bluuebunny/crossref_metadata_2025_split huggingface dataset:
QOLP-17. FACTORS ASSOCIATED WITH PSYCHOLOGICAL DISTRESS IN CAREGIVERS OF PATIENTS WITH MALIGNANT GLIOMAS
Authors: Landay Sophia , Anand Maya , Horick Nora , Jacobs Jamie , Quain Kit , Temel Jennifer , Forst Deborah 
Published: November 2019

Abstract

BACKGROUND
Caregivers of patients with newly diagnosed malignant gliomas experience high rates of psychological distress. However, the factors associated with distress in this population have not been well described. We sought to evaluate patient-related, caregiver-related and tumor-related factors associated with depression and anxiety in this caregiver population.

METHODS
We conducted a prospective study in patients with newly diagnosed malignant gliomas and their caregivers, collecting self-report data within 6 weeks of diagnosis. Patients’ and caregivers’ depression and anxiety were assessed using the Hospital Anxiety and Depression Scale, with subscale scores >7 considered clinically significant. Information about the tumor location and molecular features was extracted from the medical record. We used univariate and multivariate linear models to evaluate the association between caregiver anxiety and depression at baseline and specific caregiver-, patient- and tumor-related factors.

RESULTS
We enrolled 61 patient-caregiver dyads in this study. 26.2% (16/61) of caregivers had significant depression symptoms, and 47.5% (29/61) had significant anxiety. In the multivariable analysis, factors associated with higher caregiver depression score included younger caregiver age (< 65 years old; B=4.24, p=0.0002), left-sided tumor location (B=1.98, p=0.030), IDH wild-type tumor status (B=3.44, p=0.0008) and patient anxiety (B=2.28, p=0.017). Factors associated with higher caregiver anxiety were younger caregiver age (B=2.47, p=0.089) and left-sided tumor location (B=4.23, p=0.001).

CONCLUSIONS
Younger caregiver age and caring for a patient with a tumor on the left side of the brain were associated with worse caregiver depression and anxiety. Higher caregiver depression was correlated with caregivers whose loved one had significant anxiety or had an IDH wild-type tumor. Understanding the factors associated with caregiver anxiety and depression may guide neuro-oncology clinicians in identifying caregivers who may be at an increased risk for psychological distress at the time of their loved one’s diagnosis, allowing for earlier initiation of support services for these caregivers.
QOLP-20. IMPACT OF GLIOBLASTOMA ON PATIENT-REPORTED SYMPTOM BURDEN AND PHYSICAL ACTIVITY ASSESSED BY CONVENTIONAL INSTRUMENTS AND A NOVEL DEVICE–BASED TECHNOLOGY
Authors: Armstrong Terri , Puduvalli Vinay , Walbert Tobias , Peters Katherine , Loughan Ashlee , Ahluwalia Manmeet , Province Warren Paula , Cachia David , Taylor Jennie , O Blakeley Jaishri , Ganguli Arijit , Khandelwal Nikhil , Kamalakar Rajesh , Noe Les , Kumthekar Priya 
Published: November 2019

Abstract
Glioblastoma (GBM) is a rapidly progressing disease associated with significant deterioration in quality of life. This study evaluated clinical patient-reported outcomes (PROs) and the physical activity of patients with GBM. Adults with GBM (n=180) were stratified across 4 groups representing specific stages in the disease course: Group 1=newly diagnosed; 2=postradiation; 3=stable disease; 4=recurrence. Self-reported physical function (EORTC-QLQC30), motor dysfunction (BN20), symptom burden and interference (MDASI-BT), and objective physical activity level (via Fitbit®) were compared across groups by ANOVA. Associations between outcomes were assessed with a Pearson correlation (r) test. Patients were highly symptomatic, with overall mean (MDASI-BT) symptom severity (1.7–2.4; P=0.23) and interference (2.3–3.2; P=0.68) scores similar across groups. Patients with recurrent disease experienced the numerically greatest symptom severity and interference. Self-reported activity-related interference scores (2.7–3.6, P=0.48) were highest in patients with newly diagnosed or recurrent disease. Motor dysfunction (BN20) mean scores were highest in postradiation (22) and recurrent (22) disease groups (P=0.95). Mean physical function (EORTC-QLQC30) scores were worse in patients with recurrent disease (67) than in those with stable disease (79; P=0.38). Newly diagnosed patients and those with stable disease were the most active (≈4000 and ≈4500 mean steps/day, respectively), whereas those with recurrent disease were least active (≈2300 mean steps/day; P=0.032). Greater physical activity (via Fitbit®) correlated with better self-reported physical function (EORTC-QLQC30) for all groups (Group 1, r=0.0292; Group 2, r=0.0211; Group 3, r=0.0008; Group 4, r=0.0002). Greater motor dysfunction was correlated with lower physical activity in patients with stable (r=0.0003) and recurrent (r=0.0441) disease. Patients in this study were highly symptomatic throughout the disease stages with disease recurrence associated with worse motor and physical function. Future studies exploring these findings in a longitudinal cohort are needed to assess this relationship.
QOLP-33. ACCEPTABILITY RANDOMIZED CONTROLLED TRIAL A COUPLES-BASED MIND-BODY INTERVENTION FOR PATIENTS WITH HIGH GRADE GLIOMA AND THEIR PARTNERS
Authors: Milbury Kathrin , Pei Weathers Shiao- , Durrani Sania , Li Yisheng , Carmack Cindy , Bruera Eduardo 
Published: November 2019

Abstract

BACKGROUND
Given the incurable nature, short survival and high symptom burden of high grade glioma (HGG), patients and their partners are at risk of experiencing psychological and existential/spiritual distress. To address these concerns, we developed a dyadic intervention integrating meditation training with emotional disclosure exercises. The primary aim was to examine feasibility and acceptability of the intervention study procedures.

METHODS
Dyads completed baseline self-report measures and were randomized to a couple-based mind-body (CBMB) or a waitlist control (WLC) group. Couples in the CBMB groups attended 4 weekly (60 min each) therapist-led sessions that were delivered via FaceTime. The CBMB program focused on cultivating mindfulness, compassion, gratitude and purpose. All groups were reassessed, 1 month and 3 months after baseline.

RESULTS
We approached 60 eligible patient-partner dyads of which 37 (62%) consented and 18 were randomized to the CBMB and 16 to the WLC group. Of those randomized, 23 dyads (67%) completed all assessments (n= 12 in CBMB; n=11 in WLC). Attrition was due to patients’ death (n=3), symptom burden (n=5) or passive withdrawal (n=3). Patients (57% male; mean age=57 years) and partners’ (59% female; mean age=54 years) attended a mean of 3.17 sessions (SD=1.2) with 83% attending at least 2 sessions. All dyads in the CBMB group reported the intervention as beneficial and useful and would recommend this program to other couples. Of note, 60% of couples would have preferred in-person delivery and 95% of patients but only 33% of partners stated that a dyadic intervention is their preference.

CONCLUSION
It seems to be feasible, acceptable and possibly efficacious to deliver a dyadic intervention via FaceTime to couples coping with HGG. Although both members of the dyad reported to have benefited, dyadic delivery appears to be less desirable for partners.
RTHP-01. PENTOXIFYLLINE AND VITAMIN E FOR THE TREATMENT OF RADIATION NECROSIS AFTER STEREOTACTIC RADIOSURGERY
Authors: Sudmeier Lisa , Switchenko Jeffrey , Eaton Bree , Shu Hui-Kuo 
Published: November 2019

Abstract

BACKGROUND
The combination of oral pentoxifylline (Ptx) and vitamin E (VitE) has been used to treat radiation-induced fibrosis and soft tissue injury. A 2008 study showed an average decrease in edema with the use of Ptx + VitE in 11 patients with suspected radiation necrosis after stereotactic radiosurgery (SRS). Here we review outcomes in patients prescribed Ptx + VitE at our institution for the treatment of radiation necrosis.

METHODS
48 patients were included in this analysis. All patients were treated with SRS, had evidence of radiation necrosis, and had MR imaging before and after starting Ptx + VitE. The radiation oncologist’s impression of the imaging in the electronic medical record was used to score response to treatment. Official radiology reports were also reviewed.

RESULTS
43.8% of patients showed evidence of improvement, 18.8% showed no change, and 25% showed worsening radiation necrosis on imaging after starting Ptx + VitE. One patient had a mixed response; 5 patients (10.4%) had disease progression. The median time to response assessment after starting Ptx + Vit E was 3.17 months. 9 patients progressed significantly on Ptx + VitE and required Bevacizumab, hyperbaric oxygen therapy or surgery. Patients who had multiple lesions treated with SRS were less likely to show improvement on imaging after Ptx + VitE (p=0.037). 34 patients were also prescribed dexamethasone, either before (7), with (16), or after starting (11) Ptx + VitE. Use of dexamethasone was not associated with improved response to Ptx + VitE (p=0.471). 3 patients stopped Ptx + VitE due to reported side effects.

CONCLUSION
Ptx + VitE appears safe for the treatment of radiation necrosis, but randomized data are needed to assess efficacy.
RTHP-02. INTRACRANIAL BASAL GANGLIA/THALAMUS GERM CELL TUMOURS: CLINICAL CHARACTERISTICS, TREATMENT OUTCOMES, AND QUALITY OF LIFE OF 211 PATIENTS FROM A SINGLE CENTRE
Authors: Li Bo , Wang Jiayi , Li Youqi , Qiu Xiaoguang 
Published: November 2019

Abstract

PURPOSE
Intracranial germ cell tumours (iGCTs) originating from the basal ganglia/thalamus (BG/T) region are rare. We report the findings from a large single-centre series to explore the clinical features of this disease.

PATIENTS AND METHODS
Patients diagnosed as having BG/T iGCTs from January 2000 to December 2017 at our hospital were screened. Newly diagnosed patients who had histology-proven/tumour marker-elevated disease and received at least radiotherapy were eligible for analysis.

RESULTS
Of the 401 patients screened, 211 were eligible. The median age was 12 years (range, 5–41 years). The median duration of follow-up for surviving patients was 68 months (range, 12–189 months). In germinoma patients (n = 112), the 5-year disease-free survival (DFS) and overall survival (OS) were 94.9% and 98.2%, respectively. Multivariate analysis showed that the dose of radiotherapy could predict the DFS (hazard ratio [HR] 0.991, 95% confidence interval [CI] 0.983–0.998, p = 0.015). In non-germinomatous GCT (NGGCT) patients (n = 99), the 5-year DFS and OS were 83.8% and 88.6%, respectively. Multivariate analysis showed that irradiation field (whole-brain radiotherapy vs. local radiotherapy, HR = 0.163, 95% CI 0.031–0.897, p = 0.037; cranial spinal radiotherapy vs. local radiotherapy, HR = 0.095, 95% CI 0.009–1.031, p = 0.053) and chemotherapy cycle (>3 vs. ≤3) (HR 0.234, 95% CI 0.055–0.996, p = 0.049) were independent factors for DFS. The median Z-score for height and body mass index (BMI) in patients ≤19 years of age (n = 69) at the last follow-up were -0.45 (range, -2.67 to 3.41) and 0.59 (range, -4.73 to 3.1), respectively.

CONCLUSION
BG/T GCTs had unique characteristics. Radiation dose was an independent factor influencing the DFS in cases of germinoma. In NGGCTs, extended field radiation and more chemotherapy cycles yielded better disease control. Physical development after treatment was within the normal range for most patients.
RTHP-10. PREDICTORS OF LINEAR ACCELERATOR VERSUS GAMMA KNIFE STEREOTACTIC RADIOSURGERY USE FOR BRAIN METASTASES IN THE UNITED STATES
Authors: McClelland III Shearwood , Degnin Catherine , Chen Yiyi , Watson Gordon , Jaboin Jerry 
Published: November 2019

Abstract

INTRODUCTION
Stereotactic radiosurgery (SRS) for brain metastases is predominantly delivered via single-fraction Gamma Knife SRS (GKRS) or linear accelerator (LINAC) in 1–5 fractions. Predictors of SRS modality have been sparsely examined on a nationwide level.

METHODS
The 2010–2016 National Cancer Database identified brain metastases patients from non-small cell lung cancer throughout the United States (US) having undergone SRS. A multivariable logistic regression model characterized SRS receipt, adjusting for patient age, dose, geographic location of treatment, facility type, and distance from treatment facility.

RESULTS
A total of 1,760 patients received GKRS, while 1,064 patients received LINAC SRS. Treatment at non-academic facilities was associated with increased LINAC SRS receipt, most prominently in the Midwestern (OR= 6.23; p< 0.001), Northeastern (OR= 4.42; p< 0.001), and Southern US (OR= 1.96;p< 0.001). Administered doses of 18–19 Gy (OR= 1.42;p= 0.025), 20–21 Gy (OR= 1.82;p< 0.001), and 22–24 Gy (OR= 3.11;p< 0.001) were associated with increased LINAC SRS receipt, as was patient location within 20 miles of a radiation treatment facility (OR= 1.27;p= 0.007).

CONCLUSIONS
Despite Gamma Knife being more prominently used over LINAC for SRS, patients treated at non-academic facilities outside of the Western US were substantially more likely to receive LINAC over Gamma Knife. Patients located in the Midwest were 523% more likely, Northeast 342% more likely, and South 96% more likely to receive LINAC when treated at a non-academic facility. Increasing dose independently predicted LINAC over GKRS, indicating that smaller tumors – particularly those less than two centimeters (consistent with RTOG 90-05 recommendations) – are being treated with LINAC. Finally, patients residing in close proximity to a treatment center were 27% more likely to receive LINAC, likely indicative of the increased geographic accessibility of LINAC compared with GKRS. These findings should result in hypothesis-generating questions to further explore predictors of LINAC versus GKRS.
RTHP-32. FIRST EXPERIENCE WITH GAMMATILE PERMANENT IMPLANTS FOR RECURRENT BRAIN TUMORS
Authors: Ferreira Clara , Alaei Parham , Chen Clark , Reynolds Margaret , Sterling David , Dusenbery Kathryn 
Published: November 2019

Abstract
GammatileTM permanent brachytherapy implants have been FDA cleared for patients with recurrent brain tumors. We report our experience with the first 6 patients with recurrent high grade primary brain tumors treated with re-resection and implantation. Each tile contains 4 encapsulated radioactive Cs-131 seeds embedded in collagen. To determine the number of tiles needed, the potential tumor cavity surface area was estimated using the preoperative MRI images. The anticipated cavity surface area was calculated, the surface area of anticipated surgical approach was subtracted. This area was divided by 40mm2 (tile area) and this number of tiles were ordered. At the time of surgery, after maximal safe tumor resection, tiles were placed into the resection cavity and the surgical cavity closed as usual. On post-implant day 1, CT and MRI scans were performed. The cavity was contoured, then expanded by 5mm to create HRCTV. T1 MRI enhanced lesions were contoured as residual GTV (GTVr). A dose of 60Gy over the course of treatment was prescribed to HRCTV. In each of these 6 cases, over 95% of the HRCTV was covered by the 60Gy isodose surface, and GTVr D90 ranged from 22.9Gy to 113.8Gy. The additional time required for the tile placement in all cases was less than 10 minutes. Post-operatively exposure rates at 1m were less than 6 mR/hr (ranging from 1.3 to 3.2mR/h). Permanent GammaTile for recurrent brain tumors is a viable option for selected previously irradiated patients who are operative candidates. Benefits include irradiation of the tumor bed starting immediately after resection with no need to wait for wound healing, and no need to subsequently surgically remove the tile. We were able to accurately predict the number of tiles needed, although in one case collagen spacers were utilized. Due to low exposure rates, radiation protection issues are very manageable.
RBTT-02. RADIOSURGERY FOLLOWED BY TUMOR TREATING FIELDS FOR BRAIN METASTASES (1–10) FROM NSCLC IN THE PHASE 3 METIS TRIAL
Authors: Mehta Minesh , Gondi Vinai , Ahluwalia Manmeet , Brown Paul 
Published: November 2019

Abstract
BACKGROUND: Tumor Treating Fields (TTFields) are non-invasive, loco-regional, anti-mitotic treatment modality comprising alternating electric fields. TTFields have demonstrated efficacy in preclinical non-small cell lung cancer (NSCLC) models. TTFields treatment to the brain was safe and extended overall survival in newly-diagnosed glioblastoma. The METIS study [NCT02831959] investigates the efficacy and safety of TTFields in NSCLC patients with brain metastases. Study Design: NSCLC patients (N=270) with 1–10 brain metastases are randomized 1:1 to stereotactic radio surgery (SRS) followed by continuous TTFields ((150 kHz, > 18 hours/day) within 7 days of SRS or supportive care. The portable device delivers TTFields to the brain using 4 transducer arrays, while patients receive the best standard-of-care for systemic disease. Patients are followed every two months until second intracranial progression. Key inclusion criteria: KPS ≥70, new diagnosis of 1 inoperable or 2–10 supra- and/or infratentorial brain metastases from NSCLC amenable to SRS; and optimal therapy for extracranial disease. Prior WBRT or surgical resection of metastases, a single resectable lesion or recurrent brain metastases were exclusionary. Primary endpoint was time to 1st intracranial progression. Secondary endpoints included time to neurocognitive failure (HVLT, COWAT and TMT), overall survival, radiological response rate (RANO-BM and RECIST V1.1); quality-of-life; adverse events; time to first/second intracranial progression for patients with 1–4 and 5–10 brain metastases; bi-monthly intracranial progression rate from 2–12 months; and time to second intracranial and distant progression. The sample size (N=270) was calculated using a log-rank test (Lakatos 1988 and 2002) with 80% power at two sided alpha of 0.05 to detect a hazard ratio of 0.57. In August 2018, an independent Data Monitoring Committee (DMC) performed a review of the METIS trial data collected to that point. The DMC concluded that no unexpected safety issues had emerged and recommended continuation of the METIS study as planned.
RARE-02. SYMPTOMATIC SALIVARY GLAND-LIKE TUMORS OF THE SELLAR REGION: ADDITIONAL FEATURES AND REVIEW OF THE LITERATURE
Authors: Kleinschmidt-DeMasters Bette , Rosenblum Marc , Kerr Janice , Lillehei Kevin 
Published: November 2019

Abstract

INTRODUCTION
Sellar symptomatic salivary gland-like tumors (SSGTs) are exceedingly rare, with less than a dozen case reports in the literature. They usually consist of amorphous colloid identical to Rathke cleft cyst (RCC) contents, but additionally the cyst wall contains a large, cohesive collection of benign salivary glands. We report two new examples, one of which represents the first instance of recurrence of symptoms 2 years after first surgery, the second time with cyst confined to infundibular stalk and causing severe gliosis, indicative of mass effect. The second example underscores that SSGT remains poorly recognized, even today amongst experts.

METHODS
One case each was retrieved from the files of University of Colorado Denver (UCD) and Memorial Sloan Kettering (MSK); the UCD case represents the sole example in 2000+ sellar region masses seen at our institution since 1997. The MSK case had been recently received in consultation.

RESULTS
Case 1 is a 20-year-old female who presented with 3 weeks of symptoms referable to obstructive hydrocephalus; neuroimaging disclosed a sellar/suprasellar 2.4 x 2.2 x 2.4 cm mass. Following surgical resection, SSGT was diagnosed. She received no adjuvant therapy, but recurrence of headaches and blurred vision 2 years later prompted her return to medical attention. MRI revealed a recurrent cyst confined to the center of a thickened, bulbous infundibular stalk. Second resection yielded amorphous mucin within the cystic and severely-gliotic infundibular stalk, but no salivary-type glands. She has been followed for the last 6 years without tumor recurrence. Case 2 is a 29-year-old female with headache. The lesion was seen initially by a neuropathologist at another institution before it was sent to MSK for consultation and SSGT was diagnosed.

CONCLUSION
Few pathologists or neuropathologists have encountered SSGT in their practices; case 1 produced recurrence and significant local stalk damage, features not previously reported.
RARE-03. CNS GERMINOMA WITH SYNCHRONOUS LESIONS IN THE SELLAR AND PINEAL REGIONS
Authors: Simonyan Armen , Mikhaylova Anna , Lepsveridze Levan , Semenov Maksim 
Published: November 2019

Abstract
Germinomas comprise approximately 2–5% of all CNS malignancies, and have a favourable prognosis. Bad outcomes are relatively rare. Synchronous lesions occurs in 5–10% of cases. We report a case of 28 years old male, presented with motor aphasia, visual impairment and dysphagia. In period of last 15 months patient underwent 3 surgical interventions due to occlusive hydrocephalus. MRI revealed volume formations of the pineal and sellar regions. Taking into account the severity of the patient’s condition, consilium decided to refrain from surgical intervention and adjuvant therapy. Patient was transferred to the palliative unit. He died after 3 months. According to the results of the autopsy, the histological changes in tumors of the pineal and infundibular regions, corresponds to the germinoma. Due to the lack of information about patient’s treatment, carried out until hospitalization in our center, we don’t undertake to judge whether there was diagnostic omission, or incorrect treatment in this clinical case. But in our opinion, in case of suspected CNS germinoma, it is necessary to conduct more “aggressive treatment” (Tumor biopsy, followed by radiotherapy and chemotherapy). Symptomatic treatment should be used in cases, where the treatment of main disease is impossible. We hope that this sad clinical case will help Neurosurgeons in making decisions in a difficult situation.
RARE-08. ROSAI-DORFMAN-DESTOMBES DISEASE OF THE NERVOUS SYSTEM; A SYSTEMATIC LITERATURE REVIEW
Authors: Alshiekh Nasany Ruham , Reiner Anne , Panageas Katherine , Diamond Eli 
Published: November 2019

Abstract

INTRODUCTION
Rosai-Dorfman-Destombes disease (RDD) is a rare non–Langerhans cell histiocytosis with neurologic involvement in fewer than 5% of cases. Data about neurologic RDD is limited. Our objective was to synthesize the clinical literature about presentation, treatments, and outcomes of neurologic RDD.

METHODS
A multi-database English systematic review search using keywords related to (1) histiocytosis and (2) neurologic involvement. Candidate articles were screened for clinical content. Secondary literature and cases without treatment information were excluded. Sites of involvement, presenting symptoms, treatments, and therapeutic responses were reviewed.

RESULTS
Of 4768 screened, 153 articles presenting 223 patients were included. Mean age was 37.7 years (range 2–79; IQR 23.5–52.5). 149 patients (66.8%) were male and 74 (33.2%) were female. RDD lesions were located in the dura in 111 (49.8%) of cases, spine in 16.6%, brain parenchyma in 9.0%, orbit in 7.2%, calvarium in 2.7%, and in multiple sites in 13.5%. The most frequent presenting symptoms were headache in 101 (45.3%.), focal neurological deficits (32.7%), visual symptoms (31.8%), seizures (24.7%), cranial (11.7%), and cerebellar dysfunction (11.2%). Cognitive decline, masses were less common presentations. First-line treatments included resection, radiation, corticosteroids, chemotherapy, and combinations of these. First-line treatment led to complete (CR) or partial response (PR) in 153 (68.6%) of cases, stable disease in 30 (13.5%), and progressive disease in 40 (17.9%). CR or PR was observed in the calvarium in 5/6 (83.3%), dura in 82/111 (73.9%), spine in 29/37 (78.4%), orbit 8/16 (50.0%), parenchyma in 15/20 (75.0%), and multiple sites in 14/30 (46.7%). 47 (21.1%) of patients required second-line therapy.

DISCUSSION
Neurologic RDD is a rare form of histiocytosis with varying sites of involvement, clinical presentations, and responses to treatment. Further investigation of effective therapies for neurologic RDD may improve outcomes for this disease.