bluuebunny/crossref_metadata_2025_split huggingface dataset:
NCOG-30. ADJUVANT VERSUS SALVAGE MANAGEMENT FOR IDH-MUTANT LOW GRADE GLIOMA
Authors: Tom Martin , Park Deborah , Tewari Surabhi , Wei Wei , Chao Samuel , Yu Jennifer , Suh John , Ahluwalia Manmeet , Peereboom David , Stevens Glen , Fallah Jaleh , Prayson Richard , Barnett Gene , Angelov Lilyana , Mohammadi Alireza , Murphy Erin 
Published: December 2020

Abstract

PURPOSE
Timing of postoperative treatment in low-grade glioma (LGG) remains controversial. We sought to evaluate outcomes between adjuvant versus salvage management among patients with IDH-mutant molecularly-defined LGG.

METHODS
We analyzed a single-institutional database of adults diagnosed with LGG (grade II) with an IDH-mutation and either 1p19q-codeletion (oligodendroglioma) or 1p19q-intact (astrocytoma). Cox multivariable analysis (MVA) accounting for age, sex, and extent-of-resection, was used to compare adjuvant versus salvage approaches on overall survival (OS), progression free survival (PFS), next-intervention free survival (NIFS, defined as intervention subsequent to either adjuvant or salvage treatment), and malignant-transformation free survival (MTFS). Adjuvant treatment was defined as immediate postoperative treatment with radiotherapy (RT) and/or temozolomide (TMZ) prior to progression. Salvage management was defined as postoperative observation followed by surgery or RT and/or TMZ at progression.

RESULTS
Of 162 patients with oligodendroglioma, median follow-up was 8.5 years (range, 0.03-25.7). Adjuvant treatment was given to 97 (59.9%) patients, with 65 (40.1%) undergoing a salvage approach. On MVA, adjuvant treatment was not associated with OS, PFS, NIFS, or MTFS (p &gt; 0.05 each). Among 82 patients with astrocytoma, median follow-up was 6.1 years (range, 0.5–25.7), and adjuvant treatment was administered to 41 (50.0%) patients, while 41 (50.0%) received salvage management. On MVA, adjuvant treatment was associated with improved PFS (HR 0.42, 95% CI 0.24-0.73, p &lt; 0.001) and NIFS (HR 0.35, 95% CI 0.18–0.65, p &lt; 0.001), but was not associated with OS or MTFS (p &gt; 0.05 each).

CONCLUSIONS
Among grade II, IDH-mutant oligodendrogliomas, initial postoperative observation followed by salvage treatment at progression may be appropriate, as immediate adjuvant therapy was not associated improved outcomes. However, a more individualized postoperative management approach is required for grade II, IDH-mutant astrocytomas, as adjuvant treatment was associated with improved PFS and NIFS, but not OS. Further validation and prospective studies are required.
NCOG-31. DEVELOPMENT AND EVALUATION OF PROGNOSTIC MODELS TO PREDICT SURVIVAL OF PATIENTS WITH GLIOBLASTOMA MULTIFORME
Authors: Lin John , Mai Michelle , Paracha Saba 
Published: December 2020

Abstract
Glioblastoma multiforme (GBM), the most common form of glioma, is a malignant tumor with a high risk of mortality. By providing accurate survival estimates, prognostic models have been identified as promising tools in clinical decision support. In this study, we produced and validated two machine learning-based models to predict survival time for GBM patients. Publicly available clinical and genomic data from The Cancer Genome Atlas (TCGA) and Broad Institute GDAC Firehouse were obtained through cBioPortal. Random forest and multivariate regression models were created to predict survival. Predictive accuracy was assessed and compared through mean absolute error (MAE) and root mean square error (RMSE) calculations. 619 GBM patients were included in the dataset. There were 381 (62.9%) cases of recurrence/progression and 53 (8.7%) cases of disease-free survival. The MAE and RMSE values were 0.553 and 0.887 years respectively for the random forest regression model, and they were 1.756 and 2.451 years respectively for the multivariate regression model. Both models accurately predicted overall survival. Comparison of models through MAE, RMSE, and visual analysis produced higher accuracy values for random forest than multivariate linear regression. Further investigation on feature selection and model optimization may improve predictive power. These findings suggest that using machine learning in GBM prognostic modeling will improve clinical decision support. *Co-first authors.
NCOG-32. THE SAFETY AND EFFICACY OF DEXAMETHASONE IN THE MANAGEMENT OF GLIOMA PATIENTS
Authors: Medikonda Ravi , Patel Kisha , Saleh Laura , Srivastava Siddhartha , Jackson Christina , Mohan Aditya , Weingart Jon , Bettegowda Chetan , Gallia Gary , Brem Henry , Lim Michael 
Published: December 2020

Abstract
Dexamethasone is routinely administered to glioma patients for the management of cerebral edema. Dexamethasone is associated with significant side effects including hyperglycemia, increased risk of infection, and impaired anti-tumor immune response. Despite these risks, there are no standardized guidelines for the effective use of dexamethasone in managing glioma. In this single-institution retrospective cohort study, we evaluate the effect of dexamethasone in glioma patients undergoing surgical resection on post-operative complications and overall survival. 436 patients met the inclusion criteria for this study. 46% of patients received pre-operative dexamethasone, and 90% of patients received post-operative dexamethasone. Pre-operative dexamethasone usage did not significantly affect the immediate post-operative T2 flair volume (p=0.53), however it was associated with a higher incidence of post-operative wound infection (4.0% vs 0%, p=0.002) and post-operative hyperglycemia ((p=0.02). Administration of dexamethasone in the post-operative setting did not affect the incidence of post-operative wound infection (p = 0.38) or hyperglycemia (p=0.18). It also did not affect the 3-month T2 flair volume (p=0.87). On cox proportional hazards analysis, pre-operative dexamethasone was associated with a greater hazard of death (HR=1.48; p=0.01), and post-operative dexamethasone was associated with a lower hazard of death (HR=0.20; p=0.04) after adjusting for several possible confounders. Our findings demonstrate significant differences in the safety and efficacy of pre-operative and post-operative dexamethasone in glioma patients. Routine use of pre-operative dexamethasone appears to increase the risk of post-operative complications and negatively impact survival, whereas post-operative dexamethasone improves survival and was not associated with a higher risk of steroid-related post-operative complications. These findings reaffirm a role for dexamethasone in managing cerebral edema in glioma patients, but also highlight the potential for serious negative consequences with dexamethasone use. This study provides a rationale for re-evaluating the role of dexamethasone, particularly in the pre-operative period.
NCOG-34. AN ASSESSMENT OF OVERALL SURVIVAL AND PALLIATIVE CARE USE AMONG PATIENTS WITH GLIOSARCOMA DIAGNOSED OVER A TWELVE-YEAR SPAN
Authors: Boisclair Stephanie , Samuels Shenae , Raez Luis E , Wietecha Delia A , Cohen Alejandro Lopez , Khunger Arjun , King Kelly , Sareli Candice , Adames Jorges , Jacques Jessica , Salzberg Mathew , Hunis Brian , Vulfovich Michel , Hussein Atif M 
Published: December 2020

Abstract
Gliosarcoma (GS), a rare variant of glioblastoma, accounts for less than 5% of CNS tumors. Due to its low incidence and prevalence, very few comprehensive, large-scale studies are reported in the literature that describe prognostic elements and treatment outcomes. The objective of the study was to examine patient and treatment characteristics to identify significant predictors of survival. METHODS: Data on patients with GS, diagnosed between 2004-2016, was extracted from the National Cancer Database (NCDB). Univariate analysis and a multivariate Weibull regression model was used to determine prognostic factors of survival (months). Kaplan-Meier (KM) method with log-rank test was used to compare and estimate overall survival rates between various groups. RESULTS: There was a total of 2,656 GS patients identified in the NCDB between the years of 2004-2016 with median age of 62 years old. In multivariable Weibull regression model, increasing age (HR=1.04, p=0.000) and increasing comorbidities were independent predictors of increased hazard of death. Having 3 or more comorbidities had the strongest association with increased hazard of death (HR=1.44; P=0.001). The OS has minimally improved over the period of 2004-2016; median OS was highest among those diagnosed between 2012 and 2016 at 11.4 months followed by an OS of 10.6 months between 2004 and 2007, and 9.1 months between 2008 and 2011 (P=0.001). Although current clinical guidelines recommend chemotherapy and radiation within 30 days of surgery, there was no statistically significant difference in median OS between patients who had chemotherapy initiated within 30 days, between 30 and 60 days or later than 60 days (P=0.109). There is also no statistically significant difference in OS for time of radiation initiation categories (P=0.752). In a disease with such low OS and limited treatment options, palliative care use was found in only 45 (1.7%) patients.
NCOG-38. CLINICAL CHARACTERISTICS OF LOW GRADE GLIOMA PATIENTS WITH NON-CANONICAL IDH1 AND IDH2 MUTATIONS
Authors: Peters Katherine , Lipp Eric , Broadwater Gloria , Herndon James , Johnson Margaret , Randazzo Dina , Desjardins Annick , Friedman Henry , Ashley David , Affronti Mary 
Published: December 2020

Abstract

BACKGROUND
Low grade gliomas (LGGs) develop in young adults and represent 10-15% of all glial tumors. While LGG patients can have longer survival than higher grade tumors, progression, transformation, and ultimately mortality occurs. Mutations in Isocitrate dehydrogenase 1/2 (IDH1/IDH2) are prevalent in LGG and are responsible for gliomagenesis. The classic IDH1 mutation is located at 132 codon and represented as p.Arg132His, but there are non-canonical IDH1 and IDH2 mutations. We sought to compare clinical characteristics of LGG patients with classic IDH1 p.Arg132His mutation to LGG patients with non-canonical IDH1 and IDH2 mutations.

METHODS
We queried an IRB-approved registry retrospectively from 12/2004- 9/2019. We included IDH1/IDH2 mutant LGG (WHO grade II) and known IDH1 and IDH2 targeted mutation analysis using standard PCR followed by DNA sequencing to detect point mutations in IDH1/IDH2 genes. We obtained available clinical and histopathological data. We estimated progression-free survival (PFS), time to transformation (TT), and overall survival (OS) using Kaplan-Meier methods.

RESULTS
We identified 267 LGG patients with median follow-up of 9.1 yrs (95%CI 8.4-9.9 yrs). Classic IDH1 p.Arg132His mutation occurred in 223 (83.9%) patients. IDH2 mutations occurred in 14 (5.2%) patients. Non-canonical IDH1 mutations were in 30 (11.2%) patients and included the following mutations: p.Arg132Cys (13), p.Arg132Gly (10), p.Arg132Ser (4), p.Arg132Leu (1), p.Arg119Gln (1), and p.Arg172Met (1). Initial presentation, OS, and TT did not differ between IDH1/IDH2 groups. PFS differed significantly between groups with improved median PFS in IDH2 mutant LGG (5.4 yrs; 95%CI 3.5-25.2) versus classic IDH1 mutant LGG (4.1 yrs; 95%CI 3.7-4.9 yrs) and non-canonical IDH1 mutant LGG (2.6 yrs; 95%CI 2.1-4.8) (log-rank p=0.019). Notably, non-canonical mutations were more common in astrocytoma (22/30; 73.3%) than other LGG histologies (p=0.018).

CONCLUSIONS
In this cohort, LGG patients with non-canonical mutations have a shorter time to progression than patients with classic p.Arg132His mutation and IDH2 mutations.
NCOG-40. IMPLEMENTING RANO CRITERIA IN A RESOURCE-LIMITED SETTING AND ITS ASSOCIATION WITH OVERALL SURVIVAL OF GLIOMA PATIENTS: EXPERIENCE FROM A NATIONAL CANCER CENTER IN INDONESIA
Authors: Ghazali Malueka Rusdy , Sofyan Henry , Aninditha Tiara , Andriani Rini 
Published: December 2020

Abstract

INTRODUCTION
Gliomas are one of the most common central nervous system tumors in adults. The Response Assessment Criteria in Neuro-Oncology (RANO) was developed to standardize the radiographic parameters used to assess therapeutic outcomes in glioma patients. A previous study has shown an association between therapeutic response based on RANO criteria and overall survival in glioma patients. However, the feasibility of applying RANO criteria in settings with limited resources has never been reported. This study aims to assess the feasibility of applying RANO criteria in clinical settings in Indonesia. This study also wants to see the role of the RANO criteria as a prognostic factor for gliomas in Indonesia.

METHOD
Data of glioma patients were retrospectively collected from Dharmais Cancer Hospital in Jakarta, Indonesia. Dharmais Cancer Hospital is the highest referral hospital for brain tumors in the country. Clinical and demographic data were collected from the medical record.

RESULTS
From 138 identified glioma patients from 2017 to May 2020, only 34 patients can be assessed using RANO criteria. The majority of the patients do not have post-surgical MRI that can be used as a baseline. Among 34 included patients, 38.2% were categorized as responsive, 23.5% as stable disease and 38.2% were categorized as progressive. Kaplan-Meier analysis showed that the median overall survival in the progressive group is significantly shorter than the median survival of responsive/stable group (21.2 vs. 57.5 months respectively, p=0.001). Multivariate cox regression analysis was performed to see the association of RANO criteria and other confounding variables (sex, age, glioma grade, glioma location, and therapy) with overall survival. The result showed that RANO progression was significantly associated with decreased survival (HR 18.38, p=0.045).

CONCLUSION
This retrospective analysis demonstrates the feasibility of applying RANO criteria in Indonesia and its association with overall survival.
NCOG-41. FUNCTIONAL OUTCOME FOLLOWING NON-DOMINANT HEMISPHERIC GLIOMA SURGERY FROM THE ASPECT OF INDEPENDENCE LEVEL, COGNITIVE FUNCTION AND RETURN TO SOCIAL LIVES
Authors: Nakajima Riho , Kinoshita Masashi , Okita Hirokazu , Nakada Mitsutoshi 
Published: December 2020

Abstract

BACKGROUND
Functional outcome has been paid much attention in surgery for eloquent area or dominant hemisphere. Little is known about functional outcome following surgery for non-dominant hemispheric gliomas, although some resent reports revealed the importance of right cerebral hemisphere on glioma surgery. Here, we investigated functional outcome of right cerebral hemispheric gliomas from the aspect of independence level, cognitive function, and return to social lives.

METHODS
Totally 82 patients with right cerebral hemispheric gliomas who underwent surgery for resection in Kanazawa university hospital were studied. Patients were divided into two groups, WHO grade II/III and IV. Karnofsky Performance Status (KPS), Mini-mental state examination (MMSE), and whether or not to return to work at pre-operation and chronic phase were evaluated. To reveal responsible region for decline of each index, the voxel-based lesion symptom (VLSM) analyses were performed.

RESULTS
MMSE; no difference was found through postoperative course in grade II/III, whereas postoperative score of grade IV was declined significantly compared with pre-operation (25.1 and 21.9 point; p=0.048). KPS; preoperative independence level was maintained until chronic phase in grade II/III (94.7 and 89.5). While, in grade IV, postoperative KPS was declined significantly than that of pre-operation (82.0 and 70.0, p=0.007). Results of the VLSM analysis revealed that patients who resected temporo-parietal junction in grade IV showed significantly low KPS score. Return to social lives; Reintegration ratio of working population was 71% and 35% for grade II/III and IV, respectively. Of these, as for grade II/III gliomas, the cingulate cortex and medial orbito-frontal cortex relate to return to social lives.

CONCLUSIONS
Functional outcome following surgery depends on tumor grade and resected region in right cerebral hemispheric gliomas.
NCOG-44. NEUROLOGIC ASSESSMENT IN NEURO-ONCOLOGY (NANO) SCALE IN A PHASE II STUDY OF PEMBROLIZUMAB OR PEMBROLIZUMAB PLUS BEVACIZUMAB IN PATIENTS WITH RECURRENT GLIOBLASTOMA
Authors: Nayak Lakshmi , Molinaro Annette , Peters Katherine , Clarke Jennifer , Jordan Justin , de Groot John , Nghiemphu Phioanh , Kaley Thomas , Colman Howard , McCluskey Christine , Gaffey Sarah , Smith Timothy , Cote David , Severgnini Mariano , Yearley Jennifer , Zhao Qing , Blumenschein Wendy , Duda Gabriel , Muzikansky Alona , Jain Rakesh , Wen Patrick , Reardon David 
Published: December 2020

Abstract

PURPOSE
The neurologic assessment in neuro-oncology (NANO) scale was developed as a standardized metric to objectively measure neurologic function in brain tumor patients to complement radiographic assessment in defining overall outcome. A multicenter, phase 2 study of pembrolizumab with or without bevacizumab in patients with recurrent glioblastoma incorporated the NANO scale as an exploratory endpoint.

METHODS
Neurologic examination was evaluated at baseline and MRI assessments using the NANO scale until patients came off study. Statistical descriptive data analysis was performed using R (version 3.4.3). Correlation analysis utilized Fisher’s exact test.

RESULTS
NANO compliance rate was 94% in 80 patients accrued on the study. Of the 80 patients, 7 were missing NANO at baseline visit and were excluded from analysis for NANO response criteria. Fifteen patients did not have end of treatment NANO evaluation. Of 73 patients, 35 (48%) had a normal neurologic examination at baseline by NANO. Strength and language accounted for the majority of changes in neurologic function over the course of study treatment. Eighteen patients (25%) had neurologic progression by NANO, of whom 2 did not have concurrent radiographic progression. Three patients (pembrolizumab plus bevacizumab cohort) had a neurologic response associated with stable disease on MRI. NANO assessment prior to initiation of cycle 3 correlated with RANO response (p=0.011), change in KPS (p=0.002) and dexamethasone requirement (p=0.007) while those with NANO progression at this assessment had worse overall survival (291 vs 324 days), but this trend did not achieve statistical significance (p=0.2).

CONCLUSIONS
Evaluation of neurologic function by NANO scale was feasible in a multicenter prospective study in patients with GBM with a high compliance rate. The NANO scale objectively tracked stable neurologic function in most patients throughout the trial period and was associated with a trend for survival.
NCOG-54. SAFETY OF TRANSSPHENOIDAL SURGERY FOR NONFUNCTIONING PITUITARY ADENOMA IN ELDERLY PATIENTS
Authors: Pereira Matheus , Oh Taemin , Joshi Rushikesh , Haddad Alexander , Pereira Kaitlyn , Osorio Robert , Donohue Kevin , Peeran Zain , Sudhir Sweta , Jain Saket , Beniwal Angad , Gurrola José , El-Sayed Ivan , Blevins Lewis , Theodosopoulos Philip , Kunwar Sandeep , Aghi Manish 
Published: December 2020

Abstract

INTRODUCTION
Life expectancy has increased over the past century, shifting the demographic distribution towards older age groups. Elderly patients comprise up to 14% of patients with pituitary tumors, with most lesions being nonfunctioning adenomas (NFPAs). Here, we compare clinical and surgical outcomes and post-operative complications between non-elderly adult (age ≥ 18 years and ≤ 65 years) and elderly (age &gt; 65 years) NFPA patients.

METHODS
Retrospective review of 908 patients undergoing transsphenoidal surgery for NFPA at a single institution from 2007-2019.

RESULTS
Elderly patients represented 32.4% of patients. Both groups were similar in gender (57.3% vs 60.5% male;P=0.4), tumor size (2.56 vs 2.46 cm;P=0.2), and cavernous sinus invasion (35.8% vs 33.7%;P=0.6). Regarding post-operative outcomes, length of stay (1 vs 2 days; P=0.5), extent of resection (59.8% vs 64.8% GTR;P=0.2), CSF leak requiring surgical revision (4.3% vs 1.4%;P=0.06), 30-day readmission (8.1% vs 7.3%;P=0.7), infection (3.1% vs 2.0%;P=0.5), and new hypopituitarism (13.9% vs 12.0%;P=0.3) were similar between both groups. Elderly patients were less likely to have adjuvant radiation (8.7% vs 16.3%;P=0.009), future re-operation (3.8% vs 9.5%;P=0.003), and post-operative diabetes insipidus (DI) (3.7% vs 9.4%;P=0.002), and more likely to have post-operative hyponatremia (26.7% vs 16.4%;P&lt; 0.001) and new cranial nerve deficit (1.9% vs 0.0%;P=0.01). Elderly patients’ post-operative sodium peaked and troughed on POD3 (mean=138.7 mEq/L) and POD9 (mean=130.8 mEq/L), respectively, compared to non-elderly patients (peak POD2 mean=139.9 mEq/L, trough POD8 mean=131.3 mEq/L).

CONCLUSION
Our analysis revealed that elderly patients experienced more post-operative hyponatremia, while non-elderly patients experienced more post-operative DI. Elderly patients also experience later peak and trough in serum sodium, suggesting age-related differences in stalk-related morbidities of NFPA resection. Overall, our results show that transsphenoidal surgery for NFPA in elderly patients is safe with low complication rates. We hope our results will guide discussions with elderly patients regarding possible risks and outcomes.
NCOG-59. PROGRESSION-FREE SURVIVAL AS A PRIMARY OUTCOME MEASURE TO COMPARE CONSOLIDATIVE STRATEGIES IN RELAPSED/REFRACTORY PRIMARY CNS LYMPHOMA
Authors: Bonm Alipi , Gibson Alec , Holmberg Leona , Mielcarec Marco , McGranahan Tresa , Taylor Lynne , Graber Jerome 
Published: December 2020

Abstract
Relapsed or refractory primary CNS non-Hodgkin’s lymphoma (rrPCNSL) is a rare and challenging malignancy for which better evidence is needed to guide management. We present a retrospective cohort of 70 consecutive patients with rrPCNSL treated at the University of Washington between 2000-2020. HIV positive and secondary CNS lymphoma patients were excluded. During a median follow-up of 19.8 months, median overall survival (OS) was 18.30 months and median progression-free survival (PFS) was 12.67 months. At all stages of disease (diagnosis, first relapse, multiple relapses), PFS was an excellent predictor of OS. There was a small effect of age &lt; 70 on PFS after initial diagnosis (PFS1), but no effect on PFS after first (PFS2) or subsequent (PFS3+) relapses. There was no effect of age &lt; 60 on PFS1, PFS2, or PFS3+. Patients reinduced with high-dose methotrexate-based (HD-MTX) regimens had an overall response rate (ORR) of 86.7% and median PFS 17.2 months. For patients who responded to reinduction therapy, those consolidated with autologous stem cell transplant (ASCT) had median PFS of 30.3 months (n=11) compared with 12.1 months for other consolidation strategies (n=9), and 9.0 months for no consolidation (n=20). Although patients receiving ASCT were younger, KPS, sex, and the median number of recurrences were similar between consolidation groups. We conclude that PFS is a useful endpoint for rrPCNSL which predicts OS and is not associated with age. Using PFS as an endpoint, we did not detect a benefit to any consolidation strategy other than ASCT.