bluuebunny/crossref_metadata_2025_split huggingface dataset:
QOLP-10. PATIENT-REPORTED OUTCOMES DURING TREATMENT FOR GLIOBLASTOMA: SYMPTOM BURDEN AND ASSOCIATED IMPACT ON DAILY LIFE
Authors: Hultman Meghan , Tipps Megan , Liu Minda , Banerji Nilanjana , Bruns Patricia , Trusheim John 
Published: November 2019

Abstract

INTRODUCTION
Glioblastoma is the most common primary malignant brain tumor, with an annual incidence of 3–4 new cases per 100,000 people. Despite advances in chemotherapy, radiotherapy, and surgical interventions, prognosis remains poor. Aims of treatment for life-limiting diagnoses should extend beyond increasing survival time to include palliation of symptoms and promotion of quality of life. Here we describe patient-reported symptoms both early and late in the glioblastoma treatment trajectory, as well as their associated interference with daily life.

METHODS
Fifty patients with newly diagnosed glioblastoma were recruited between September 2015-March 2018. Demographic and clinical information was collected from medical records. Patients also completed the brain tumor-specific MD Anderson Symptom Inventory (MDASI-BT) approximately every 8 weeks from completion of chemoradiation through cessation of active disease treatment. Both individual and categories of related symptoms reported in the initial two (early treatment) and final two (late treatment) MDASI-BT assessments were examined for symptom frequency, severity, and relationships between symptom severity and interference with daily life. Patients still receiving treatment or who completed < 4 total MDASI-BT assessments were excluded from the analysis.

RESULTS
The most commonly reported symptoms were often, but not always, consistent with the symptoms rated as most severe. This was true for individual symptoms as well as categories of symptoms. The most common/severe symptoms also changed from early to late treatment. Overall symptom burden was positively correlated with symptom interference in daily life (r=0.67, p< 0.0001). Regression analysis identified different symptoms as predictors of interference in early as opposed to late treatment, and these predictors did not necessarily align with the most common/severe symptoms.

CONCLUSION
Symptom experience for patients with glioblastoma is complex and dynamic. Attention to symptom trajectories for patients with glioblastoma may direct approaches to assessment, early identification, and symptom management, thus promoting better quality of life.
QOLP-12. EVALUATION OF THE UCLA NEURO-ONCOLOGY PROGRAM PSYCHOSOCIAL PATIENT SCREENING FORM IN IDENTIFYING DEPRESSION, FATIGUE, AND PERCEIVED COGNITIVE FUNCTION IN PATIENTS WITH GLIOMAS
Authors: Choi Justin , Van Dyk Kathleen , Heimberg Brandon F , Cloughesy Timothy , Lai Albert , Fong Nanette , Michelson Lauren , Vargas Erika , Leia Nghiemphu P 
Published: November 2019

Abstract
Given the high prevalence of neurobehavioral symptoms such as depression, fatigue, and cognitive dysfunction in patients with gliomas, it is critical to regularly screen for these symptoms at each oncology visit. The current study evaluated the validity of the UCLA Neuro-Oncology Program Psychosocial Patient Screening Form (PPSF) to measure depression, fatigue, and cognitive complaints in a sample of 22 patients enrolled in a study observing neurocognitive and psychosocial change in long-term survivors. Patients were asked to complete the PPSF at regular clinical visits, and this data was retrospectively reviewed. The PPSF consisted of the Patient Health Questionnaire-2 (PHQ-2) and options to endorse experiencing more fatigue, as well as significant memory, speech, attention, or thinking difficulties. At the most recent visit, patients also completed a validated psychosocial assessment that included the Beck Depression Inventory-II (BDI-II), Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), and Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog). Endorsement of recent depressive symptoms, increased fatigue, and elevated cognitive difficulties on the PPSF at the most recent visit were found to be significantly correlated with abnormal mean scores on the BDI-II (M= 22.5, SD= 11.24, t= -3.47, p= 0.003), MFSI-SF (M= 26.08, SD= 15.51, t= -2.34, p= 0.029), and perceived cognitive abilities subscale of the FACT-Cog (M= 5, SD= 2, t= 4.642, p= 0.00), respectively. Abnormal scores on the MFSI-SF and FACT-Cog were also significantly correlated with endorsement of fatigue and cognitive complaints at any previous visit. Although other measures of screening for depression, fatigue, and cognitive complaints exist, the PPSF is effective in providing immediate, clinically significant information to the clinician for comprehensive patient care. The PPSF should be utilized to capture and address psychosocial changes and facilitate a deeper understanding of the effects of treatment on glioma patients.
QOLP-21. LONG-TERM FOLLOW-UP OF GERM CELL TUMOR SURVIVORS
Authors: Matsutani Tomoo , Horiguchi Kentarou , Ikegami Siro , Hirono Seiichiro , Murai Hisayuki , Saeki Naokatsu , Iwadate Yasuo 
Published: November 2019

Abstract
Germ cell tumor (GCT) is a juvenile tumor, completely cured by adequate treatments, including radiation therapy and chemotherapy. However, survivors require continuous medical treatment mostly due to hypopituitarism, and several issues could be observed during follow-up. In the present report, we analyzed medical records of long-term GCT survivors, retrospectively, and make the issues clear. Of ninety-three, 82 GCT patients with several medical and social information are included in the analysis. Median follow-up time is 11.95 years, and 47 patients followed more than ten years. Fifteen deaths are recorded, and 8 are tumor-progression, and 7 are treatment-related long-term events, including four subsequent gliomas, one cerebral vascular disease, one renal cancer, and one sudden death. Seven survivors developed subsequent malignancy, and all lived more than 19 years and received more than 50Gy of irradiation. The overall survival rate is gradually decreasing more than ten years follow-up, such as 10-, 15- and 25-years survival are 92.3, 87.7 and 73.3%, respectively. Long-term follow-up also clarified several social issues. Forty-two of 50 adult survivors had a job after the treatments, but only thirty-four (70.8%) are still working. Of note, only nine (18.8% of adults) survivors got married. All four women require any hormone replacement, while only one of 4 men requires the replacement. Long-term follow-up of GCT survivors revealed subsequent malignancy and social problems. Recent attempt to decrease radiation dose and to give adequate hormone replacement might overcome these problems. Clinicians still observed GCT patients closely.
QOLP-22. DRIVERS OF COST OF SURGERY IN NEWLY-DIAGNOSED GLIOBLASTOMA PATIENTS
Authors: Chandra Ankush , Young Jacob , Dalle-Ore Cecilia , Lau Darryl , Rick Jonathan , Wadhwa Harsh , McDermott Mike , Berger Mitchel , Aghi Manish 
Published: November 2019

Abstract

INTRODUCTION
Glioblastoma carries a high economic burden for patients and caregivers. We investigated drivers of hospital costs of surgery for newly-diagnosed glioblastoma.

METHODS
Retrospective review of GBM patients undergoing first resection at UCSF (2010–2015) and corresponding hospital charges. Our cohort was divided into low (LC) and high cost (HC) groups for total surgical cost. Multivariate regression was used to identify factors driving cost of surgery.

RESULTS
Of 242 patients, 36.7% (n=86) were females (median age=62 years). The mean total hospital cost for surgery among our patient cohort was $40,384. When comparing the LC and HC groups, mean total hospital cost for surgery for HC patients was almost twice as much as LC group ($51,744 vs $29,023, p< 0.001). Kaplan-Meier analysis revealed that having higher cost of surgery worsened patient prognosis, with a 21% longer overall survival in the LC cohort versus the HC cohort (14.7 vs 17.9 months, p=0.02; HR=1.41 [1.05–1.91], p= 0.023). Tumor diameter at diagnosis was largest for HC group (4.7 cm) versus LC patients (3.9 cm, p=0.002). Multivariate analysis revealed longer hospital stay (F-ratio=8.87; p=0.01), longer ICU stay (F-ratio= 12.34, p< 0.001), younger age at surgery (F-ratio=6.71, p=0.02) and multifocal disease (F-ratio=6.26, p=0.02) to be independent predictors of higher cost of surgery, while having PCP at diagnosis (F-ratio=6.92, p=0.02), health insurance coverage (F-ratio= 4.23, p=0.03) and being married (F-ratio=3.71, p=0.04) were independent predictors of lower cost of surgery.

CONCLUSIONS
Higher costs of surgery correlate with worse survival outcomes in glioblastoma patients. Beyond the anticipated finding that greater disease burden drives some of this inverse correlation between cost and survival, correctable socioeconomic factors such as PCP and insurance status also drive higher hospital charges for GBM surgery. Manipulation of these factors is necessary to minimize the economic burden of disease and adopt cost-effective surgical treatments for GBM patients.
QOLP-24. PATIENTS’/PARENTS’ EXPERIENCES OF RECEIVING OPTUNE DELIVERED TUMOR TREATMENT FIELDS: A PEDIATRIC BRAIN TUMOR CONSORTIUM STUDY: PBTC-048
Authors: Lai Jin-Shei , Goldman Stewart , Hwang Eugene , Kocak Mehmet , Lulla Rishi , Dhall Girish , Robison Nathan , Onar-Thomas Arzu , Dunkel Ira 
Published: November 2019

Abstract

BACKGROUND
Optune-delivered TTFields is a promising anti-mitotic FDA-approved cancer therapy in adult patients with high-grade gliomas (HGG), although effectiveness is not yet proven in pediatric patients. A multicenter trial [NCT03033992] evaluating the feasibility and device-related toxicity for children with recurrent or progressive supratentorial high-grade glioma (HGG) and ependymoma is being conducted. This presentation reports the interim health-related quality of life (HRQOL) and device-use experiences reported by patients and parents.

METHODS
Participating patients (aged 5–21 years) and one of their parents completed the following measures at baseline and prior to each intervention cycle: PROMIS Fatigue, Anger, Anxiety, Depressive Symptoms, Mobility, Upper Extremity Function, and Peer Relationships and Neuro-QOL Stigma. Participants completed an exit survey when they were off the study regarding their experiences wearing the device.

RESULTS
This planned interim analysis included 11 patients (7 males/4 females) with supratentorial tumors: ten HGG and one ependymoma. Median age was 14.2 (6.4–21.3) years. Patients reported worse HRQOL than the norms on all domains. Of these 11 patients, 6 completed the exit survey. No significant changes (p< 0.05) between the baseline and the final assessment were found except for Stigma. Patients perceived less stigma at baseline than at the final assessment (t=2.82, p=0.0370). Of these 6 parents who completed the Exit Survey: most considered wearing the device to be easy (n=5).Patient reminders were unnecessary (n=5), patients rarely/didn’t complain (n=4) or refuse (n=5) to wear the device, there was rare/no (n=4) difficulty with daily activities because of the device, and patients were not (n=4) or sometimes (n=2) embarrassed to wear the device.

CONCLUSION
Preliminary results indicate Optune-delivered TTFields therapy is feasible and accepted by children and parent with no evidence of negatively impacting patients’ QOL. Accrual has been expanded beyond the interim analysis.
QOLP-27. CLINICAL FACTORS AND MOLECULAR MARKERS ASSOCIATED WITH POSTOPERATIVE SEIZURES IN GLIOBLASTOMA
Authors: Chandra Ankush , Kanungo Ishan , Rick Jonathan , Yue John , Dayani Fara , Nguyen Alan , Flanigan Patrick , Chang Edward , McDermott Mike , Berger Mitchel , Aghi Manish 
Published: November 2019

Abstract

INTRODUCTION
Glioblastoma has a poor prognosis, further complicated by postoperative seizures. We analyzed various factors associated with postoperative seizures in glioblastoma.

METHODS
Retrospective chart review of 932 patients who underwent craniotomy for glioblastoma (777=83.4% newly diagnosed; 155=16.6% recurrent) at our institution (2002–2014). Postoperative seizures were defined as those occurring within 14 days of surgery.

RESULTS
Our cohort consisted of 49.9% (n=465) males with mean age of 55.8 (range 9–91) years. In total, 69 (7.4%) had postoperative seizures with mean time from surgery to seizure of 3.1 days (IQR=1–4). Of 536 patients (57.5%) receiving seizure prophylaxis, those treated with Keppra were more likely to have postoperative seizures compared to those on Dilantin (10.9% vs 5.0%; p=0.022). Primary tumor patients were less likely to seize postoperatively compared to recurrent tumor patients (9.7% vs 19%; p=0.016). Patients presenting with seizure as chief complaint (12.1% vs 5.1%; p=0.025) and those with >20% of Chromosome 10 deletion were more likely to have seizures postoperatively (12.4% vs 6.1%; p=0.0029). Risk factors for postop seizures for newly-diagnosed patients included subtotal resection versus gross total resection (28.0% vs 7.1%; p=0.022). Risk factors for postop seizures for recurrent patients were >5% EGFR amplification (23.5% vs 5.8%; p=0.0021) and hyponatremia within mean 2.5 days (IQR 0–1) after surgery (20.8% vs 7.1%; p=0.035).

CONCLUSION
We identified several risk factors for postoperative seizures in glioblastoma patients, most of which were clinical (seizure as chief complaint, the antiepileptic chosen for prophylaxis, and extent of resection), while some were molecular and linked to genes whose products have demonstrated links to epileptogeneicity (Chromosome 10, EGFR). These findings may assist physicians in detecting glioblastoma patients that are at higher risk for postoperative seizures and in providing prophylaxis to reduce morbidity.
QOLP-37. QUALITATIVE RESEARCH IN LOWER GRADE GLIOMA: UNDERSTANDING SIGNS, SYMPTOMS, AND DISEASE IMPACTS DURING EXPECTANT MANAGEMENT
Authors: Boscoe Audra , Wells Ted , Graham Christina , Pohl Caitlin , Witherspoon Brooke , Kerkorian Christa , Steelman Lori , S Pandya Shuchi 
Published: November 2019

Abstract

BACKGROUND
Patients with lower grade glioma (LGG) (i.e., grade II or III) have limited treatment options. After surgical resection of their tumor, patients will undergo either a period of expectant management (watch and wait) or treatment with adjuvant chemotherapy and/or radiotherapy. Approximately 80% of patients with LGG have an isocitrate dehydrogenase mutation, which is a viable target for molecular therapy. This offers a therapeutic intervention that could potentially delay the need for chemotherapy and/or radiotherapy in select patients. Several prognostic and patient-specific factors contribute to the decision to recommend expectant management, including concerns about the side effects of chemotherapy and radiotherapy. The aim of this project was to understand patients’ signs and symptoms during the expectant management period and how LGG impacts their lives.

METHODS
Concept elicitation interviews were conducted in the US with patients with LGG as well as key opinion leaders (KOLs) with experience treating patients with LGG. Interview data were analyzed using Atlas.ti, and patient data were reviewed against KOL data.

RESULTS
Seven patients with ≥ 3 months of expectant management experience and three KOLs were interviewed. During their expectant management periods, patients reported 12 signs/symptoms, mostly related to deficits in cognition. Patients reported 16 impacts across four categories, with a substantial proportion of the impacts identified as negatively affecting emotional function. The signs/symptoms and impacts reported by patients were generally also reported by KOLs. During expectant management, patients typically resume their original quality of life post-surgery, but may also experience anxiety. Patients and KOLs indicated a preference for expectant management and delaying chemotherapy or radiotherapy.

CONCLUSIONS
Patient and KOL interviews characterized the LGG experience and indicated a preference for expectant management, which may be supported by therapies that delay the initiation of chemotherapy and/or radiotherapy.
RDNA-09. RADIATION PRIMES SB28 GLIOBLASTOMA FOR RESPONSE TO TGFβ AND PD-L1 NEUTRALIZING ANTIBODIES
Authors: Borrero Garcia Luis , Reiners Oliver , Gonzalez-Junca Alba , Okada Hideho , Helen Barcellos-Hoff Mary 
Published: November 2019

Abstract
SB28 is a new luciferase expressing murine glioblastoma (GBM) cell line whose morphology, growth pattern, mutational burden immune infiltrate more closely resembles human GBM and is unresponsive to immunotherapy (OncoImmunology, 7:12, e1501137). Radiation therapy (RT) has the potential to improve response to combinations by multiple means: cell kill that may activate an immune response, effects on vascular system may improve drug access, induction of DNA damage that can be augmented by targeted or chemotherapy, and modulation of the tumor microenvironment. High transforming growth factor β (TGFβ) activity in most GBM, which increases with radiation, likely opposes effective therapy by endorsing an effective DNA damage response and being immunosuppressive. Here evaluated the response of SB28 to radiation in combination with PD-L1 checkpoint blockade or neutralizing TGFβ. Establishment of intracranial tumors was monitored by bioluminescence. We determined that SB28 endogenously activate TGFβ as evaluated by biomarkers. We used radiolabeled antibodies and PET-CT to demonstrate access to intracranial tumors, indicative of a compromised blood-brain barrier. TGFβ neutralizing antibody, 1D11, had little effect on tumor growth compared to mice receiving IgG control antibody (median survival control: 19 days vs 1D11: 20.5 days). A single dose of radiation of 10 Gy delivered to the tumor site increased median survival to 21 day, which was increased to 31 days in mice treated with 1D11. In a second experiment in which the radiation dose was 6 Gy, 1D11 provided no benefit. In contrast, median survival of mice treated with PD-L1 neutralizing antibodies 3 days after being irradiated with 6 Gy demonstrated increased median survival (Control: 18 day; anti-PD-L1 20.5; RT: 25 days; RT + anti- PD-L1: 28 days). Double treatment resulted in 1/7 long term survival and loss of bioluminescence indicative of tumor elimination. Thus, radiation can prime SB28 GBM for response to biological agents.
RTHP-22. EDEMA PROGRESSION DURING MRI-GUIDED GLIOBLASTOMA RADIOTHERAPY
Authors: Dooley Sarah , LLorente Ricardo , Jones Kolton , Ford John , Mellon Eric 
Published: November 2019

Abstract

PURPOSE
Despite the common finding of pseudoprogression or true progression one month after primary chemoradiotherapy for glioblastoma, there are few studies evaluating brain MRI changes that occur during concurrent chemotherapy and radiotherapy (RT). With the first generation combination MRI-RT device, daily predominantly T2-weighted MRIs are obtained of glioblastoma during RT. We quantified how many patients had significant MRI detectable volumetric changes through the six week course of primary chemoradiotherapy. This is of particular importance since glioblastoma RT is only planned at the beginning of therapy and not commonly re-planned for changes during therapy.

METHODS
We retrospectively reviewed the daily set-up imaging of 8 patients at our institution who received RT for glioblastoma using the Cobalt-60 MRI-RT system. Patients received standard chemoradiation at 60 Gy in 30 fractions with temozolomide per EORTC22981/26981. We contoured the abnormality on the initial ViewRay setup scan and the set-up scan for fraction 30. After rigid fusion of the contours of the initial setup MRI and fraction 30 MRI, the volumes were compared.

RESULTS
Of the 8 patients, 3 patients (37.5%) demonstrated edema expansion greater than 5 mm. The maximum distances of T2-weighted abnormality volume growth for these patients were 1.0 cm, 1.5 cm, and 4.1 cm. These findings were correlated with the post-treatment diagnostic MRIs at 3–4 weeks which demonstrated similar FLAIR abnormalities and expansion in T1 with gadolinium contrast volumes within these areas of the radiotherapy fields (pseudoprogression vs. true progression).

CONCLUSION
Review of MRIs obtained by daily MRI-RT for glioblastoma indicates that 3 of 8 patients had over 5 mm of change in T2-weighted dimensions from beginning to end of radiotherapy. Groups using limited CTV margins for treatment planning should be aware that MRI volumes could significantly increase during radiotherapy.
RTHP-29. HYPOFRACTIONNATED RADIOTHERAPY FOR REFRACTORY SKULL BASE CHORDOMA
Authors: Cai Linbo , Li Shaoqun , Lai Mingyao , Shan Changguo , Li Juan , Zhen Junjie , Hong Weiping 
Published: November 2019

Abstract

OBJECTIVE
Skull base chordoma is difficult to be totally excised by surgery because of the complex anatomical structures of skull base. Postoperative radiotherapy is one of the most important treatment options for skull base chordoma. However, the response of chordoma to conventional fractionation radiotherapy is poor. Therefore, it is of great value to explore the therapeutic effects of hypofractionnated radiotherapy for refractory skull base chordoma.

METHODS
A retrospective analysis was performed on the clinical data of patients with refractory skull base chordomas who were admitted to Guangdong Sanjiu Brain Hospital from 2007 to April 2019. The characteristics of the selected cases and prognosis-related factors were analyzed with Kaplan-Meier method.

RESULTS
A total of 21 patients were enrolled in this study, including 11 male (52.4%) and 10 female (47.6%). Twenty patients received surgery, including gross total resection in 5 cases (25%), subtotal resection in 14 cases (70%) and biopsy in 1 case (5%). Among 18 patients who received radiotherapy, 17 (94.4%) received radiotherapy after the first diagnosis; 1 (5.6%) were treated with radiotherapy after tumor recurrence; and 3 (16.7%) received the secondary radiotherapy after tumor recurrence. The median overall survival of 11 patients receiving hypofractionnated radiotherapy (45-60Gy/8-20F) and 7 patients receiving conventional fractionation radiotherapy (40-60Gy/20-30F) reached 33 months (7–130) and 68 months (27–105), respectively. The results of Kaplan-Meier analysis revealed that the overall survival of patients who were treated with hypofractionnated radiotherapy was significantly longer than that of those receiving conventional fractionation radiotherapy. No one suffered from radiation-induced acute brain injury (≥grade 3), and only 1 patient who received hypofractionnated radiotherapy developed radiation-induced brain necrosis at 3 years after hypofractionnated radiotherapy.

CONCLUSION
Hypofractionnated radiotherapy for refractory skull base chordoma can not only achieve a therapeutic effect, but also reduce the risk of radiation-induced necrosis.