), and only 40.4% were interested in medication. Interest in cognitive rehabilitation was not predicted by symptom distress, subjective cognitive functioning, age, gender, or time since diagnosis (ps>.05). Gender was the only significant predictor of interest in mindful movement (b=.18, p=.041), with greater interest among women (χ2(1)=4.65, p=.031).

CONCLUSIONS

Fatigue and cognitive decline were the most distressing cancer-related symptoms for neuro-oncology patients. These findings emphasize the need for integrated interventions, including cognitive rehabilitation and mindfulness, as well as multi-targeted and individualized treatments for fatigue and cognitive decline in neuro-oncology.
QOL-29. PREVALENCE, MANAGEMENT, AND OUTCOMES OF PROCARBAZINE-ASSOCIATED HYPERSENSITIVITY REACTIONS IN PATIENTS RECEIVING PCV FOR LOW-GRADE GLIOMA
Authors: Knott Jack , Liebling Simon , Reed-Guy Lauren , Croteau Desiree , Phillips Richard , Desai Arati , Bagley Stephen
Published: November 2024

Procarbazine is an alkylating agent commonly used to treat low-grade gliomas as part of the PCV regimen. The use of procarbazine is frequently limited by the development of hypersensitivity reactions (HSRs), which often require dose reduction or cessation of procarbazine therapy prior to the completion of a planned treatment course. The prevalence, clinical characteristics, and potential predictors of these reactions are not well defined. We conducted a retrospective cohort study of patients with low-grade glioma who received PCV between January 2016 and January 2024 at a tertiary academic hospital. Data on patient demographics, tumor type, clinical characteristics, treatment course, and hypersensitivity reactions were collected and analyzed. 61 total patients were included. The overall prevalence of HSRs was 60.7% (95% CI: 48.4% - 72.9%). The median cycle during which HSRs occurred was cycle 3 (IQR: 2-4, Range: 1-5). All HSRs involved the development of rash, with 86.5% being pruritic and 21.6% involving the face. Treatments for HSRs included antihistamines (62.2%), topical corticosteroids (35.1%), and systemic corticosteroids (27.0%). Three patients with HSRs presented to the emergency department with concern for anaphylaxis, and one required treatment with epinephrine. Out of six patients rechallenged with procarbazine after experiencing HSRs, one patient redeveloped a diffuse, pruritic rash that resolved with systemic corticosteroids. A multiple logistic regression analysis was performed to assess the association between HSRs and gender, age at PCV C1D1, elevated liver enzymes, and concomitant anticonvulsant use, but no significant correlation was observed. In summary, our study provides a contemporary and comprehensive analysis of the prevalence and severity of HSRs to procarbazine in patients with low-grade glioma. The high rate of HSRs in this population, including a relatively high rate of suspected anaphylaxis, should be considered carefully by clinicians in choosing chemotherapy for low-grade glioma and warrants routine counseling and close monitoring.
QOL-31. RESULTS OF A TELEHEALTH-BASED PSYCHOLOGICAL INTERVENTION FOR CAREGIVERS OF PATIENTS WITH PRIMARY MALIGNANT BRAIN TUMORS: A MODERATION ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL
Authors: Willis Kelcie , Horick Nora , Strander Sumita , Whitman Jessica , Chiu Daniel , Pintro Kedie , Corveleyn Amy , El-Jawahri Areej , Greer Joseph , Temel Jennifer , Jacobs Jamie , Forst Deborah
Published: November 2024

BACKGROUND

In a recent randomized controlled trial, caregivers of patients with primary malignant brain tumors (PMBT) who received NeuroCARE—a six-session, telehealth-based psychological intervention—demonstrated improved anxiety and depression symptoms, coping, and self-efficacy at 11-weeks compared to usual care (UC) participants. We now explore how sociodemographic variables, disease-specific factors, and baseline mood symptoms moderate intervention effects on anxiety and depression symptoms.

METHODS

We examined data from 120 enrolled caregivers (Mage=53 years; 83% female, 92% White, 70% spouses/partners) of PMBT patients (84% glioblastoma). Eligible caregivers had elevated anxiety (Generalized Anxiety Disorder-7 ≥ 5). Participants were randomized 1:1 to NeuroCARE or UC and completed baseline sociodemographic questionnaires and the Hospital Anxiety and Depression Scale at baseline and 11-weeks. We used linear regression to evaluate whether selected sociodemographic characteristics (gender, age, relationship to patient), tumor characteristics (tumor location/laterality, IDH mutation status), and baseline mood symptoms moderated intervention effects on anxiety and depression symptoms. We report the group-by-moderator (b) effects, using a 0.20 significance level.

RESULTS

The beneficial effects of NeuroCARE on reducing 11-week anxiety symptoms were greater in women compared to men (b=-2.63, CI: -6.17, 0.91, p=0.14) and greater in caregivers who reported higher baseline anxiety symptoms (b=-0.43, CI: -0.78, -0.08, p=0.02) and depression symptoms (b=-0.56, CI: -0.96, -0.17, p=0.01). The beneficial effects of NeuroCARE on reducing 11-week depression symptoms were greater in caregivers of patients with IDH-wildtype tumors compared to caregivers of patients with IDH-mutant tumors (b=2.49, CI: -0.26, 5.24, p=0.08). Caregiver age, relationship to patient, and tumor location/laterality did not significantly moderate NeuroCARE effects on mood.

CONCLUSIONS

The positive effects of NeuroCARE were particularly salient for caregivers with elevated anxiety and/or depression symptoms and those caring for patients with IDH-wildtype tumors. Content may be further tailored to account for the unique needs of men and caregivers of patients with IDH-mutant tumors.
RBIO-08. INVESTIGATING THE EFFICACY AND MECHANISMS OF TUMOR TREATING FIELDS IN RADIATION-RESISTANT GLIOBLASTOMA MODELS
Authors: Schanel Taylor , Pandit Rhea , Anderson Joshua , Alrefai Hasan , Jones Amber , Hicks Patricia , Hjelmeland Anita , Willey Christopher
Published: November 2024

Glioblastoma (GBM) is an aggressive malignant brain tumor with poor prognosis despite current treatment regimens involving surgical resection, radiation, temozolomide, and the newly approved use of Tumor Treating Fields (TTFields; a noninvasive, transdermal, administration of alternating low-intensity, intermediate-frequency electrical fields). Acquired radiation resistance, thought to be partially driven by brain tumor-initiating cells (BTICs), underscores therapeutic challenges in GBM. While clinical evidence supports the therapeutic benefit of TTFields, its precise mechanisms of action are poorly understood, and TTFields impact on radiation-resistant GBM is unknown. To better understand the effect and mechanism of TTFields in radiation-resistant GBM, we utilized patient-derived xenolines (PDX) and their acquired radio-resistant pairs to assess changes in viability and molecular signaling. PDX were previously developed by subcutaneous implantation of patient GBM cells into immunodeficient (nu/nu) mice. Acquired radiation-resistant PDX were generated through serial in vivo radiation. TTFields were administered with the Novocure inovitroTM device in a cooling incubator to maintain 37oC sample temperature in the ceramic well plates of the device. PDX were cultured on geltrex-coated coverslips under serum-free conditions. Cytotoxicity was quantified 72h post TTFields with crystal violet. Molecular signaling was captured with PamChip peptide-based kinase activity arrays and RayBiotech proteomic arrays. We found that TTFields inhibit cell growth in both parental and acquired radiation-resistant PDX. Differences in molecular signatures between the PDX lines suggest molecular mechanisms of TTFields sensitivity signatures and interactions with acquired radio-resistant PDX. We are currently trying to generate TTFields-resistant PDX lines through serial treatment with plans to examine BTIC populations relative to TTFields efficacy. We also plan to explore targetable TTFields-induced alterations in the future.
RBIO-10. RADIATION FRACTION SIZE DIFFERENTIALLY AFFECTS MYELOID-DERIVED SUPPRESSOR CELL (MDSC) SUBSETS IN WHO GRADE 1 MENINGIOMA
Authors: Boorsma Bergerud Kyra , Berkseth Matthew , Golden Lydia , Sando Nicole , Chen Liam , Venteicher Andrew , Sloan Lindsey
Published: November 2024

Meningiomas are often cured after focal therapy with surgical resection and/or radiotherapy (RT); however, a small proportion still recur. RT dose can be used to modulate anti-tumor immune responses, potentially through regulating immunosuppressive MDSCs. Here, we investigate the effect of a single fraction of RT (2Gy vs. 15Gy) on frequency and activation status of MDSC subsets in patients with WHO grade 1 meningioma. We hypothesize that 2Gy will promote immunosuppressive MDSC activity more than 15Gy. Fresh tumor cells from patients with a presumed diagnosis of meningioma were digested into primary cell cultures and treated with a single fraction of 2 or 15 Gy or were sham irradiated using a XRAD 320 Biological Irradiator. Cells were incubated for 18hrs prior to flow cytometric analysis. MDSC populations were identified as Live/Dead-CD11b+CD33+HLA-DR-. MDSC subsets were then divided into M-MDSC (CD14+CD15-) or G-MDSC (CD15+CD14-). Five WHO grade 1 meningiomas were analyzed. The total frequency of MDSCs in tumors increased from 3% with sham RT to 4% after irradiation with 2Gy (p=0.03). This was driven by a 2-fold increase in frequency of total M-MDSCs, as G-MDSCs decreased by half after 2Gy (p=0.03). After irradiation with 15Gy, M-MDSC frequency was nearly half that of 2Gy. The frequency of TGF-β+MDSCs increased after 15 Gy (p=0.02). The frequency of IL-10+G-MDSCs increased in response to 2Gy (p =0.03) but decreased 4-fold after 15Gy. 18hrs after 2Gy, IFN-γ+M-MDSCs increased compared to sham (p=0.01). In this small cohort of grade 1 meningiomas, a 2Gy fraction of RT appeared to support expansion of the M-MDSC subset. RT at both fraction sizes increased immunosuppressive cytokine producing-MDSCs: M-MDSC-IL-10; G-MDSC-TGF-β. These findings indicate the need for further studies to understand the subset-specific impact of RT on MDSC, a key immune cell type in brain cancers.
SURG-01. INTRAOPERATIVE FLUORESCENCE ACTIVITY OF 5-AMINOLEVULINIC ACID IN BRAIN METASTASIS OF LUNG CANCER IS ASSOCIATED WITH THE GENETIC ALTERATION OF CELL CYCLE REGULATION
Authors: Kim Young Zoon , Go Kyeong-O
Published: November 2024

With advancement of technology in brain tumor surgery, fluorescence image, such as 5-Aminolevulinic Acid (5-ALA), can help detect the residual tumor during surgery. Recently, genetic alteration of cancer is additionally considered as prognostic factor with being added into traditional prognostic system, such as Graded Prognostic Assessment (GPA) scoring system. The primary objective of this study was to investigate the association of certain genetic alterations and intraoperative fluorescent activity of 5-ALA in brain metastasis (BM) of lung adenocarcinoma. A retrospective cohort study was conducted among 72 patients who underwent surgical resection of BM of lung adenocarcinoma at our institute for five years. Cancer cell infiltration was estimated by the intraoperative fluorescent activity of 5-ALA, and genetic alterations were analyzed by next-generation sequencing (NGS). Total 72 patients were eligible for analysis. Strong fluorescence was obtained in 56 (77.8%) patient during surgery. The sensitivity and specificity for detecting cancer cell infiltration using 5-ALA were 87.5% and 96.4%, respectively. In the NGS data of BM, genetic alteration of cell cycle regulation, DNA repair, tumorigenesis, proliferation, epigenetic regulation, and cancer immunology were detected in 73.6%, 44.4%, 56.9%, 66.7%, 30.6%, and 2.8%, respectively. Genes associated with cell cycle regulation (p = 0.003) and cell proliferation (p = 0.044) were significantly associated with positive fluorescence activity of 5-ALA in the adjacent brain tissue. Genetic alterations in cell cycle regulation and cell proliferation were also associated with shorter recurrence-free survival (p = 0.013 and p = 0.042, respectively) and overall survival (p = 0.026 and p = 0.042, respectively) in the multivariate analysis. Additionally, age, KPS, status of NSCLC, RPA class, GPA score, modality of adjuvant treatment were associated with PFS and OS.The results suggest that genetic alterations in cell cycle regulation and cell proliferation are associated with positive fluorescence activity of 5-ALA in the adjacent infiltrative brain tissue and influence the clinical outcome of BM of lung adenocarcinoma.
SURG-06. IMPACT OF LASER INTERSTITIAL THERMAL THERAPY VERSUS RESECTION FOR METASTASES ASSOCIATED WITH THE MOTOR CORTEX
Authors: Jackson Joshua , Haskell-Mendoza Aden , Flusche Ann Marie , Woo Joshua , Reason Ellery , Gonzalez Ariel , Srinivasan Ethan , Lerner Emily , Edwards Ryan , Huie David , Calabrese Evan , Fecci Peter
Published: November 2024

BACKGROUND

For brain metastases (BM), resection remains a mainstay for the upfront management of large, symptomatic lesions, while laser interstitial thermal therapy (LITT) has become a key treatment for radiographically progressive BM following stereotactic radiosurgery (SRS). Compared to LITT, resection-associated morbidity may delay systemic therapies. We evaluated functional outcomes for resection versus LITT to primary motor cortex (PMC)-associated metastases.

METHODS

Patients receiving resection or LITT for BM radiographically associated with the PMC from 2015-2023 were retrospectively reviewed. Demographic and survival data were collected, with patient Karnofsky Performance Status (KPS) or modified Rankin Scale (mRS) scores assessed out to 1-year by independent raters.

RESULTS

Forty-one patients underwent resection and 30 underwent LITT to a PMC-associated lesion. Median age was 67 (range 38 – 80) vs 65 (44 – 80) for resection vs LITT; median pre-operative KPS (70 vs 80, P = 0.1) or mRS (2 vs 2, P = 0.66) did not differ between groups. Lung was the most common primary (56.1% resections vs 56.7% LITTs). Resected lesions were of larger median diameter than LITT, 2.8 vs 1.9 cm, P = 0.0001. For resections, length of stay was longer, median 2 vs 1 day, P = 0.0002, and ICU use more frequent (75.6% versus 20.0%, P < 0.0001). At 1-month post-op, 66.7% of resection patients and 51.7% of LITT patients had stable or improved symptoms from pre-op, P = 0.21, with parity at 3-months (65.7% vs 62.9%) and therafter. Further, there was no significant decrement in KPS or mRS score out to a year for either intervention.

CONCLUSIONS

While there is a short-term increased risk of post-operative neurologic worsening due to LITT-associated edema, our data shows that, relative to resection, this is a transient and clinically limited phenomenon. With careful patient selection, LITT to lesions involving the PMC is feasible.
SURG-11. COMPARATIVE RISK ANALYSIS OF DEVELOPMENT OF ANEMIA IN RADIOTHERAPY-TREATED VS. NON-TREATED MULTIPLE SCLEROSIS PATIENTS: A MULTICENTER RETROSPECTIVE COHORT STUDY
Authors: Hong Jinpyo , Stoltzfus Mason , Hallan David , Rizk Elias
Published: November 2024

INTRODUCTION

The use of RT in patients who are diagnosed with multiple sclerosis (MS) is controversial due to adverse effects such as inflammation. Simultaneously, the relationship between oncologic RT and worsening anemia is well established. However, there is not a clear understanding of the risk associated with undergoing RT due to their oncologic diagnosis in MS patients for developing anemia.

OBJECTIVE

This study aims to analyze the risk of developing anemia for patients with MS who have been treated with RT versus who have not.

METHODS

This retrospective study consists of analysis of the data acquired from TriNetX, a database that houses clinical data from 92 healthcare organizations. Cohort 1 included MS patients with history of RT, while cohort 2 included MS patients without any history of RT. The cohorts were propensity score matched for demographics such as age, sex, race, and ethnicity. All neoplasms were also matched to eliminate cancer as a confounding variable. The analysis included outcomes of interest, ICD-10 code D64 (Other anemia), up to 6 months after the first occurrence of the index event.

RESULTS

4,844 patients were identified for each cohort post-propensity score matching. The mean age was 65.4 and 67.3 years old, and most patients were white at 76.3% and 77.0% for the MS with RT and without RT cohorts, respectively. Cohort 1 had 628 patients who developed anemia, while cohort 2 only had 511 patients. The odds ratio was 1.263 with 95% confidence interval of 1.116 to 1.430 showing the statistically significant difference between the cohorts.

CONCLUSION

This study demonstrates that there is a significant increase in the likelihood of developing broadly categorized anemia for multiple sclerosis patients with or without radiation therapy. Further study is warranted to understand other potential factors leading to an increased risk of developing anemia in the irradiated cohort.
SURG-16. MULTIDISCIPLINARY TREATMENT OF HEMANGIOBLASTOMAS IN CENTRAL NERVOUS SYSTEM AND FUTURE PROSPECTS
Authors: takayanagi shunsaku , Takami Hirokazu , Nomura Masashi , Kitagawa Yosuke , Saito Nobuhito
Published: November 2024

Hemangioblastomas (HB) in central nervous system are originally benign tumors. However, they are extremely vascular and appropriate treatment of the feeders and drainers is important when performing HB resection. Approximately 20% of HB cases are thought to be caused by von Hippel-Lindau (VHL) disease. Patients with VHL disease often develop multiple HBs, and it may be difficult to treat them with excision alone. Recently, belzutifan, a molecular targeted drug indicated for treating HB in VHL disease cases, was approved by FDA. In this presentation, we will provide an overview of the multidisciplinary treatment at our facility.

METHOD

At our facility, we performed 84 cases of excision surgery from 1996 to 2019, and analyzed the results of these treatments. A high-definition 3D fused image was created before surgery to identify the feeders and drainers. Tumor embolization was performed on the feeder, which was thought to be located deep within the surgical field. In addition, gamma knife treatment was performed as appropriate for HBs that did not undergo extirpation.

RESULTS

The breakdown of cases was 46 with VHL disease and 38 with non-VHL disease. Postoperatively, KPS improved in 55% of cases, and some complications occurred in 18%. Gamma Knife treatment has been performed on 58 cases so far, and the 10-year tumor control rate is approximately 80%.

DISCUSSION/SUMMARY

This presentation revealed that multidisciplinary treatment is effective for HBs. In the future it is necessary to consider which HB cases belzutifan is useful for and how it should be combined with other treatments.
SURG-19. THE SYNDROME OF THE SUPPLEMENTARY MOTOR AREA: CLINICAL COURSE AND PREDICTORS OF OUTCOME AFTER RESECTION OF PREMOTOR LESIONS
Authors: Teske Nico , Jung Leonard B , Nöldeke Jan O , Weig Thomas , Blobner Jens , Forbrig Robert , Tonn Joerg-Christian , Kunz Mathias , Thon Niklas , Karschnia Philipp
Published: November 2024

OBJECTIVE

Supplementary motor area (SMA) syndrome frequently occurs after resection of premotor lesions. Interhemispheric connectivity including the contralateral SMA might be crucially involved in its development and recovery. We aimed to identify predictors of outcome by quantifying preoperative structural alterations in the non-affected contralateral hemisphere.

METHODS

We retrospectively searched our database for patients developing SMA syndrome after resection of premotor lesions between 2013 and 2023. Clinical characteristics and imaging data were collected. Structural network analysis was performed using the previously validated morphometric inverse divergence network.

RESULTS

27 patients with a mean age of 39.2 ± 17.7 years developed SMA syndrome, including 13/27 patients (48.1%) with primary brain tumors and 14/27 patients (51.9%) with intractable lesional epilepsy. Postoperative SMA syndrome was commonly characterized by contralateral upper extremity hemiparesis (19/27 patients, 70.4%) and aphasia in case of dominant hemisphere involvement (13/13 patients, 100%). Tumor patients were less likely to fully recover from SMA syndrome after 7 days compared to epilepsy patients (2/13 [15.4%] versus 9/14 [64.3%] patients, p=0.018). Most patients (23/27, 85.2%) experienced full recovery of SMA syndrome after a median follow-up of 5 months (IR 3-16 months), with no difference between patients with tumors or epilepsy (p=0.999). Preoperative contralateral intra-hemispheric connectivity was similar between patients receiving tumor or focal resection (0.183 vs 0.177, p=0.295). However, imaging analyses demonstrated baseline affection of SMA connectivity in patients with brain tumors as characterized by reduced cortical thickness of the contralateral frontal lobe and the cingulate gyrus compared to epilepsy patients.

CONCLUSION

While full recovery from SMA syndrome is common, SMA syndrome is frequently less severe and more transient in patients with epilepsy. This might be due to affection of the contralateral SMA network in tumor patients due to the infiltrative nature of the disease. Imaging analyses might assist in identifying network affections at baseline.
SURG-21. DEVELOPMENT AND VALIDATION OF A CLINICAL RISK SCORE FOR POSTOPERATIVE OUTCOME IN NEWLY DIAGNOSED GLIOBLASTOMA: A REPORT OF THE RANORESECT GROUP
Authors: Karschnia Philipp , Young Jacob S , Youssef Gilbert C , Dono Antonio , Häni Levin , Sciortino Tommaso , Bruno Francesco , Juenger Stephanie T , Teske Nico , Dietrich Jorg , Weller Michael , Vogelbaum Michael A , van den Bent Martin , Beck Juergen , Thon Niklas , Gerritsen Jasper K W , Hervey-Jumper Shawn , Cahill Daniel P , Chang Susan M , Rudà Roberta , Bello Lorenzo , Schnell Oliver , Esquenazi Yoshua , Ruge Maximilian I , Grau Stefan J , Huang Raymond Y , Wen Patrick Y , Berger Mitchel S , Molinaro Annette M , Tonn Joerg-Christian
Published: November 2024

BACKGROUND

Following resection or biopsy, patients with newly diagnosed glioblastoma frequently enter clinical trials. Nuanced risk assessment is warranted to reduce imbalances between study arms. Here, we aim to make use of our RANO classification for extent of resection (I) to analyze the interactive effects of residual tumor with clinical and molecular factors on outcome and (II) to define a postoperative risk assessment tool.

METHODS

The RANO resect group retrospectively compiled an international, seven-center training cohort of patients with newly diagnosed glioblastoma. The combined associations of residual tumor with molecular or clinical factors and survival were analyzed, and recursive partitioning analysis was performed for risk modeling. The resulting model was prognostically verified in a separate external validation cohort.

RESULTS

Our training cohort compromised 1003 patients with newly diagnosed IDH-wildtype glioblastoma, including 744 patients who underwent adjuvant radiochemotherapy (TMZ/RT→TMZ). Residual tumor, MGMT promotor methylation status, age, and KPS were prognostic of overall survival and forwarded into regression tree analysis. By combining eleven terminal nodes and individually weighting the prognostic factors, an additive scale (range, 0-9 points) integrating these four variables distinguished patients with low (0-2 points), intermediate (3-5 points), and high risk (6-9 points) for poor postoperative outcome (median overall survival: 24 vs. 16 vs. 6 months; p<0.01). The presence of the three risk groups was confirmed in the subgroups of patients treated with or without RT/TMZ→TMZ. The prognostic value of the risk score was verified in a external single-center validation cohort of newly diagnosed glioblastoma (n = 258, p<0.01). Compared to previously postulated models, goodness-of-fit measurements were superior for our score.

CONCLUSIONS

The novel RANO risk score serves as an easy-to-use, yet highly prognostic tool for postoperative patient stratification prior to further therapy. The score may serve to guide patient management and reduce imbalances between study arms in prospective trials.
SURG-34. NEURO ENDOSCOPIC VS CRANIOTOMY APPROACH IN SUPRATENTORIAL HYPERTENSIVE INTRACEREBRAL HEMORRHAGE: AN UPDATED META-ANALYSIS
Authors: Haseeb Abdul , Shafique Muhammad Ashir , Mustafa Muhammad Saqlain , Singh Ajeet , Iftikhar Sadaf , Rangwala Burhanuddin Sohail , Waggan Anzah Imtiaz , Ahmad Tagwa Kalool Fadlalla , Wold Brandon Lucke
Published: November 2024

INTRODUCTION

Intracerebral hemorrhage (ICH) is a serious medical condition associated with high mortality and disability rates. Surgical interventions, including neuro-endoscopic surgery (NES) and craniotomy, are employed to manage ICH and improve patient outcomes. This meta-analysis compares the effectiveness of NES versus craniotomy in treating ICH.

METHODS

A systematic literature search was conducted to identify relevant studies comparing NES with craniotomy for ICH. Inclusion criteria encompassed primary or secondary results from randomized controlled trials (RCTs) or observational studies (OSs) with confirmed supratentorial ICH. Data were extracted, and methodological quality was assessed using appropriate tools. Statistical analysis was performed using Comprehensive Meta-Analysis.

RESULTS

Twenty-six studies (n=3237 patients) were included in the analysis. NES was associated with significantly lower mortality compared to craniotomy (OR: 0.45, 95% CI 0.33 to 0.60, p < 0.00001). Hematoma evacuation rates were higher with NES (SDM: 1.505, 95% CI 0.835 to 2.160, p < 0.00001). NES also showed better functional outcomes (OR: 3.31, 95% CI 1.78 to 6.17, p = 0.0002) and reduced blood loss (SDM: -3.06, 95% CI -3.979 to -2.141, p = 0.000). Additionally, NES was associated with shorter hospital and ICU stays, shorter operative times, and fewer complications such as infection and rebleeding.

CONCLUSION

NES emerges as a promising alternative to craniotomy for treating ICH, offering advantages in terms of mortality reduction, improved functional outcomes, and fewer complications. Future studies should explore advancements in neuro-endoscopic techniques to optimize patient outcomes further.
SURG-35. NEURONAVIGATED INTRAOPERATIVE ULTRASSOUND X SODIUM FLUORESCEIN FOR BRAIN METASTASIS: WHICH IS BETTER?
Authors: Campos Paiva Aline Lariessy , Araujo João Luiz Vitorino , Lovato Renan Maximillian , de Oliveira Jean Gonçalves , Veiga José Carlos Esteves
Published: November 2024

BACKGROUND

Improve quality of life with a maximum surgical resection is the main goal of neurosurgeons. Brain metastasis are even more prevalent because of patients are living more. The grade of resection and the maintenance of a good performance are fundamental for these patients perform adjuvant radiotherapy. There are several technologies that may help. Considering two of them that have an easier access and are cheaper, we compared a high definition ultrasound (BK 3000) coupled to neuronavigation system (Brainlab) and sodium fluorescein (SF).

METHODS

Adult patients with main radiological hypothesis of brain metastasis were included in a PhD study previously approved by ethics committee. 3-5mg/kg of SF was administered by intravenous infusion during anesthetic induction. An specific craniotomy transducer was used in all cases with shift correction in real time by neuronavigator. All procedures were guided by the same neurosurgeon.

RESULTS

High definition ultrasound allows an excellent tumor delimitation. SF helped to increase grade of resection however made confusion about what is infiltration and what is tumor and for this ultrasound were superior. Increased fluorescence is easily detected when compared to ultrasound information’s.. For both technologies, when the surgical site had blood, the evaluation about grade of resection is not accurate because in ultrasound appears a posterior shadow and considering SF it seems that there are not further tumor because blood does not have increased fluorescence.

CONCLUSIONS

US and SF are different tools which improve brain metastasis resection. In each moment of surgery one technology was superior or not. We used an specific probe for neurosurgery that has high quality and allowed detailed evaluations. These technologies helps surgeons take quick decision and optimized brain tumor removal. The neurosurgeon should be more familiar to US images because provide a real time evaluation with low cost.
SURG-36. ACCURACY OF THE ROSA ONE BRAIN ROBOTIC PLATFORM FOR THE PLACEMENT OF NEUROBLATE AND VISUALASE LASER INTERSTITIAL THERMAL THERAPY PROBES
Authors: Rademacher Anneliese , Imran Zunaira , Fadel Hassan , Pawloski Jacob , Anzalone Anthony , Latack Katie , Lee Ian
Published: November 2024

Laser interstitial thermal therapy (LITT) is a minimally invasive treatment option for patients with intracranial lesions. The success of LITT is dependent on accurate placement of the laser probe in target tissue. Placement can be facilitated by various stereotactic methods, including the Robotic Surgical Assistant (ROSA) ONE Brain robotic platform. The aim of this study is to examine the accuracy of stereotactic probe placement utilizing the ROSA robot. Primary outcomes were entry distance, target distance, and entry angle error. Accuracy differences between two major LITT platforms, the Neuroblate (Monteris Medical) and Visualase Systems, were compared. A prospective institutional database was used to identify all patients who underwent LITT for intracranial tumors utilizing the ROSA robot between 2013-2023. The sign test was used to compare error values to test their difference from a null value of 0. Spearman correlation was used to assess the relationship between angle of error and trajectory length. Kuskal-Wallis test was used to compare errors and trajectory length between the two companies. Of the 105 patients who underwent LITT during the study period, 337 probes were placed. For Visualase probes, median entry distance (1.1mm, IQR=0.4-2.0), target distance (1.6mm, IQR =0.9-2.4), and entry angle error (1.5°, IQR=0.9-2.5), were significantly different than zero (p=<.0001). For Neuroblate probes, median entry distance (1.5mm, IQR=1.0-2.1), target distance (1.8mm, IQR=1.1-2.4), and entry angle error (1.8°, IQR=1.1-2.5) were significantly different than zero (p=<.0001). When comparing laser systems, there was a significant difference in median entry distance error with Neuroblate having a higher error (1.5mm, IQR=1.0-2.1) than Visualase (1.1mm IQR=0.4-2.0, p=0.0041). Stereotactic placement of LITT probes utilizing the ROSA robotic system was not able to achieve perfect alignment with the planned trajectory. When comparing the systems, Visualase probes were placed more accurately at the entry point than Neuroblate probes.
SURG-43. PATTERNS OF FAILURE FOLLOWING REIRRADIATION WITH GAMMA KNIFE STEREOTACTIC RADIOSURGERY FOR RECURRENT HIGH-GRADE GLIOMAS
Authors: Bindal Shivani , Gonzalez Brandon , Esquenazi Yoshua , Dono Antonio , Riascos Roy , Zhu Jay , Hsu Sigmund , Tandon Nitin , Martir Magda , Blanco Angel , Amsbaugh Mark
Published: November 2024

Re-irradiation with stereotactic radiosurgery (SRS) is an increasingly used treatment for recurrent high-grade glioma (HGG). We analyzed the patterns of failure and outcomes of salvage Gamma Knife SRS for recurrent HGG to better identify which patients would most benefit. We reviewed all patients who received SRS for recurrent HGG from January 2008 to May 2020. Pattern of failure was defined by the distance of recurrence from the SRS isodose line as follows: in-field local, marginal local, regional local, and distant failure. Overall survival (OS), progression-free survival (PFS), and local-failure free survival (LFS) were estimated using Kaplan-Meier methods, and regression model analysis was performed to analyze clinical predictors of failure. A total of 146 patients with HGG underwent SRS treatment to 410 target lesions. The median target volume was 3.3 cm3 and median total dose was 18 Gy. Sixty-one (41.8%) patients developed progression following SRS. PFS at 6 and 12 months were 65.8% and 37.3% respectively. Median OS was 12.4 months from salvage SRS. There were 113 (79.5%) local failures (53.1% in-field, 45.1% marginal, and 1.8% regional), 2 (1.4%) distant, and 27 (19%) concomitant local and distant failures. LFS at 6 and 12 months was 82.9% and 66.6%, respectively. Non-white race (HR = 0.37), SRS dose ≥ 20 Gy (HR = 0.34), age < 60 years (HR = 0.43), and KPS ≥ 70 (HR = 0.44) were associated with longer time to local failure. Non-white race (HR = 5.55) and SRS dose ≥ 20 Gy (HR = 5.62) were associated with more distant failure. No grade 4 or 5 toxicity was observed. In conclusion, the dominant pattern of failure remains local and in-field despite conformal dose distribution with SRS and infiltrative tumor histology. This supports the role of reirradiation with SRS in well selected patients with recurrent HGG.