bluuebunny/crossref_metadata_2025_split huggingface dataset:
RTHP-06. IMPACT OF THE AMERICAN TAX PAYER RELIEF ACT ON STEREOTACTIC RADIOSURGERY UTILIZATION IN THE UNITED STATES
Authors: McClelland III Shearwood , Degnin Catherine , Chen Yiyi , Watson Gordon , Jaboin Jerry 
Published: November 2019

Abstract

INTRODUCTION
For brain metastases, single-fraction stereotactic radiosurgery (SRS) spares appropriately chosen patients from the invasiveness of operative intervention and the permanent cognitive morbidity of whole brain radiation. SRS is delivered predominantly via two modalities: Gamma Knife, and linear accelerator (LINAC). The implementation of the American Tax Payer Relief Act (ATRA) in 2013 represented the first time limitations specifically targeting SRS reimbursement were introduced into federal law. The subsequent impact of the ATRA on SRS utilization in the United States (US) has yet to be examined.

METHODS
The National Cancer Data Base (NCDB) from 2010–2016 identified brain metastases patients from non-small cell lung cancer (NSCLC) throughout the US having undergone SRS. Utilization between GKRS and LINAC was assessed before (2010–2012) versus after (2013–2016) ATRA implementation. Utilization was adjusted for several variables, including patient demographics and healthcare system characteristics.

RESULTS
From 2012 to 2013, there was a substantial decrease of LINAC SRS in favor of GKRS overall (37% to 28%) and individually in both academic and non-academic centers. Over the three-year span immediately preceding ATRA implementation, 65.8% received GKRS and the remaining 34.2% receiving LINAC. In the four years immediately following ATRA implementation 68.0% received GKRS compared with 32% receiving LINAC; these differences were not statistically significant.

CONCLUSIONS
ATRA implementation in 2013 caused an initial spike in Gamma Knife SRS utilization, followed by a steady decline, similar to rates prior to implementation. These findings are indicative that the ATRA provision mandating Medicare reduction of outpatient payment rates for Gamma Knife to be equivalent with those of LINAC SRS had a significant short-term impact on the radiosurgical treatment of metastatic brain disease throughout the US. Such findings should serve as a reminder of the importance and impact of public policy on treatment modality utilization by physicians and hospitals.
RTHP-17. APPLICATION OF EXACTRAC X-RAY IMAGE GUIDE SYSTEM IN STEREOTACTIC RADIOSURGERY FOR INTRACRANIAL NEURAL TUMORS IN PATIENTS AGED 3–14 YEARS
Authors: Cai Linbo , Xiao Qing 
Published: November 2019

Abstract

OBJECTIVES
To investigate the setup accuracy in stereotactic radiosurgery based on Exactrac Xray image guide system for intracranial neural tumors in patients aged between 3 and 14 years, and to discuss the related influence factors.

METHODS
Thirty seven patients with intracranial neural tumors, at the age of 314 years old, who were admitted to Guangdong Sanjiu Brain Hospital between March 2017 to January 2019 were enrolled in this study. After automatic setup with infrared markers, Exactrac Xray image guide system was applied to obtain the image of bilateral oblique intersection field, which were then registered with the field image digitally reconstructed with planning system, so as to obtain the translational errors in LAT (X), LNG (Y), VRT (Z) directions and the corresponding rotational errors.

RESULTS
After the positioning with Exactrac Xray image guide system and sixdimensional couch, the translational errors of all 37 patients in LAT, LNG, VRT directions were (0.26±0.13), (0.17±0.13), (0.15±0.11) mm, respectively, and the corresponding rotational errors were 0.21°±0.15°, 0.18°±0.15°, 0.18°±0.14°, respectively. The space vector error was (0.32±0.16) mm; translational errors were all less than 0.5 mm; rotational errors were all less than 0.5°. All of these errors were less than specified values and in accordance with the requirements of SRS.

CONCLUSION
Using Exactrac Xray image guide system and sixdimensional couch can remarkably improve the accuracy of SRS for intracranial neural tumors in patients aged 314 years. Exactrac Xray image guide system is worthy of application in the clinic.
RTHP-20. MULTI-INSTITUTIONAL ANALYSIS OF HIGH-RISK WHO GRADE II OLIGODENDROGLIOMA TREATED WITH ADJUVANT RADIOTHERAPY PLUS TEMOZOLOMIDE (TMZ) VERSUS PROCARBAZINE, LOMUSTINE, AND VINCRISTINE (PCV)
Authors: Tom Martin , Routman David , Laack Nadia , Frechette Kelsey , Park Deborah , (Auston) Wei Wei , Leyrer Marc , Peereboom David , Ahluwalia Manmeet , Chao Samuel , Suh John , Murphy Erin 
Published: November 2019

Abstract

PURPOSE
To compare outcomes of adults with high-risk grade II oligodendroglioma treated with adjuvant radiotherapy plus adjunctive TMZ versus PCV.

METHODS
We queried a multi-institutional database from the Cleveland Clinic and Mayo Clinic of 158 adults with WHO grade II glioma who were high-risk (age > 40 and/or subtotal-resection [STR]) and underwent adjuvant chemoradiation (TMZ or PCV) between 1997–2017. We included patients with oligodendroglioma by 1p/19q-codeletion or traditional histopathology. Fisher’s exact test was used to associate factors with chemotherapy group. The log-rank test was used to compare OS and PFS by chemotherapy group and clinical characteristics.

RESULTS
52 patients were included with a median follow-up of 44 months (range, 3–259). Median age was 44 (range, 22–73), 49 (94%) underwent STR, and 28 (54%) were male. Presenting symptoms were seizure in 35 (67%) patients, sensory in 14 (27%), and motor in 8 (15%). Oligodendroglioma classification was by 1p/19q-codeletion in 27 (52%) and traditional histopathology in 25 (48%) patients. Median radiation dose was 54 Gy (range, 45–60). Chemotherapy was TMZ in 34 (65%) patients and PCV in 18 (35%). Patients who were older (P=0.003), lacked seizures (P=0.03), or had motor symptoms (P=0.04) were more likely to receive TMZ. Median OS was 223 months (95% CI, 181-not estimable) and median PFS was 118 months (95% CI, 69–223). Treatment with TMZ versus PCV was not associated with OS (median 186 vs. 223 months, respectively; P=0.71) or PFS (median 110 vs. 131 months, respectively; P=0.19). Age >40 (P=0.009) and motor symptoms (P=0.027) were associated with adverse OS. Presence of motor symptoms was associated with worse PFS (P=0.008).

CONCLUSION
There was no statistically significant difference in OS or PFS between adjunctive TMZ versus PCV for adult high-risk grade II oligodendroglioma. A larger cohort with longer follow-up will provide additional insight.
RBTT-03. USE OF VIRTUAL REALITY ENVIRONMENTS TO IMPROVE SELF-REPORTED DISTRESS, MOOD DISTURBANCE AND OVERALL SYMPTOM BURDEN USING CORRELATIVE STRESS BIOMARKERS IN PRIMARY BRAIN TUMOR (PBT) PATIENTS
Authors: King Amanda , Leggiero Nicole , Acquaye Alvina , Vera Elizabeth , Crandon Sonja , Gilbert Mark , Armstrong Terri 
Published: November 2019

Abstract
Approximately 20% of PBT patients experience moderate-severe distress at the time of neuroimaging & diagnostic evaluation, which can adversely impact their psychological health and ability to tolerate oncologic therapies. Virtual reality (VR) technology is increasingly being utilized in clinical populations with demonstrated improvement in self-reported pain, anxiety, and distress, though little is known about the biological pathways involved. We hypothesize that VR can improve distress through a combination of distraction and promotion of the relaxation response, both of which could blunt activity of physiological stress pathways. The purpose of this study is to assess the effect of VR breathing and relaxation scenarios on self-reported acute and long-term distress incorporating correlative stress biomarkers, as well as assessing long-term effects on mood disturbance and overall symptom burden. This is a phase 2 experimental pre-post design with a sample size of 100 PBT patients, stratified into low and high distress groups. Self-reported measures include the Distress Thermometer, PROMIS Anxiety and Depression Short Forms, and the MD Anderson Symptom Inventory Brain Tumor instrument. Correlative stress biomarkers include salivary cortisol and dehydroepiandrosterone-sulfate (DHEA-S), representing hypothalamic-pituitary-adrenal (HPA) axis activity, and salivary alpha amylase (sAA) and heart rate, representing activity of the sympathetic-adrenal-medullary (SAM) system. Baseline and post-intervention assessments will be taken surrounding a 5 to 10 minute VR experience in clinic, with repeat assessments 1 week later and at the next clinic appointment. Anticipated outcomes include a decrease in self-reported acute and remote distress with correlative decrease in stress biomarkers, as well as improvement of mood disturbance and overall symptom burden. VR has the potential to help PBT patients improve self-management of their psychological symptoms, potentially enhancing their tolerance of oncologic therapies and overall quality of life. Additionally, the benefits of this intervention may have broad applicability to other cancer patient populations.
RBTT-11. NRG ONCOLOGY NRG-BN006: A PHASE II/III RANDOMIZED, OPEN-LABEL STUDY OF TOCA 511 AND TOCA FC WITH STANDARD OF CARE COMPARED TO STANDARD OF CARE IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA
Authors: Ahluwalia Manmeet , Pugh Stephanie , Ellingson Benjamin , Kotecha Rupesh , Cloughesy Timothy , Vogelbaum Michael , Aldape Kenneth , Cui Yunfeng , Armstrong Terri , Mehta Minesh 
Published: November 2019

Abstract
The standard of care (SOC) in newly diagnosed glioblastoma (nGBM) includes resection and chemoradiotherapy. With a median overall survival (OS) of only 16–18 months for well-selected patients in clinical trials, better therapeutic options are needed. Toca 511 (vocimagene amiretrorepvec) is a retroviral replicating vector encoding a codon optimized, heat stabilized cytosine deaminase that converts Toca FC (extended-release 5- fluorocytosine,5-FC) into 5-fluorouracil. Preclinical evidence demonstrates that Toca 511 & 5-FC kill cancer cells and immunosuppressive myeloid cells in the tumor microenvironment, leading to durable antitumor immune responses. Three phase (P) 1 studies in patients with recurrent high grade glioma have demonstrated tolerable safety profile and encouraging efficacy. NRG-BN006 is a randomized P2/3 trial of Toca 511 & Toca FC with SOC versus SOC for patients with nGBM. Optune use is allowed on the SOC arm, but not on the experimental arm. Patients will be stratified by age and KPS score for 1:1 randomization. The primary endpoint is progression-free survival for P2 and OS for P3. The secondary endpoints include objective response rate in patients with measurable disease and safety. Key inclusion criteria include presumptive diagnosis of glioblastoma with anticipated 80% resection, unifocal tumor, and KPS≥70. Immune monitoring and molecular profiling will be performed. P2 has 90% power to detect a hazard ratio (HR)=0.67 in 250 nGBM patients. P3 has 85% power to detect a HR=0.75 in 720 nGBM patients. Since patients are enrolled prior to surgery and confirmatory diagnosis of GBM, approximately 900 patients will be enrolled, and two interim analyses are planned for OS. In addition, two interim safety analyses will be conducted for the experimental treatment, with the first 15 and 30 eligible and analyzable patients randomized to the experimental arm. NRG-BN006 is anticipated to start enrollment in Q4 2019. Supported by grants U10CA180868, U10CA180822 from NCI and Tocagen.
RARE-10. IMPROVING CARE FOR ADULT PATIENTS WITH RARE CNS TUMORS: THE NATIONAL CANCER INSTITUTE-COMPREHENSIVE ONCOLOGY NETWORK EVALUATING RARE CNS TUMORS (NCI-CONNECT) PROGRAM AND CLINIC
Authors: Siegel Christine , Raygada Margarita , Acquaye Alvina , Stearn Sylvia , Wall Kathleen , Crandon Sonja , Stevens-Brown Kristen , Wu Jing , Vera Liz , Theeler Brett , Reyes Jennifer , Leggiero Nicole , Cordova Christine , Bryla Christine , Burton Eric , Boris Lisa , Antony Ramya , Ani Tracy , Aboud Orwa , Armstrong Terri , Gilbert Mark , Penas-Prado Marta 
Published: November 2019

Abstract

BACKGROUND
While rare cancers have provided insight into mechanisms of tumorigenesis and familial syndromes, patients with rare CNS tumors and providers face unique challenges, including diagnostic delays and errors, lack of standardized approaches to care/treatment, and limited social support. Scant data exists on the natural history, health status, and impact of these tumors on life quality. This report describes an innovative clinic designed to fulfill the mission of the NCI-CONNECT program: To advance our understanding and to improve approaches to care and treatment of rare CNS tumors.

METHODS
A specialized weekly clinic was established incorporating routine comprehensive analysis of tumor tissue, genetic counseling with individual pedigree assessment, group meetings with a health and wellness counselor and comprehensive clinical evaluation. Patients and caregivers both participated. Descriptive statistics report of NCI-CONNECT clinic patients from January 1-May 8, 2019 are presented.

RESULTS
33 patients and 32 caregivers have participated to date, representing 6 of the 12 rare tumors studied in NCI-CONNECT: 19 ependymomas, 9 oligodendrogliomas, 2 PXAs, 1 papillary pineal tumor, 1 medulloblastoma, 1 gliosarcoma. The median time from receiving pathologic material to appointment was 22 days, with analysis including methylation and next generation sequencing testing. All 33 patients underwent genetic counseling, most (n=26) having at least ≥ 2 first- or second-degree relatives diagnosed with cancer (Germline mutations/genetic predisposition testing underway). 44 patients attended (33 with 8 repeat visits) the health and wellness group sessions, with education on coping/wellness techniques included. During this same period, 7 patients participated in a rare CNS basket trial using nivolumab.

CONCLUSIONS
We have developed an innovative clinic model to interrogate rare CNS tumors for therapeutic targets, understand individual risk, how the patient feels and functions and conduct clinical trials. This effort has the potential to accelerate our understanding of these rare tumors and provide guidance on care.
RARE-13. CHARACTERISTICS AND TREATMENT PATTERNS IN CHILDREN WITH NEUROFIBROMATOSIS TYPE 1 (NF1) AND PLEXIFORM NEUROFIBROMAS (PN): A CROSS-SECTIONAL ANALYSIS OF CHILDREN’S TUMOR FOUNDATION (CTF) REGISTRY DATA
Authors: He Jinghua , Anne Pinto Cathy , Yang Xiaoqin , Diede Scott , Deitz Anne 
Published: November 2019

Abstract

BACKGROUND
NF1-related PN can cause substantial morbidity, with no currently approved drug treatment available for PN treatment. Although surgery is the standard of care, complete resection of PN is often difficult due to encasement of vital structures and invasive and extensive PN growth. With limited real-world data among children with NF1-related PN, the study objectives were to describe the demographic, clinical characteristics, and treatment of these children.

METHODS
A cross-sectional analysis of existing CTF web-based, patient-entered, registry data collected between 2012–2018 was conducted. To be included in analysis, patients had to complete at least one registry survey, and be ≤ 19 years of age at the time of first survey completion, with patient- or parent/ guardian reported diagnosis of NF1 and at least 1 PN. Descriptive statistical analysis was conducted on data collected from the first survey for each patient, to describe patient characteristics and treatment patterns. Results were stratified by region (US, ex-US).

RESULTS
The sample included 943 pediatric patients (n=750 US, n=193 ex-US). The majority (85.9%) were less than 5 years of age at NF1 diagnosis (US: 87.6%; ex-US: 79.3%). Approximately half were male, and half reported more than 1 PN. The most common PN site include head (15.1%) and neck (12.6%). More than half of patients received no treatment (53.1%) for their PN. The most common treatments reported for PN were surgery (27.0%) and chemotherapy or drug therapy (10.0%). These results were generally consistent across regions. A malignant peripheral nerve sheath tumor (MPNST) and optic glioma (OG) were diagnosed in 21 (2.2%) and 308 (32.7%) patients, respectively; a large proportion of OG patients remained untreated (57.5%). Too few ex-US patients were available for detailed regional analysis.

CONCLUSIONS
This study demonstrated that a large proportion of children diagnosed with NF1-related PN remain untreated, highlighting a substantial unmet need.
RARE-15. OUTCOMES OF TREATMENT OF GLIOMAS IN PATIENTS WITH NEUROFIBROMATOSIS TYPE I TREATED WITH RADIATION THERAPY
Authors: Son Jessica , Sloan Lindsey , O Blakeley Jaishri , Slobogean Bronwyn , Kleinberg Lawrence 
Published: November 2019

Abstract

INTRODUCTION
Neurofibromatosis type 1 (NF1) is a rare tumor suppressor syndrome that predisposes to nervous system tumors. The optimal treatment of gliomas in adults with NF1 is uncertain. Specifically, little is known about the effectiveness or toxicity of radiation therapy (RT) in this population although it is standard of care for progressive low grade glioma (LGG) or high grade glioma (HGG) in general. We evaluated the tolerability of RT and time to progression (TTP) after completion of RT in people with NF1 diagnosed with glioma in adulthood.

METHODS
Charts were reviewed for patients with a confirmed NF1 syndrome, LGG or HGG, > 18 years old, receiving RT and followed at Johns Hopkins University between 2009–2019. Secondary outcomes were overall survival (OS) from diagnosis and RT associated toxicity. Progression was defined radiographically; toxicity was graded by CTCAE.

RESULTS
Eight people (6 males) with median age of 36.5 years (range, 20–63) received RT at median of 56.7Gy either at the time of diagnosis (N=4) or at recurrence (N=4). Three patients (37.5%) had LGG; five (62.5%) had HGG. Tumor locations were brainstem (6) and temporal lobe (2). All patients received concurrent chemotherapy with RT; temozolomide (7) or bevacizumab (1). At median follow-up of 28.3 months (0.9–90.2) from RT completion, 5/8 patients had progression. Of those who progressed, median TTP was 12.7 months (2.5–26.6). The longest period of disease control was 28.9 months. One and two-year OS rates were 87% and 32%, respectively. RT associated toxicities were within the expected range.

CONCLUSIONS
Overall disease control after RT was variable, with some examples of extraordinary duration of disease control, and RT toxicities were within expected range. Collaborative efforts to examine a larger cohort of adults with NF1 associated gliomas are needed to define optimal care, but these observations suggest RT is a feasible modality.
RARE-16. A NOVEL RADIOMICS MODEL DIFFERENTIATING CHORDOMA AND CHONDROSARCOMA
Authors: Yamazawa Erika , Takahashi Satoshi , Tanaka Shota , Takahashi Wataru , Nakamoto Takahiro , Takayanagi Shunsaku , Kitagawa Yosuke , Hana Taijun , Koike Tsukasa , Kushihara Yoshihiro , Shin Masahiro , Saito Nobuhito 
Published: November 2019

Abstract

BACKGROUND
Chordoma and chondrosarcoma account for the majority of skull base tumors affecting the petroclival region. Chondrosarcoma has better prognosis than chordoma; heavy particle therapy is often indicated for residual/recurrent chordoma. Preoperative, precise diagnosis of the tumor would be desirable, as it can potentially impact on the choice of a surgical approach and the aggressiveness of surgery.

METHODS
We conducted a radiomics study to create a machine learning model distinguishing chondrosarcoma from chordoma. We collected DICOM T2-weighted images and T1-weighted images with gadolinium (GdT1) enhancement in the consective patients of chordoma or chondrosarcoma who underwent surgery at The University of Tokyo Hospital from September of 2012 to January of 2019. We selected patients with uniform MRI images. VOI (volume of interest) was set using Monaco (https://www.elekta.com/software-solutions/treatment-management/external-beam-planning/monaco.html). Not only sematic features but also agnostic features were calculated. The original images and 8 wavelet transformed images were calculated for texture agnostic features such as Gray-Level Co-occurrence Matrix (GLCM). Features were selected by recursive feature elimination (RFE). The final model evaluation was performed by average area under the curve (AUC).

RESULTS
The study population included 17 chordomas and 22 chondrosarcomas in a total of 39 patients. 476 features were obtained per image sequence. The number of features per case was 476 × 2 = 952 The most accurate machine learning model was created using the extracted three features from only T2. The best AUC was 0.77 ± 0.11 in logistic regression (dataset was divided randomly into halves, average value of AUC calculated six times).

CONCLUSIONS
This novel machine learning model can differentiate chordoma and chondrosarcoma reasonably well. A validation study with a larger number of patients is warranted.
RARE-18. CLINICAL EXPERIENCE OF DABRAFENIB IN COMBINATION WITH TRAMETINIB TREATMENT FOR ANAPLASTIC PXA CASES
Authors: Maruyama Takashi , Muragaki Yoshihiro , Tsuzuki Syunsuke 
Published: November 2019

Abstract
Anaplastic PXA is classed as grade III tumor because of its aggressive behavior in 2016 WHO classification. Typical treatment of PXA is gross total resection followed by radiotherapy and cytotoxic chemotherapy at recurrence. Despite aggressive behavior of anaplastic PXA, there is some evidence for the use of BRAF inhibitors in BRAF V600 mutant PXA. We report two cases of successful treatment with BRAF-MEK inhibitor combination therapy (dabrafenib plus trametinib). A 19 year-old man initially diagnosed as PXA for rt temporal tumor. Subtotal removal and following 30Gy radiation was performed. After eight years, the recurrent tumor was removed subtotally and diagnosed as anaplastic PXA. Residual tumor and distant metastasis region were completely disappeared by Dabrafenib-Trametinib therapy. Tumor was diagnosed as BRAF V600 mutant and TERT wt. A 30 year-old female initially diagnosed as PXA for rt temporal cystic tumor. She was treated with subtotal removal followed by stereotactic radiosurgery. Instead of Gd-total removal, tumor recurred six times. Chemotherapy with alkyl-agent did not respond. Tumor at first surgery was diagnosed as grade II PXA. Tissues collected after SRS showed malignant feature and diagnosed as anaplastic PXA. All five specimens showed BRAF V600 mutation and additional TERT mutation was confirmed after SRS treatment. She showed paraparesis because of thoracic metastases then Dabrafenib-Trametinib therapy was started. Thoracic tumor showed PR and no remarkable recurrence in intracranial region for more than eight months, so far. BRAF and MEK inhibitor combination treatment are thought to have potential for BRAF V600 mutant NSCLC and melanoma. Anaplastic PXA with BRAF V600 mutation could be another target for the treatment.