bluuebunny/crossref_metadata_2025_split huggingface dataset:
NCOG-52. TUMOR TREATING FIELDS IN MENINGIOMA
Authors: Mawrin Christian 
Published: December 2020

Abstract

BACKGROUND
High-grade meningioma are aggressive intracranial tumors and currently only limited treatment options exist. Therefore, there is a need for further studies in search of new therapies. Tumor Treating TTFields (TTFields) therapy serves as an effective treatment against glioblastoma (GBM). Phase 3 clinical trials investigate the use of TTFields in other intracranial tumors, i.e. brain metastases of the non-small cell lung cancer. We here provide an overview of the currently available data regarding the use of TTFields in meningioma.

MATERIALS AND METHODS
We performed a literature search using the term “Tumor treating fields” “NovoTTF”, “TTFields” and “Optune” in combination with “Meningioma”. A brief overview of TTFields in meningioma is provided here.

RESULTS
In vitro studies using patient-derived anaplastic grade III meningioma cell lines showed that TTFields treatment at a frequency of 200 kHz causes a significant reduction of cell proliferation and clonogenicity as well as altering cell morphology. In a case report of a 44-year-old woman suffering from a right anterior temporal tumor as well as a distant right parietal extra-axial convexity meningioma TTFields and Temozolomide treatment was initiated. Brain MRI scans 8, 16 and 20 weeks later showed a reduction in the meningioma tumor size of 42%, 58% & 60%, respectively. Currently, two ongoing trials test the efficacy and safety of the use of TTFields in meningioma patients: a phase II single arm trial (n=27), investigating the combination of TTFields and Bevacizumab in recurrent or progressive meningioma (NCT02847559); and a pilot trial, investigating the effects of TTFields as monotherapy on recurrent atypical and anaplastic meningioma (NCT01892397).

CONCLUSIONS
First data indicate that TTFields might be an option in future high-grade meningioma treatment. Clinical trials need to show safety and efficacy for the TTFields treatment in meningioma patients.
NCOG-61. A CASE OF LONG TERM SURVIVOR OF DISSEMINATED AND RELAPSED GERMINOMA. EIGHTEEN YEARS OF FOLLOW UP
Authors: Fujimaki Takamitsu , Matsuno Akira 
Published: December 2020

Abstract
Germinomas will respond to first-line treatment in general, but prognoses of disseminated and/or relapsed disease are sometimes poor and detailed course of those patients are not well documented. Here we report one of such cases. PATIENT: A 35-year-old man (at the time of abstract submission) initially had polyuria at the age of 15 and anorexia at 16. At the age of 17, MRI showed neurohypophyseal and disseminated tumor along lateral ventricular walls. He was diagnosed to have germinoma by partial resection of the tumor. ICE (Ifosfamide, Cisplatin, Etoposide) chemotherapy was given followed by 24 Gy whole ventricular irradiation. The tumor was well controlled for 22 months. However despite maintenance ICE chemotherapy, the tumor relapsed along the ventricular walls. With simultaneous BEP (Bleomycin, Etoposide, Cisplatin) chemotherapy and 40 Gy whole neuroaxis irradiation, all the tumor disappeared and he remains in complete remission now. He is receiving hormone replacement therapy. Eight years after the initial surgery, an MRI showed cavernous angioma in the cerebellum and the number has been increasing in follow-up scans. Asymptomatic minor bleeding occurred 14 and 15 years after the initial surgery. On MRA, no vasculopathy on major vessels has been identified. His wife gave birth to his first child through infertility treatment, when he was 34. He finished graduate school to obtain master degree and working as a company employee. CONCLUSION: Germinoma is a disease that can cause long-term survival even after recurrence. However, complications may occur and multimodality approaches are needed for the survivors.
NCOG-67. QUANTIFYING THE UTILITY OF A MULTIDISCIPLINARY NEURO-ONCOLOGY TUMOR BOARD
Authors: Khalafallah Adham , Jimenez Adrian , Romo Carlos , Kamson David , Kleinberg Lawrence , Weingart Jon , Brem Henry , Grossman Stuart , Mukherjee Debraj 
Published: December 2020

Abstract

BACKGROUND
There is limited research attempting to measure the efficacy of tumor boards (MDTBs) in the treatment of patients with tumors affecting the nervous system.

OBJECTIVE
The objective of the present study was to quantify the utility of a MDTB in providing alternative diagnostic interpretations and treatment plans for this patient population.

METHODS
A prospective study of patient cases discussed at four hospitals’ MDTBs between July and November 2019 was performed. Demographic data, diagnoses, treatment plans, and eligibility for clinical trials were recorded, among other variables.

RESULTS
A total of 176 patient cases met eligibility criteria. The majority of patients (53%) were male with a mean age of 52 years. The most frequent diagnosis was glioblastoma (32.4%). Among the evaluable cases, MDTBs led to 38 (21.6%) changes in image interpretation and 103 (58.2%) changes in patient management. Additionally, patients whose cases were discussed at MDTBs had significantly shorter referral times compared to patients whose cases were not discussed (p= 0.024).

CONCLUSION
MDTB discussions led to a significant number of diagnostic and treatment plan changes as well as shortened referral times, highlighting the potential clinical impact of multidisciplinary care for patients with nervous system tumors.
NCOG-69. SEX DIFFERENCES IN GLIOBLASTOMA PATIENT SURVIVAL AS A FUNCTION OF EXTENT OF SURGICAL RESECTION AND CYCLES OF ADJUVANT TEMOZOLOMIDE DURING STANDARD-OF-CARE REGIMENS
Authors: Lorence Julia , Bencomo Tomas , White Haylye , Rickertsen Cassandra , Massey Susan , Singleton Kyle , Hawkins-Daarud Andrea , Johnston Sandra , Porter Alyx , Mrugala Maciej , Bendok Bernard , Hu Leland , Rubin Joshua , Swanson Kristin 
Published: December 2020

Abstract

OBJECTIVE
Glioblastoma (GBM) is the most common malignant primary brain tumor in adults, with males more commonly affected than females(1.6:1). Despite advancements in treatments, prognosis is dismal with a median overall survival of 15 months. Our aim was to investigate sex as a variable in GBM patient survival after receiving incremental levels of standard-of-care treatment regimens – different extents of surgical resection and different numbers of cycles of adjuvant temozolomide chemotherapy.

METHODS
Drawing from our extensive multi-institutional brain tumor repository, we investigated GBM subjects with overall survival (OS), extent of resection (EOR), number of temozolomide (TMZ) cycles, and sex data (n=620, males: n=387, females: n=233). Cox proportional hazard ratios were computed to investigate the multivariable predictive value of the patient variables with OS. Patients were then divided into groups based on their sex, EOR (either biopsy, subtotal resection (STR) or gross total resection (GTR)), and TMZ cycles (I: &lt; 6 cycles, II: 7-11 cycles and III: &gt;12 cycles).

RESULTS
We observed that STR was beneficial for females (HR=0.52; CI=0.33-0.83; p-value=0.013), while for males the benefit was not detected (HR=0.73; CI=0.46-1.15; p-value=0.173) for STR but was detectable for GTR (HR=0.58, CI=0.37-0.90; p-value=0.014). Females receiving 7-11 cycles of TMZ showed a survival benefit (HR=0.52; CI=0.12-0.53; p-value=0.048) while males in the same group did not (HR=0.74; CI=0.46-1.19; p-value=0.21), in comparison to those in group I of TMZ cycles. No sex differences were identified in patients receiving &lt; =6 cycles or &gt;=12 cycles.

CONCLUSION
Together, our results contribute to the growing literature that sex differences exist in GBM patients, even in response to standard-of-care therapies. This should be accounted for when designing clinical trials for GBM so that we may advance our pursuit to deliver personalized medicine.
NIMG-09. PREDICTING OVERALL SURVIVAL OF GLIOBLASTOMA PATIENTS ON MULTI-INSTITUTIONAL HISTOPATHOLOGY STAINED SLIDES USING DEEP LEARNING AND POPULATION-BASED NORMALIZATION
Authors: Hao Jie , Agraz Jose , Grenko Caleb , Park Ji Won , Viaene Angela , Nasrallah Maclean , Kim Dokyoon , Bakas Spyridon 
Published: December 2020

Abstract

MOTIVATION
Glioblastoma is the most common and aggressive adult brain tumor. Clinical histopathologic evaluation is essential for tumor classification, which according to the World Health Organization is associated with prognostic information. Accurate prediction of patient overall survival (OS) from clinical routine baseline histopathology whole slide images (WSI) using advanced computational methods, while considering variations in the staining process, could contribute to clinical decision-making and patient management optimization.

METHODS
We utilize The Cancer Genome Atlas glioblastoma (TCGA-GBM) collection, comprising multi-institutional hematoxylin and eosin (H&E) stained frozen top-section WSI, genomic, and clinical data from 121 subjects. Data are randomly split into training (80%), validation (10%), and testing (10%) sets, while proportionally keeping the ratio of censored patients. We propose a novel deep learning algorithm to identify survival-discriminative histopathological patterns in a WSI, through feature maps, and quantitatively integrate them with gene expression and clinical data to predict patient OS. The concordance index (C-index) is used to quantify the predictive OS performance. Variations in slide staining are assessed through a novel population-based stain normalization approach, informed of glioblastoma distinct histologic sub-regions and their appearance from 509 H&E stained slides with corresponding anatomical annotations from the Ivy Glioblastoma Atlas Project (IvyGAP).

RESULTS
C-index was equal to 0.797, 0.713, and 0.703 for the training, validation, and testing data, respectively, prior to stain normalization. Following normalization, staining variations in H&E and ‘E’ gained significant improvements in IvyGAP (pWilcoxon&lt; 0.01) and TCGA-GBM (pWilcoxon&lt; 0.0001) data, respectively. These improvements contributed to further optimizing the C-index to 0.871, 0.777, and 0.780 for the training, validation, and testing data, respectively.

CONCLUSIONS
Appropriate normalization and integrative deep learning yield accurate OS prediction of glioblastoma patients through H&E slides, generalizable in multi-institutional data, potentially contributing to patient stratification in clinical trials. Our computationally-identified survival-discriminative histopathological patterns can contribute in further understanding glioblastoma.
NIMG-25. TRANSFERRIN RECEPTOR 1 TARGETED PET/CT AND NIFR PROBES FOR IMAGING GLIOBLASTOMA MOUSE MODELS
Authors: Ni Xiang-Rong , Zhao Yi-Ying , Cai Hai-Ping , Yu Zhi-Hui , Wang Jing , Chen Fu-Rong , Yu Yan-Jiao , Feng Guo-Kai , chen Zhong-ping 
Published: December 2020

Abstract

OBJECTIVE
A new imaging technology that indiscriminately detects intracranial glioblastoma (GBM) can help neurosurgeons remove tumor mass completely. Transferrin receptors (TfR 1) have been widely investigated as a diagnostic and therapeutic target in GBM. A TfR 1-targeted peptide, CRTIGPSVC (CRT) can accumulate at high levels in GBM tissues. In our study, taking the advantage of CRT, we synthesized two molecular imaging probes for imaging GBM precisely. One is a PET/CT probe 18F-NOTA-CRT, and the other is a near-infrared fluorescent (NIFR) probe Cy5-CRT.

METHODS
We initially confirmed the overexpression of TfR 1 in most of GBM and the tumor-specific homing ability of 18F-NOTA-CRT and Cy5-CRT in orthotopic U87 GBM (TfR 1 overexpression) mouse models. We then examined the feasibility of Cy5-CRT for specially identifying the GBM tissue margin in the intracranial U87 xenografts in vivo and ex vivo. Next, we compared Cy5-CRT with the clinically used fluorescein sodium in identifying tumor margins. Finally, we used Cy5-CRT to carry out a fluorescence-guided operation on a orthotopic U87 mouse model.

RESULTS
Both 18F-NOTA-CRT and Cy5-CRT probes specifically accumulated in U87 GBM xenografts with TfR 1 overexpression, but not in U373 GBM xenografts with very low TfR 1 expression. Cy5-CRT detected the intracranial tumor burden with exceptional contrast, enabling fluorescence-guided GBM resection under NIFR live imaging conditions. Importantly, Cy5-CRT recognized the GBM tissue margin more clearly than fluorescein sodium.

CONCLUSIONS
Our probes were capable of thoroughly detecting GBM tissue in vivo imaging. For translational applications, we may screen patients before surgery by PET/CT imaging with 18F-NOTA-CRT to identify gliomas with TfR 1 overexpression. As for fluorescence-guided surgery, the TfR 1-targeted optical probe Cy5-CRT specifically differentiates tumor tissues from normal brain with high sensitivity, indicating its potential application for the precise surgical removal of GBM. Keywords: Transferrin receptor 1; PET/CT; near-infrared fluorescence imaging; glioblastoma, fluorescence-guided surgery
NIMG-35. IMPROVING CETCS MICRONEEDLE VISIBILITY IN A MAGNETIC RESONANCE IMAGING ENVIRONMENT
Authors: Morales Brianna , Mehta Jason , Rylander Christopher 
Published: December 2020

Abstract

INTRODUCTION
Annually, there are less than 20,000 cases of glioblastoma reported in the United States. This malignant tumor type has a survival rate of 5.6% and patient survival is approximately 14 months. The current standard of treatment is tumor resection, an attempt to remove the tumor; followed by, chemotherapy and radiation treatment. A newer form of treatment is convection-enhanced delivery (CED). Dr. Chris Rylander’s lab developed a novel method of CED, known as the convection-enhanced thermo-therapy catheter system (CETCS). The implementation of CETCS will be in an MRI environment, which calls for a need to improve the contrast of the needles against the native brain tissue. Increased contrast of the needles could improve remote control of the needles, and delivery of the drug.

METHODS
We evaluated several groups: (1) Control (water and air), (2) Nanomaterials in Polyimide Resin (Iron oxide nanoparticles and gadolinium oxide nanoparticles, some were contained in a polyetheretherketone tubing), and (3) Stainless Steel Wire (SS 316L). We cast needle groups into a 0.6% (w/w) Agarose phantom. Then, images were acquired with a 3T Siemens MRI and a 20-channel head coil in a series of 30 slices through the axial face of the phantom to the proximal face of the cube. Width analysis was conducted using Syngo FastView to determine the size of the artifacts in the MR images.

RESULTS
All modifications had a higher contrast than the controls, and the two largest artifacts measured were the SS 316L (4.9 ± 0.3 mm) and the iron oxide nanoparticles in the polyimide resin (3.5 ± 0.1 mm). An additional observation was the non-uniform shape of the two groups with the large artifacts.

DISCUSSION
Future iterations of these modifications need to be adjusted based on the desired artifact size, currently set to be at least 2 mm in diameter.
NIMG-56. THE RARE CASE OF PRIMARY DURAL BASED MARGINAL ZONE B-CELL LYMPHOMA CAMOUFLAGING AS MILD FOCAL DURA THICKNESS AND PACYMENINGEAL ENHANCEMENT
Authors: Hrachova Maya , Perez-Rosendahl Mari , Kong Xiao-Tang 
Published: December 2020

Abstract

INTRODUCTION
Primary Dural Based Marginal Zone B-Cell Lymphoma (MZBCL) is a subtype of PCNSL with an incidence rate ranging from 0.6 to 3% of all brain tumors. MZBCL typically presents as an extra-axial mass resembling meningioma. Here we report an unusual case of MZBCL with initial radiographic findings of mild nonspecific thickening tentorium and pachymeningeal enhancement surrounding 7th and 8th cranial nerves.

CASE REPORT
A 58-year old woman with clinical history of CMV infection, polyclonal gammopathy and unruptured left ICA aneurysm post coil embolization who presented for an evaluation of mild thickening and enhancement of the left tentorium cerebelli and 7th/8th nerve root complex. Differential considerations included inflammatory/autoimmune conditions (idiopathic hypertrophic pachymeningitis, neurosarcoidosis, Tolosa-Hunt syndrome), infections, structural lesion, benign or malignant neoplasm. Serum studies were normal. Multiple CSF studies were negative. Flow cytometry showed no malignant cells with few small lymphocytes. She was followed with the imaging surveillance for nine months until further increased thickening of dura on MRI. She underwent cerebellar dural biopsy that was consistent with MZBCL composed mainly of small CD20+ B-cells and negative MYD88. PET scan showed no systemic involvement. Bone biopsy revealed no evidence of lymphoma. The focal leptomeningeal enhancement improved significantly after she received four doses of systemic rituximab treatments.

DISCUSSION
Our case highlights the importance of surveillance and brain biopsy in cases of mild focal dura/pachymeningeal thickness and enhancement if no conclusive diagnosis has been established, as it might be one of the rare tumors such as MZBLC.
NIMG-64. DISTINCT IMAGING PATTERNS OF PSEUDOPROGRESSION IN GLIOMA PATIENTS FOLLOWING PROTON VERSUS PHOTON RADIATION THERAPY
Authors: Graber Jerome , Ritterbusch Reed , Halasz Lia 
Published: December 2020

Abstract

PURPOSE
Radiologic Assessment in Neuro-Oncology (RANO) criteria define pseudoprogression (Ps) after photon radiation for gliomas, as occurring less than twelve weeks from radiation, within the high dose radiation field. However, some patients receiving proton manifest lesions that appear subjectively different from photon Ps based on timing and location (more than six months from radiation and deeper to the prior tumor), which would be called tumor progression by RANO. We retrospectively reviewed MRI changes after proton or photon radiation for gliomas. We propose criteria to characterize proton pseudoprogression (ProPs) distinct from photon pseudoprogression or tumor progression.

METHODS
Post-treatment MRIs of patients with gliomas were reviewed, along with clinical and pathological data. 77 proton patients were reviewed for the presence of ProPs, and 64 photon patients were reviewed for imaging changes. Data collected included the location, timing, and morphology of the lesions, tumor type, chemotherapy, and clinical symptoms.

RESULTS
16 (21%) of the patients who received protons had imaging changes unique to protons, at a mean of 14.6 months after radiation. We established the following criteria to characterize ProPs: not immediately in or adjacent to the resection cavity; ~ 2cm opposite from target beam entry; can resolve without treatment; subjectively multifocal, patchy, small (&lt; 1cm). None of the photon patients had lesions that met our criteria for ProPs (p&lt; 0.001).

CONCLUSION
Patients who receive protons can have a unique subtype of pseudoprogression (Ps), which we refer to as proton pseudoprogression (or ProPs). These lesions could be mistaken for tumor progression, but typically resolve spontaneously. ProPs can possibly be explained by the increased relative biological effectiveness of protons and beam angle selection which may deposit at ~2cm deep to the target. Recognizing these lesions can prevent unnecessary treatment for mistaken tumor progression, especially in the context of clinical trials that include proton.
NIMG-66. AI-BASED PROGNOSTIC IMAGING BIOMARKERS FOR PRECISION NEUROONCOLOGY AND THE RESPOND CONSORTIUM
Authors: Davatzikos Christos , Badve Chaitra , Kazerooni Anahita Fathi , Bashyam Vishnu , Bakas Spyridon , Colen Rivka , Mahajan Abhishek , Balaña Carmen , Capellades Jaume , Puig Josep , Jain Rajan , Sloan Andrew E , Marcus Daniel S , Choi Yoon Seong , Lee Seung-Koo , Chang Jong Hee , Poisson Laila M , Griffith Brent , Dicker Adam P , Flanders Adam E , Booth Thomas C , Rathore Saima , Akbari Hamed , Sako Chiharu , Bilello Michel , Shukla Gaurav , Brem Steven , Lustig Robert , Mohan Suyash , Nasrallah MacLean , O’Rourke Donald M , Bagley Stephen , Barnholtz-Sloan Jill S 
Published: December 2020

Abstract
AI-based methods have shown great promise in a variety of biomedical research fields, including neurooncologic imaging. For example, machine learning methods have offered informative predictions of overall survival (OS) and progression-free survival (PFS), differentiation between pseudoprogression (PsP) and progressive disease (PD), and estimation of mutational status from imaging data. Despite their promise, AI, and especially the emerging deep learning (DL) methods, are challenged by several factors, including imaging heterogeneity across scanners and lack of sufficiently large and diverse training datasets, which limits their reproducibility and general acceptance. These challenges prompted the development of the ReSPOND (Radiomics Signatures for PrecisiON Diagnostics) consortium on glioblastoma, a growing effort to bring together a community of researchers sharing imaging, demographic, clinical and (currently) limited molecular data in order to address the following aims: 1) pool and harmonize data across diverse hospitals and patient populations worldwide; 2) derive robust and generalizable AI models for prediction of (initially) OS, PFS, PsP vs. PD, and recurrence; 3) test these predictive models across multiple sites. In its first phase, ReSPOND aims to pool together approximately 3,000MRI scans (from 10institutions plus TCIA), along with demographics, KPS, and (for a subset) MGMT/IDH1 status. We present initial results testing the generalization of a previously trained model of OS on 505Penn datasets to 2independent cohorts from Case Western Reserve University and University Hospitals (N=44), and Penn (N=67). The results indicate good generalization, with correlation coefficients between OS/predicted-OS between 0.25 to 0.5, depending on variable availability, which is comparable to cross-validated accuracy previously obtained from the training set itself (N=505). Additional preliminary studies evaluating prediction of future recurrence from baseline pre-operative scans in de novo patients (Penn model applied to CWR) indicated potential for guiding targeted dose escalation and supra-total resection (excellent predictions in 6/12 patients, modest in 1/12, and poor in 5/12).
PATH-38. METASTATIC MENINGIOMA CAUSING CHRONIC RESPIRATORY FAILURE
Authors: Wallace Dhiren , Wallace Gerald , Fenwick Nichols , Vender John , Sood Ambika , Mattox Samantha , Sharma Suash 
Published: December 2020

Abstract
Meningiomas are the most common primary intracranial tumor accounting for almost 37% of all CNS tumors. Malignant meningiomas are uncommon, accounting for 0.5% of all meningiomas. Malignant meningioma that is metastatic outside the cranium/skull is even rarer, with only a few case reports. Metastases to the lung and abdomen have been reported and thought to travel via venous drainage. WHO Grading suggest that Grade III meningiomas have the greatest potential to metastasize extra-cranially. We present the case for the 47-year-old Senegalese American man with biopsy proven Grade II meningioma metastatic to his lungs with resultant hypercapnic respiratory failure.