bluuebunny/crossref_metadata_2025_split huggingface dataset:
NCOG-18. IS THE RANO CRITERIA FOR LOW-GRADE GLIOMA RELIABLE IN THE CLINICAL SETTING? – A RELIABILITY STUDY
Authors: Horta Erika , Zhou Yueren , Poisson Laila M , Griffith Brent , Stone Michael , Snyder James , Walbert Tobias 
Published: December 2020

Abstract

INTRODUCTION
Magnetic resonance imaging (MRI) is a fundamental component of longitudinal neuro-oncology evaluation and decision-making. The Response Assessment in Neuro-Oncology criteria for low-grade gliomas (RANOLGG) was designed as an outcome measure for clinical trials. Thus, this project intends to study the reliability of RANOLGG in the clinic setting.

METHODS
21 pairs of brain MRIs, that averaged three years apart, were selected from 21 patients with tissue diagnosis of WHO grade 2 gliomas. Two neuro-oncologists and two neuro-radiologists reviewed and independently scored the MRI pairs according to RANOLGG categories of progressive disease, stable disease, minor response, partial response, and complete response. Kappa-Fleiss (KF) was used to evaluate agreement among reviewers.

RESULTS
Reviewers awarded identical scores in only 33% of MRI pairs and there was a complete disagreement in one MRI pair. Overall reliability of the criteria in the clinical setting is moderate (KF = 0.44). Agreement between neuroradiologists (KF = 0.51) and between neuro-oncologists (KF = 0.48) were similar. Interpretation of post-contrast T1-weighted images had a better agreement (KF = 0.31) than T2/FLAIR-weighted images which had a poor agreement (KF = -0.02). Classification of progression versus non-progression had only a moderate agreement (KF= 0.49). History of radiation therapy or chemotherapy did not influence the criteria reliability (fisher exact text, p = 0.58, p =0.27, respectively).

CONCLUSION
RANOLGG reliability in the clinical setting is moderate, therefore it should be used cautiously for clinical decision-making. Other tools that can support the neuro-oncologist in the follow-up of patients with low-grade glioma are additional MRI sequences other than T2/FLAIR and contrast – weighted images, computer-aided diagnosis such as volumetrics, spectroscopy, positron emission tomography, and multidisciplinary tumor boards. Likewise, when image criteria for low-grade gliomas are designed, T2/FLAIR should be used guardedly, due to low interpretation agreement.
NCOG-19. BEVACIZUMAB IN REAL LIFE PATIENTS WITH RECURRENT GLIOBLASTOMA: BENEFIT OR FUTILITY?
Authors: Smolenschi Cristina , Colomba Emeline , Rassy Elie , Lezghed Naima , Kettab Mohamed , Louvel Guillaume , Garcia Gabriel , Cheaib Bianca , Bockel Sophie , Pallud Johan , Dezamis Edouard , Copaciu Razvan , Knafo Steven , Ammari Samy , Dhermain Frederic , Domont Julien , Martanovschi Larisa , Mahmoud Fekih , Dumont Sarah 
Published: December 2020

Abstract
Angiogenesis represents a hallmark of glioblastoma but most trials disappointed and failed to change the poor outcome of this disease. However, Bevacizumab (Bev) is widely used in clinical practice by expert oncologists due to experience or efficacy in real life.We retrospectively reviewed the use of Bev and its benefit in terms of Time to treatment failure (TTF), Overall Survival(OS), Objective Response Rate (ORR) and clinical benefit. METHODS: We analyzed two hundred and two patients treated at Gustave Roussy Cancer Campus with Bev until definitive failure for recurrent glioblastoma between 2006 and 2016. Patients were treated with Bev alone or in association with radiotherapy, temozolomide, lomustine or irinotecan. RESULTS: The median duration of Bev treatment until definitive failure was 6 months. The median TTF was 7.27 months(95%CI 6.30-8.24) and the median OS from diagnosis was 22.43 months(95%CI 19.68-25.18). Two patients were still alive without active treatment at the end of study. A hundred and fourteen (56%) patients experienced symptom amelioration and seventy-five (37%) improved their Performance Status. Fifty percent of patients exhibited Partial and Complete Response on MRI, as best radiological response, within 1.6 months. No patient had anaphylactic reaction. Grade 1-2 hypertension(HT)(17%) and grade 1(10%) proteinuria were most common. Six patients presented lethal toxicity: 4 with GI perforation, 1 p with cerebral hemorrhage and 1 p with arterial bleeding. HT was correlated with treatment response in 67% of patients. A neutrophil count superior to 6000/mm³ was associated with longer TTF(mTTF 8.23m(95%CI 6.64-9.82). CONCLUSION: This retrospective study reports a substantial clinical benefit of Bev in patients with recurrent glioblastoma with an acceptable toxicity profile. As the panel of therapeutic option is still very limited in these tumors, this work supports the maintained use of Bev as a therapeutic option.
NCOG-20. AWAKE SURGERY FOR RIGHT FRONTAL LOBE GLIOMA CAN IMPROVE THE RESECTION RATE AND PRESERVE HIGHER COGNITIVE FUNCTIONS
Authors: Nakada Mitsutoshi , Nakajima Riho , Kinoshita Masashi 
Published: December 2020

Abstract

OBJECTIVE
Awake surgery is the standard treatment to preserve motor and language functions. The aim of this study is to evaluate the awake surgery for the patients with right frontal lobe (RFL) glioma on resection rate and preservation of higher cognitive functions.

METHODS
Out of the 139 cases that underwent awake surgery at our hospital between 2013 and 2019, 34 cases (mean age: 47.8 years) of RFL glioma were included in this study. The WHO classification was grade II, III, and IV for 15, 13, and 6 cases, respectively. We evaluated visual spatial cognition (VSC), spatial working memory (SWM), and social cognition (SC) before and after the surgery. These relevant areas were mapped intraoperatively. We did not map these areas in the cases in which the task could not be accomplished. Therefore, each function was divided into an intraoperative evaluation group (EG) and a non-evaluation group (NEG), and the resection rate and functional outcomes were compared.

RESULTS
The removal rate was significantly higher in the EG group for VSC and SC than that in the NEG (p= 0.0078 and 0.0024, respectively). The chronic disability rate of VSC was significantly lower in the EG than that in the NEG (5.6% vs. 31.3%, p= 0.043). None of the patients had postoperative disability of SWM in the EG which is significantly lower than that in the NEG (16.7%, p= 0.049). SC tended to have a lower disability rate (20.0%) in the EG compared to that in the NEG (45.8%). The probability that the posterior deep part of the middle frontal gyrus, which is the relevant area of VSC, was resected higher in the NEG (p= 0.0052).

CONCLUSIONS
We scientifically verified that the awake surgery for RFL glioma contributes to the improvement of resection rate and the preservation of higher cognitive functions.
NCOG-39. PROGRESSION-FREE AND SURVIVAL RATE OF CHEMOTHERAPY IN PEDIATRICS WITH OPTIC PATHWAY GLIOMAS: A SYSTEMATIC REVIEW
Authors: Pangaribuan Vega , Kurniawan Jemmy , Widyandana Doni 
Published: December 2020

Abstract

BACKGROUND
Optic pathway gliomas (OPG) are typically astrocytic neoplasms that represent 3-5% of all pediatric brain tumors. The prognosis of these tumors has often been poor. Total surgical resection of OPG is not amenable, thus the role of surgery remains limited. Chemotherapy can be considered as the main modality of treatment; it is also able to postpone the use of radiotherapy which may harm the brain growth in children.

METHODS
We conducted the PRISMA-guided systematic literature search from 6 electronic databases to identify studies reporting outcomes of chemotherapy in OPG patients. The inclusion criteria are literature reporting the survival outcomes of chemotherapy in OPG patients with minimum subjects of 10 patients and aged below 22 years old.

RESULTS
A total of 48 out of 557 studies were assessed for its full paper eligibility. Thus, we found 10 studies comprising of 451 patients that met the inclusion criteria for analysis. From 8 different regimens of chemotherapy that were reported, the most commonly used regimens are Carboplastin ± Vincristine. The 3-year, 5-year, and 10-year progression-free survival (PFS) rates were ranged from 23-70%, 34-73%, and 47.1% respectively. The 3-year, 5-year, and 10-year overall survival (OS) rate has a range of 91-95%, 70.1-97%, and 61.3%-62.3% respectively. In detail, we found that 1 study with Cisplatin with Etoposide regimens reported 0% of the 5-year PFS rate, therefore it was excluded from the analysis. There are 2 studies that reported a high rate of 5-year radiotherapy free survival with chemotherapy, ranging from 61-82%.

CONCLUSION
This systematic review showed that chemotherapy in patients with OPG leads to an unsatisfactory 5-year PFS rate (34-73%), however it is able to provide a high 5-year OS (91-95%). In the absence of good quality control for these studies, future prospective clinical trials with adjusted confounding factors are urgently needed.
NCOG-56. THE NATURAL COURSE OF ATYPICAL MENINGIOMA AFTER GROSS TOTAL RESECTION WITHOUT ADJUVANT TREATMENT
Authors: Jun Yoo Hee , Kim Jeong Hoon 
Published: December 2020

Abstract
Atypical meningioma represent more aggressive clinical behaviors than WHO grade I meningiomas. In this study, We research natural course of atypical meningioma after gross total resection without adjuvant treatment. MATERIAL AND METHODS: We retrospectively reviewed the records of patients with histopathologically diagnosed atypical meningiomas between June 1990 and December 2015 at Asan Medical Center, Korea. Patients treated with Simpson grade I, II resection were included. Patients variably underwent adjuvant radiation therapy according to each surgeon’s preferences. RESULTS: In this study, 117 patients were enrolled and the average follow-up was 43 months (range 3~228 months). In Simpson grade I tumor resection group, recurrence was confirmed in 10 out of 63 patients without adjuvant treatment, and 1 out of 13 patients with adjuvant radiation treatment. There were 12 recurrence cases in Simpson grade II tumor resection and no adjuvant treatment group, of the total 32 cases. There was 4 recurrence case of total 8 cases of Simpson grade II tumor resection with adjuvant radiation treatment group. In groups with no adjuvant treatment, Simpson grade I resection group had a better prognosis on 5-year PFS (82.9% vs 54.9%, p=0.005) compared to Simpson grade II resection group. DISCUSSION: The results of this study show that there is a significant difference in 5-year PFS between the Simpson grade I and II groups without adjuvant treatment, commonly referred to as the gross total resection group. Although this study report adjuvant RT is not superior to observation, more intensive post-operative imaging surveillance protocols would be considered in Simpson grade II resection group without adjuvant treatment. CONCLUSION: The natural course of atypical meningioma after gross total resection without adjuvant treatment signified Simpson grade I and II resection show significant different prognosis.
NCOG-57. NEUROPSYCHOLOGICAL FUNCTION IN MENINGEAL MELANOCYTOMA: A CASE REPORT
Authors: Baughman Brandon , Pebley Kinsey , Pandey Manjari , Ballo Matthew , Michael Madison 
Published: December 2020

Abstract
Meningeal melanocytomas are rare tumors derived from leptomeningeal melanocytes. The aggressive subtype is considered a rare variant of malignant melanoma, carrying a poor prognosis. To date, the extant literature is void of any studies that have systematically assessed cognition or neuropsychological function in these patients. We present a case report of a 61-year-old male, right-hand dominant, Caucasian male with 16 years of formal education. He has an unremarkable medical history, and his presenting symptom were syncopal episodes. An extensive work-up revealed a complex pineal region mass. Serum markers (CEA, AFP, and beta HcG) were negative. The patient continued to deteriorate neurologically and underwent a gross total resection of the mass. At the time of resection, there was evidence of definitive leptomeningeal dissemination. Because of the leptomeningeal spread, he underwent whole brain radiation therapy with a boost to the cerebellum and surgical site. He subsequently required implantation of a ventriculoperitoneal shunt for treatment of communicating hydrocephalus. Prior to WBRT, the patient underwent comprehensive neuropsychological testing. According to the patient and his spouse, they estimated functioning at approximately 50% of normal cognition, with precipitous decline noted prior to resection of the lesion. At the time of the exam, he was dependent in essentially all instrumental activities of daily living. The examination identified a pattern consistent with diffuse subcortical involvement, characterized by impairments in cognitive processing speed, attention, working memory and executive function. Conversely, the patient demonstrated no amnesia or higher cortical dysfunction. Moreover, mood, anxiety, or other psychopathology failed to account for his cognitive impairment. In our review, this is the first case in the literature of a patient with meningeal melanocytoma (with leptomeningeal spread) who has been comprehensively assessed neuropsychologically. Conceptualizations, treatment, and prognosis will be discussed.
NCOG-58. IMPACT OF TIME FROM PRESENTATION TO TREATMENT INITIATION ON CLINICAL OUTCOMES IN CENTRAL NERVOUS SYSTEM LYMPHOMA
Authors: Barbaro Marissa , Pan Peter , Torres Sara , Thakur Kiran , Welch Mary 
Published: December 2020

Abstract

OBJECTIVE
To examine impact of time from presentation to treatment initiation (TPT) on clinical outcomes in a cohort of patients with central nervous system lymphoma (CNSL).

INTRODUCTION
Earlier work in our population found that multifocal disease, cerebrospinal fluid (CSF) sampling, and use of immunomodulatory therapies were associated with longer TPT in CNSL, but impact on clinical outcomes was not assessed.

METHODS
We retrospectively reviewed records of patients who were diagnosed with CNSL from 2010-2018 and treated at Columbia University Irving Medical Center (CUIMC). Regression models were applied to examine the impact of age, gender, response to methotrexate (MTX), use of radiation, and TPT &gt;/= 30 days on survival 1 year from diagnosis (one-year survival), overall survival (OS), and functional independence (FI, defined as Karnofsky Performance Status (KPS) &gt; 70).

RESULTS
There were sixty-nine patients (51% men; median age at diagnosis 70 years, range 21-90). Median TPT was 24 days (range 7-372). TPT was &lt; 30 days in 59 (85%) and &gt;/= 30 days in 10 (15%). One-year survival was 77%, and FI rate was 78%. Negative prognostic factors for OS were age &gt; 65 years (HR 5.34, CI 1.20-24.30, p=0.03) and absence of complete response to MTX (HR 2.40, CI 0.87-6.69, p=0.09). Only complete response to MTX predicted both FI (OR 4.71, CI 1.17-19.02, p=0.03) and one-year survival (OR 6.77, CI 1.98-23.13, p=0.002). Notably, OS was numerically improved among patients with TPT &gt;/= 30 days vs. &lt; 30 days (HR 0.31, p=0.27), though this did not meet statistical significance.

CONCLUSIONS
Longer TPT has been associated with worse outcomes in systemic lymphoma, but such a correlation has not always been observed in brain cancers such as glioblastoma. We found no negative impact of longer TPT on survival or FI.
NCOG-60. MALIGNANT MELANOMA IN NEUROCUTANEOUS MELANOCYTOSIS: A RETROSPECTIVE CASE SERIES (2000-2020)
Authors: Elmore Kevin , Sener Ugur , Ennin Elsie , Suser Stephanie , Marghoob Ashfaq , Haque Sofia , Khakoo Yasmin 
Published: December 2020

Abstract
Neurocutaneous melanocytosis (NCM) is a rare neurocutaneous syndrome which typically develops in children with large congenital melanocytic nevi (LCMN) and excessive melanocyte proliferation in the leptomeninges and brain parenchyma. Malignant melanoma develops in an estimated 2.3% of patients with LCMN and 40-60% of patients with NCM. NCM-associated melanomas frequently harbor NRAS mutations with no well-established role for targeted therapy. In a retrospective, single-institution study, we reviewed eleven patients with NCM-associated CNS melanoma evaluated at Memorial Sloan Kettering Cancer Center from June 2000 to January 2020. Five patients had previously identified focal melanocytosis prior to developing melanoma. In this subgroup, the median time from identification of focal melanocytosis to melanoma diagnosis was 80 months (range: 18-200). Median age at melanoma diagnosis was 9.9 years (range: 1.1-25.3). Presentation at the time of diagnosis with CNS melanoma included headache (45%), focal deficits (45%), and seizure (18%). Eight patients had hydrocephalus (73%). Five patients presented with a focal mass (45%) and six patients had focal or diffuse leptomeningeal disease without a mass (55%). Leptomeningeal spread eventually developed in all patients. Where molecular testing was available, three melanomas had NRAS mutations and none were associated with BRAF mutations. Seven patients were treated with cancer-directed therapy including temozolomide, trametinib, ipilimumab, and nivolumab, with each therapy being administered to two patients. Radiation therapy was used in three patients, including whole brain radiation therapy and stereotactic radiosurgery. Median survival from melanoma diagnosis was 9.1 months (range: 1-60.4). The longest surviving patient was initially diagnosed with cutaneous melanoma, surviving 60.4 months after diagnosis with cutaneous melanoma and 22.7 months after diagnosis with CNS melanoma. Prognosis remains guarded in patients with NCM-associated melanoma, and further investigation is warranted to identify effective management strategies.
NCOG-64. INCIDENCE OF EARLY OCULAR COMPLICATIONS AFTER PROTON RADIATION FOR CHILDHOOD BRAIN TUMORS
Authors: Bavle Abhishek , Confer Michael , Simpson Hilarie , Gavula Theresa , Gross Naina , Lim Maria , McNall-Knapp Rene , Collinge Janine 
Published: December 2020

Abstract

OBJECTIVES
To determine the incidence, timing and risk factors of ocular complications after proton radiation (RT) in childhood brain tumor patients, to better inform screening for these complications.

METHODS
We performed a single-institution retrospective review of children treated with proton RT for brain tumors, with ophthalmology data available. Data abstracted included demographics, radiation details and ocular complications (cataract, dry eyes, retinal changes).

RESULTS
We treated 81 children with brain tumors, with protons, from 2010-18. Forty three patients with ophthalmology data available, were included in the study, with a median age of 8.3 years (y) (0.8 – 20.6y) (13 craniospinal irradiation/CSI, 27 involved-field radiation/IFRT, 3 whole ventricle). Median follow-up from end of radiation to last eye exam was 2.1y (0.2 – 7.2y). The incidence of ocular complications was 21% (9/43 patients) overall, and 62% (8/13) after CSI. Bilateral cataracts were detected at a median of 3.2y post-radiation, with incidence of 14% (6/43) overall and 38% (5/13) after CSI. Three patients underwent lens replacement. Dry eyes developed in 23% (3/13) of patients during or soon after CSI (0.04 and 0.7y post-RT). One patient with craniopharyngioma developed retinal scarring and cataracts, 2.2y and 3.5y, after IFRT. The median radiation dose to the lenses, for patients with cataract, was 26.02 Gy RBE (4 patients: 19.41 – 31.54). For 3 patients with dry eyes, the median dose (Gy RBE) was 27.93 (11.98 – 28.71) to lenses, 36.96 (25.12 – 47.49) to lacrimal glands and 30.78 (25.08 – 36.49) to corneas (mean doses to bilateral ocular structures).

CONCLUSIONS
Children are at risk for cataract and dry eyes after cranial protons, especially CSI, and need ophthalmology follow-up. Larger studies are needed to validate these findings and identify risk-mitigation strategies, with longer follow-up to determine the incidence of ocular complications, and functional outcomes, after cranial proton radiation.
NCOG-68. COMPARING COGNITIVE PROFILES OF PERSONS WITH BRAIN AND NON-BRAIN METASTATIC CANCER
Authors: Willhelm Gabrielle , Del Bene Victor , Aita Stephen , Gammon Meredith , Gerstenecker Adam , Fiveash John , Marotta Dario , Triebel Kristen 
Published: December 2020

Abstract

OBJECTIVE
Cognitive impairment in primary cancer and brain metastatic (BM) cancer has been well-documented. However, to date, there are no neuropsychological studies comparing the cognitive profiles of people with BM and non-brain metastatic cancer (NBM). The present study addressed this gap in the literature by comparing the cognitive profiles of participants with BM and NBM.

METHOD
The study sample consisted of 61 BM, 40 NBM, and 37 healthy control (HC) participants. All participants completed the same neuropsychological battery, including tests of processing speed, attention, working memory, expressive language, auditory-verbal memory, and executive functioning.

RESULTS
Both clinical groups showed reduced processing speed, verbal learning/memory, and executive functions. BM participants performed below HC participants across all neuropsychological tests, while NBM participants performed below control participants on tests of processing speed and executive functioning. The clinical groups differed in semantic verbal fluency (NBM &gt; BM). Fifty-seven percent of BM participants had ≥ 3 impaired scores (i.e., ≤ 5th percentile), and 25% of NBM participants had the same level of cognitive impairment.

CONCLUSION
Over half of BM participants were cognitively impaired on at least three neuropsychological tests, and 25% of NBM participants also demonstrated this same level of cognitive impairment. In the BM group, the elevated rate of cognitive dysfunction is likely due to the greater neurologic disease burden posed by brain metastases, while in the NBM group, the cognitive deficits are possibly due to systemic illness and treatment effects.