bluuebunny/crossref_metadata_2025_split huggingface dataset:
QOLP-29. INFORMATION ON HEADACHE FOR BRAIN TUMOR PATIENTS ON INTERNET – GUIDING OR MISLEADING?
Authors: Kallio Merja 
Published: December 2020

Abstract
Patients often consult the internet if they suspect a brain tumor. Migraine and tension type headache have an active prevalence of round 50%. 96% of the general population has had some kind of headache during their lifetime. There are many possible exacerbating factors for precipitating or worsening headache. Consequently headache makes many people suspect a brain tumor. Nowadays when MRI and CT are widely available making earlier diagnosis of brain tumors possible, it has been discovered that in adults headache is rarely the most important or even existing symptom. Nelson and Taylor (1) find headache in 2% of brain tumor patients and Posti et al (2) found it in 20% of glioma patients as presenting symptom but never as a sole symptom. What is the information the patients get on the internet sites? In order to find out the author analyzed 36 webpages concerning headache and brain tumors by brain tumor and cancer societies, Neuro-oncology clinics, University clinics and general health information pages in 4 different languages (Finnish, English, Swedish and German). On 13 of these 36 pages headache was considered the presenting or main symptom. Particularly different cancer and brain tumor societies (8 of 9) explain that headache is the main symptom. On some pages it was concluded that brain tumor patients often have headache but headache patients seldom brain tumors. This is obviously true but does not help patients much. Consequently many of these information sites give patients somewhat vague or even misleading information. This will cause unnecessary anxiety, fear and visits to healthcare. We should strive to make patient information both more clear and more accurate. In order to accomplish this we need more information of the current situation.
RADT-04. RESECTION CAVITY FAILURE OF MELANOMA BRAIN METASTASES WHEN TREATED WITH SYSTEMIC THERAPY, WITH OR WITHOUT FOCAL RADIOTHERAPY
Authors: Susko Matthew S , Vasudevan Harish N , Ma Lijun , Nakamura Jean , Raleigh David , Boreta Lauren , Fogh Shannon , Theodosopoulos Philip , McDermott Michael , Tsai Katy , Sneed Penny , Braunstein Steve 
Published: December 2020

Abstract

OBJECTIVES
Brain metastases are a common sequelae of advanced melanoma, and can lead to significant morbidity and mortality. Systemic therapy, inclusive of BRAF/MEK inhibitors and immunotherapy, are increasingly being utilized for metastatic melanoma brain metastases. This study sought to evaluate the clinical outcomes of resected melanoma brain metastases treated with systemic therapy, with or without focal radiotherapy.

METHODS
Patients at a single institution who underwent resection of a melanoma brain metastasis were retrospectively identified and reviewed. Patients were required to have received immunotherapy or BRAF/MEK inhibitors in the 3-month perioperative time period. This cohort was then analyzed by receipt of focal radiotherapy, including SRS and brachytherapy, for resection cavity failure, distant CNS progression, and adverse radiation effect, using the Kaplan Meier method.

RESULTS
From 2011-2020, 43 resections for melanoma brain metastases were performed, of which 29 patients and 37 resection cavities met criteria for analysis. Median MRI follow up was 15 months (IQR: 6-38). Twenty-two (59%) lesions were treated with focal radiotherapy and systemic therapy, and 15 (41%) were treated with systemic therapy alone. 12-month freedom from local recurrence was 64.8% (95% CI: 42.1-99.8%) for systemic therapy alone, and 93.3% (95% CI: 81.5-100%) for focal radiotherapy with systemic therapy (p=0.01). 12-month CNS progression free survival was 35.7% (95% CI: 17.7-72.1%) for systemic therapy alone, and 31.8% (95% CI: 17.3-58.7%) for focal radiotherapy (p=0.51). UVA demonstrated focal radiotherapy (HR: 0.10; 95% CI: 0.01-0.85; p=0.04) was the only significant factor associated with reduction of risk for surgical cavity recurrence.

CONCLUSIONS
Use of focal radiotherapy with systemic therapy for resected melanoma brain metastases significantly reduced surgical cavity recurrence compared to systemic therapy alone. Focal radiotherapy did not delay initiation of systemic therapy and should be the preferred treatment option for optimal local control of the surgical cavity in melanoma brain metastases.
RADT-06. VOLUME KINETICS FOLLOWING TWO-SESSION GAMMA KNIFE RADIOSURGERY FOR LARGE BRAIN METASTASES (BM)
Authors: Damron Ethan , Esquenazi Yoshua , Tandon Nitin , Yu Tse-Kuan , Chafi Hatim , Martir Magda , Khwaja Shariq , Amsbaugh Mark , Blanco Angel 
Published: December 2020

Abstract

INTRODUCTION
Resection is a well-established treatment for BM ≥ 2 cm, albeit with potential for perioperative complications and delays in systemic treatment. Staged stereotactic radiosurgery (S-SRS) may improve outcomes versus traditional SRS, representing an alternative to surgery in responders. We reviewed institutional outcomes using 2-session S-SRS, focusing on lesion volume kinetics.

METHODS
25 patients with 27 lesions underwent S-SRS at our institution between 2014 and 2020. Tumor volumes (TV) were measured at both S-SRS sessions and on follow-up MRI studies.

RESULTS
Median age at S-SRS was 61 years (range (r:) 31–84). Nine patients (10 BM) were lost to follow-up. Two patients failed to receive their second S-SRS due to local progression. The median margin tumor doses at first and second S-SRS were 15 Gy (r: 12–18 Gy) and 15 Gy (r: 12–16 Gy). The median interval between stages was 32 days (r: 8–63), and median TV at the first and second stages were 9.3 cm3 (r: 1.5–34.7 cm3) and 3.3 cm3 (r: 0.76–26.1 cm3), respectively. The median absolute and relative decrement between S-SRS sessions was 3.7 cm3 (r: 2.8-16.5 cm3) and 49.5% (r: 17.1-87.1%), respectively. [1-2]-month, [3-5]-month, and [6-12]-month MRI scans were available for 17, 10, and 15 lesions. The median decrease in TV compared to baseline was 50.2%, 78.2%, 74.9%. Two of 17 lesions (12%) had initial control but subsequently experienced volumetric progression and required resection. There were no G3+ adverse events (AE). Crude tumor control was achieved in 14 of 17 individual lesions (82%).

CONCLUSION
Two-session S-SRS is an effective treatment modality for treating patients with large BM, which is feasible in over 80% of patients with sustained tumor control and early volumetric regression.
RADT-07. STEREOTACTIC RADIOSURGERY OF PATIENTS WITH BRAIN METASTASES AND POOR PROGNOSIS
Authors: Harat Maciej , Blok Maciej , Kowalewska Joanna , Miechowicz Iza 
Published: December 2020

Abstract

PURPOSE/OBJECTIVE(S)
Stereotactic radiosurgery (SRS) in patients with risk factors other than the number of intracranial metastases remains controversial. Here we define factors related to early death after SRS alone and compared SRS alone with WBRT in high-risk patients. The aim of our study was to verify if optimal brain treatment may extend survival in patients with poor prognosis and select optimal candidates.

MATERIALS AND METHODS
In this prospectively collected data, 180 patients with brain metastases and adverse prognostic factors not previously treated with WBRT were analyzed. SRS patients were divided into training (n=82) and validation (n=48) cohorts and compared to retrospective data of WBRT patients (n=50). Overall survival (OS) and probability of 3-month survival in relation to risk factors were defined by univariable and multivariable analyses.

RESULTS
In multivariable analysis, GPA (OR 0.44, 95%CI 0.21-0.95; p=0.001), extensive extracranial disease (OR 0.13, 95%CI 0.02-0.66; p=0.013), and serious neurological deficits (OR 0.13, 95%CI 0.04-0.45; p=0.001) were associated with early death. If one factor was favorable, 73% (training) and 92% (validation) of patients survived 3 months. Patients with coexisting GPA&lt; 2, serious neurological deficits, and extracranial extensive disease had the highest risk of death within 3 months (AUC 0.822 training; 0.932 validation). Median survival of the WBRT and SRS cohorts was 86 days (interquartile range (IQR): 38-172 days) and 201 days (IQR: 86-not reached), respectively (p&lt; 0.0001). OS in very high-risk patients (GPA&lt; 2) was significantly longer in the SRS vs. WBRT group (123 vs. 58 days; p=0.008).

CONCLUSIONS
Extracranial oligometastatic disease, intact neurological status, or GPA ≥2 should be present to justify SRS in patients with 1-10 brain metastases. SRS alone is a viable treatment option in comparison to WBRT and most importantly survival benefits may be expected even for high-risk patients (GPA&lt; 2).
RADT-12. DISEASE CHARACTERISTICS IN ACUTE SEIZURE FOLLOWING RADIOTHERAPY FOR BRAIN METASTASES
Authors: Levin-Epstein Rebecca , Tenn Stephen , Ruan Dan , Lahlaf Safiya , Chu Brian , Lee Seung , Steinberg Michael , Yang Isaac , Pouratian Nader , Kim Won , Hegde John , Kaprealian Tania 
Published: December 2020

Abstract

INTRODUCTION
Acute seizure following radiotherapy (RT) for brain metastases is an infrequent but significant adverse event that has not been well-described. Prophylactic antiepileptic drug (AED) or steroid therapy is not recommended for asymptomatic lesions. However, there is minimal data incorporating individualized factors into acute seizure risk-assessment with respect to RT.

METHODS
We retrospectively examined patients treated for brain metastases with any RT modality from 2013-2020 who experienced acute post-treatment seizure, which we defined as within 4 weeks post-RT.

RESULTS
Twenty patients experienced acute seizure at median 2 days post-treatment (range 0-27); 15 (75%) within 7 days and 7 (35%) on day 0 (radiosurgery date or during fractionated RT). Seizures occurred after radiosurgery (n=9, 45%), fractionated stereotactic RT (n=3, 15%), whole-brain RT (n=5, 25%), and post-operative RT (n=3, 15%). All RT encompassed at least one supratentorial lesion; 11 (55%) had &gt;1 lesion treated. Median lesion size was 23mm (range 7-51mm). Moderate-to-severe perilesional edema was present in 12 (60%) and hemorrhage in 8 (40%) cases. Seizures occurred despite AED therapy in 8 (40%) overall; 5/8 (63%) were hemorrhagic and 7/8 (88%) had moderate-to-severe edema. Nine (45%) patients receiving steroids developed seizures. Primary pathologies were: melanoma (5), non-small cell lung (5), renal cell carcinoma (4), breast (3), colon (1), Merkel cell (1), and thyroid (1). Patients with melanoma who developed acute seizure had mainly non-hemorrhagic (80%), small lesions (median 9mm), not receiving AED (0%) or steroid (20%) therapy.

CONCLUSIONS
In acute post-RT seizure, lesions were predominantly supratentorial, &gt;23mm, and had moderate-to-severe edema. Breakthrough seizures were common in edematous and/or hemorrhagic lesions. However, acute seizure also occurred with smaller, non-hemorrhagic melanoma lesions not receiving AED therapy. A larger series is needed to further evaluate these identified characteristics in acute seizure, and whether prophylactic therapy may be appropriate.
RADT-14. COMPARISON OF MACHINE LEARNING ALGORITHMS IN DISTINGUISHING RADIATION NECROSIS FROM PROGRESSION OF BRAIN METASTASES TREATED WITH STEREOTACTIC RADIOSURGERY (SRS)
Authors: Chen Xuguang , Parekh Vishwa , peng Luke , Chan Michael , Soike Michael , McTyre Emory , Jacobs Michael , Kleinberg Lawrence 
Published: December 2020

Abstract

PURPOSE
To test the effectiveness of machine learning algorithms in distinguishing radiation necrosis (RN) from tumor progression (TP) using MRI radiomic features.

METHODS
Brain metastases were treated with SRS to a median dose of 18Gy. Lesions that showed evidence of progression on follow-up MRI were sampled surgically, and diagnoses confirmed by histopathology. Cases from 2 institutions were combined and randomly assigned for training (70%) and testing (30%). T1 post-contrast (T1c) and T2 fluid attenuated inversion recovery (T2 FLAIR) MRI were used for radiomic feature extraction (50 features each). Three subsets of radiomic features were obtained and tested: Signature #1 included 10 previously published features that correlated with diagnosis on T test; signature #2 and #3 included 5 and 12 features obtained through recursive elimination using random forest (RF) and support vector machine (SVM), respectively. Supervised machine learning models were trained using RF, SVM (radial kernel) and regularized discriminant analysis (RDA) algorithms based on all three radiomics signatures. Receiver operator characteristics (ROC) were compared between signatures and algorithms.

RESULTS
A total of 135 individual lesions (37 RN and 98 TP) were included. Signature #3 demonstrated the highest area under the curve in the training set (average AUC=0.98, vs 0.95 and 0.92 for signature #1 and #2), as well as the testing set (average AUC=0.83, vs 0.74 and 0.79 for signature #1 and #2). RF and SVM demonstrated similar performance in both training (average AUC 0.99-1) and testing datasets (average AUC 0.79-0.80) among all three signatures. Both RF and SVM were superior to RDA in performance (average training AUC 0.83, testing AUC 0.77). The greatest sensitivity (83%) and specificity (100%) in the testing set were achieved using signature #3 and SVM.

CONCLUSION
RF and SVM are effective in distinguishing RN from TP in a multi-institution dataset using radiomic signatures.
RADT-21. NATIONAL PRACTICE PATTERNS AND OUTCOMES OF STEREOTACTIC BODY RADIOTHERAPY VS. CONVENTIONAL EXTERNAL BEAM RADIOTHERAPY FOR SPINAL METASTASES
Authors: Lak Asad , Lamba Nayan , Smith Timothy , Iorgulescu Bryan 
Published: December 2020

Abstract

INTRODUCTION
Up to 10% of cancer patients experience spinal cord compression from metastatic disease. Palliation and local control were traditionally pursued with conventional external beam radiotherapy (cEBRT), but advancements in image-guidance and intensity-modulation for stereotactic body radiotherapy (SBRT) have dramatically changed the management of these lesions. Herein we evaluate the national practice patterns and outcomes associated with cEBRT vs. SBRT.

METHODS
U.S. patients newly diagnosed with metastatic cancer necessitating RT to the spine were identified from the National Cancer Database (2004-2016), stratified by RT modality and cancer type, and evaluated using multivariable logistic regression and Cox proportional hazards.

RESULTS
34,759 U.S. patients required spinal RT within 3 months of initial stage 4 cancer presentation, primarily for lung adenocarcinoma (25%), lung small cell carcinoma (14%), and prostatic (12%) metastases. Patients overwhelming received cEBRT (30Gy/10; 50%), followed by hypo-fractionated SBRT (15-30Gy/2-6; 11%) and single-fraction SBRT (i.e. stereotactic radiosurgery, SRS; 15-24Gy/1; 0.9%); whereas 38% received another regimen (e.g. 30-37.5Gy/12-15 or 40Gy/20). From 2004→2016, the rates of single-fraction SRS (0.4→1.9%) and hypo-fractionated SBRT (13.1→23.6%) increased, whereas cEBRT (86.5→74.4%) decreased. SBRT was significantly more likely to be utilized at academic hospitals as compared to cEBRT (OR 0.57; 95% CI: 0.49-0.66; p&lt; 0.01). SBRT was more likely utilized for elderly or high comorbidity patients and varied across cancer types. Survival analysis indicated that across all cancer types, single-fraction SRS, was independently associated with improved overall survival compared to cEBRT (HR 1.51; 95%CI: 1.31-1.74; p&lt; 0.01) after adjusting for patient characteristics, care setting, tumor type and systemic treatment.

CONCLUSIONS
Through analysis of cancer registry data, we found that practice patterns of RT for spinal metastases have been evolving nationally, with an increase in the use of SBRT. Single-fraction SBRT was associated with improved adjusted OS. Notably, we found that utilization of SBRT lags in the community setting.
RADT-22. RE-IRRADIATION FOR RECURRENT GLIOBLASTOMAS (GBM)
Authors: Moro Mario 
Published: December 2020

Abstract

AIMS
In this report, we describe our experience in dealing with recurrent GBMs in terms of efficacy and toxicity of second RT course (re-RT) with 3DCTR or VMAT protocols. We carefully reviewed our patient’s outcomes and additionally performed a comprehensive and updated meta-analysis of recent recurrent re-RT GBMs literature to compare our results with the ongoing findings of the t studies.

METHODS
We retrospectively collected data between 2017 and 2020 at our Institution. Also, we used the random-effects model to pool outcomes across studies about re-RT GBMs from the recent literature (prospective studies from 2010 to 2020, ≥ 30 patients, re-RT with 3DCTR or IMRT-VMAT) to have a more homogenous cohort in terms of treatment modalities, thus reducing the selection bias.

RESULTS
Re-irradiation was performed at a median interval time of 13.5 (range 4 - 192 months) months from the first RT. The median re-RT dose was 18 Gy (range 12–36 Gy), and the median fraction size was 3,45 Gy (range 1,8–6 Gy). The total median equivalent dose (EQD2) was 84 Gy (range 65.7 – 110 Gy). Our cohort median PFS is 12.5 months (range 4 – 192 months), while the median OS was 26 months (range 6 – 213 months). Our results show that OS-6 and OS-12, from time of re-irradiation, to be 69.2% and 30.7% respectively and the PFS-6 and PFS-12 to be 76.9% and 23.0%, respectively. None of our patients experienced acute toxicity. In our literature research, we found 22 eligible studies, including 1065 patients. The results of the pooled outcomes were: OS-12 rate 35% (95% CI: 30–40%), PFS-12 rate 16% (95% CI 13–19%), and Grade 3 + AE rate &lt; 5% (95% CI 0–10%).

CONCLUSIONS
Our data confirm re-RT is safe and feasible treatment with a limited toxicity for salvage treatment in recurrent GBMs.
RADT-29. EFFECT OF RADIATION THERAPY ON OVERALL SURVIVAL FOLLOWING SUBTOTAL RESECTION OF ADULT PILOCYTIC ASTROCYTOMA
Authors: Khalafallah Adham , Jimenez Adrian , Brem Henry , Mukherjee Debraj 
Published: December 2020

Abstract

BACKGROUND
Pilocytic astrocytoma (PCA) is a low-grade glioma common in children but also rarely diagnosed in adults. The role of adjuvant radiation therapy (RT) in treating these tumors remains unclear.

OBJECTIVE
We investigated the effect of RT on overall survival, specifically among adult patients who had undergone subtotal PCA resection.

METHODS
Information on adult patients (age 18 years old) who had undergone subtotal PCA resection between 2004 and 2016 was collected from the National Cancer Database (NCDB). A multivariate Cox proportional hazards model was utilized to determine factors independently associated with overall survival.

RESULTS
A total of 451 patients were identified. The mean age of our patient cohort was 36.8 years old, and the majority of patients (83.4%) did not receive radiation treatment following subtotal PCA resection. Overall median survival was 93.8 months. Survival was longer (p &lt; 0.001) in the patients who did not receive post-surgical RT (median: 98.3 months) compared to patients who did (median: 54.8 months). Patients who had older age at diagnosis (hazard ratio [HR]=1.05, 95% confidence interval [CI]=1.03-1.07, p &lt; 0.01), were Black or African American (HR=2.76, CI=1.12-6.46, p=0.019), received radiation during their initial treatment (HR=4.53, CI=2.08-9.89, p &lt; 0.01), or had a Charlson/Deyo score of &gt; 1 (HR=3.68, CI=1.55, p=0.003) had a significantly higher risk of death following subtotal PCA resection.

CONCLUSION
Postoperative RT is independently associated with a significantly higher risk of death among adults who underwent subtotal PCA resection. Our findings provide a rationale for further investigation into the efficacy and safety of RT within this patient population.
RADT-34. PREDICTIVE FACTORS FOR OVERALL SURVIVAL IN SURGICAL CASES OF GLIOMATOSIS CEREBRI FROM THE NATIONAL CANCER DATABASE
Authors: Khalafallah Adham , Kopparapu Srujan , Mukherjee Debraj 
Published: December 2020

Abstract
Gliomatosis Cerebri (GC) is a rare, aggressive, diffusely infiltrating cerebral tumor. Prognostic indicators and management strategies are currently poorly characterized. The National Cancer Database was queried for patients with histologically confirmed GC between 2004 and 2016. Demographic, tumor, and treatment characteristics were collected, including the Charlson/Deyo score, a comorbidity index adapted from the Charleston Comorbidity Index. Allowable values for the Charlson/Deyo score are 0 (no recorded comorbidities), 1, 2, and 3+ (most severe). Factors associated with overall survival were identified via bivariate log-rank tests and multivariate stepwise Cox proportional hazards models. The query returned 108 GC patients. The median age was 60.0 years, males were predominantly affected (63%), and most patients were white (86%). While 12% of cases achieved near/gross total resection and 27% of cases achieved partial resection, most surgeries were for biopsy (61%). Treatments included radiation therapy in 64% and chemotherapy in 63% of patients. The median overall survival was 15.1 (95% confidence interval [CI]=11.1-24.8) months. On bivariate analysis, chemotherapy improved overall survival (p=0.01) while radiation therapy (p=0.07) and extent of resection (p=0.48) did not. On multivariate analysis, older patients (hazard ratio [HR]=1.07, CI=1.03-1.11, p&lt; 0.01) and Charlson/Deyo scores of ≥1 versus 0 (HR=3.47, CI=1.40-8.60, p&lt; 0.01) had significantly increased mortality risk following surgery. In particular, the Charlson/Deyo score is a novel prognostic factor for GC that may guide clinical and surgical decision-making for this rare, rapidly fatal tumor. Further prospective studies are warranted to clarify the effects of chemotherapy versus radiation as treatment modalities for GC.
RADT-37. THE IMPACT OF POSTOPERATIVE RADIATION THERAPY (PORT) AND EXTENT OF SURGERY ON CLINICAL OUTCOMES OF ATYPICAL MENINGIOMA (AM): A META-ANALYSIS
Authors: Haddad Philip , Akhtar Furqan , Gallagher Kevin 
Published: December 2020

Abstract

BACKGROUND
Although meningiomas are among the most prevalent types of brain tumors, AMs account for around 4% of all meningiomas. AMs tend to be more aggressive with relatively higher rates of recurrence and mortality. Gross total resection (GTR) has been the standard of care when possible. However, GTR itself is not always enough to prevent the recurrence of AMs. The role of PORT remains controversial in AM as the comparative studies to support its use have provided conflicting RESULTS: The purpose of this meta-analysis is to evaluate the impact of PORT on clinical outcomes according to the extent of resection in AMs.

METHODS
A review of the medical literature was conducted using online databases. Inclusion criteria consisted of AM diagnosis, English language, Simpson graded resections, and comparative studies reporting recurrence rates (RcR), Progression-Free Survival (PFS), and Overall Survival (OS) with hazard ratios (HR) or Kaplan-Meier curves. A meta-analysis was conducted using an inverse variance method with a random-effects model.

RESULTS
Twenty-two comparative studies with a total of 5,129 patients were included and analyzed. When GTR was attained, PORT was associated with improved RcR (HR =0.72, 95%CI:0.59-0.86) and PFS (HR=0.77, 95%CI:0.65-0.90), but not OS (HR=0.93, 95%CI:0.83-1.04). When subtotal resection (STR) was attained, PORT was associated with improved PFS (HR=0.35, 95%CI:0.26-0.48) as well as OS (HR=0.70, 95%CI:0.54-0.89). The extent of surgery also impacted AM outcomes as GTR demonstrated superior PFS (HR=0.45, 95%CI:0.31-0.65) and OS (HR=0.30, 95%CI:0.13-0.72).

CONCLUSIONS
This is the first meta-analysis to show that PORT is associated with PFS benefit in AMs with GTR and STR. Moreover, PORT significantly improved OS of AMs that underwent STR but had no impact on OS when GTR was achieved. In the absence of randomized clinical trials, this meta-analysis represents the most compelling data supporting the use of PORT in this patient population.