bluuebunny/crossref_metadata_2025_split huggingface dataset:
MPC-05 TUMOR RELATED EPILEPSY AND IDH MUTATIONS IN GLIOMAS
Authors: Wakabayashi Hikaru , Inaji Motoki , Fujii Shoko , Aoyama Jiro , Hashimoto Satoka , Tamura Kaoru , Maehara Taketoshi 
Published: December 2019

Abstract

OBJECTIVE
Tumor related epilepsy (TRE) is an important complication in the treatment of brain tumors. In recent studies, it is assumed that isocitrate dehydrogenase (IDH) mutations are concerned with TRE in gliomas. Here, we examined the association between IDH mutations and TRE in our cases.

METHODS
115 patients who had a supratentorial glioma and were treated in our hospital from February 2009 to November 2018 were retrospectively assessed for IDH mutations and TRE.

RESULTS
38 patients were the IDH mutant group (16 females, mean age 43.7±12.9 years, mean follow-up time 44.0 months). 77 patients were the IDH wild group (35 females, mean age 61.6±16.6 year, mean follow-up time 18.1 months). Compared to the IDH wild group, the IDH mutant group was significantly younger and mean follow-up time was longer. There was no difference in the postoperative radiation and chemotherapy in both groups. The incidence of seizures as presenting symptom was 20 patients (52.6%) in the IDH mutant group and 16 patients (20.8%) in the IDH wild group, and was significantly higher in the IDH mutant group (p&lt;0.01). 27 patients (71.1%) in the IDH mutant group had TRE at least once during follow-up time and 39 patients (50.0%) in the IDH wild group (p=0.06). In addition, the median OS for the group with seizure onset (36 patients) was 69.2 months and the group with the other onset forms (79 patients) was 22.4 months. The seizure onset group had a significantly better prognosis (p&lt;0.05).

CONCLUSION
Gliomas with IDH mutations have a higher incidence of TRE. Although IDH mutations are considered to be a risk factor for TRE, which is consistent with previous studies, but it is suggested that differences in survival may have an effect on the incidence of TRE.
MPC-07 MECHANISMS OF BETTER PROGNOSIS IN IDH-MUTATED ASTROCYTOMA WITH 19Q-LOSS
Authors: Otani Ryohei , Uzuka Takeo , Higuchi Fumi , Matsuda Hadzki , Kim Phyo , Ueki Keisuke 
Published: December 2019

Abstract
We previously reported that there was a subgroup of IDH-mutated astrocytomas harboring only 19q-loss showing oligodendroglioma-like morphology and significantly longer overall survival (OS) compared with 19q-intact astrocytomas (Otani et al. Cancer Sci 2018). The purpose of the present study was to reveal how 19q-loss contributed to better prognosis and the morphology in the subgroup. We compared expression pattern between five 19q-loss and five 19q-intact IDH-mutated astrocytomas by microarray analysis.
136 up-regulated genes and 203 down regulated genes were extracted in 19q-loss astrocytomas compared with 19q-intact astrocytomas. Significantly changed genes distributed throughout all chromosomes, but more down-regulated genes were on 19q and 4p, and more up-regulated genes were on 4q.
Genes associated with apoptosis, cell adhesion, and antigen presentation were up-regulated, and genes associated with Ras signaling pathway were down-regulated. These changes could result in better prognosis. By contrast, there was few expression changed gene associated with oligodendroglioma-like morphology although up-regulation of genes associated with axon guidance and down-regulation of genes associated with cell shape might result in the morphology or neuronal differentiation. Expression pattern of 19q-loss astrocytomas indicated no tendency of oligodendroglial differentiation.
Better prognosis of 19q-loss astrocytomas was derived from expression changes associated with tumor proliferation and tumor immunity.
NI-02 THE ASSOCIATION BETWEEN 11C-METHIONINE UPTAKE, IDH GENE MUTATION, AND MGMT PROMOTER METHYLATION IN PATIENTS WITH GRADE II AND III GLIOMAS
Authors: Okita Yoshiko , Shofuda Tomoko , Kanematsu Daisuek , Yoshioka Ema , Kodama Yoshinori , Mano Masayuki , Kinoshita Manabu , Nonaka Masahiro , Fujinaka Toshiyuki , Kanemura Yonehiro 
Published: December 2019

Abstract

AIM
We evaluated the association between 11C-methionine positron emission tomography (11C-methionine PET) findings, isocitrate dehydrogenase (IDH) gene mutation, and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation in patients with grade II and III gliomas.

MATERIALS AND METHODS
Data were collected from 40 patients with grade II and III gliomas who underwent both magnetic resonance imaging (MRI) and 11C-methionine positron emission tomography (PET) as part of their pre-surgical examination. We examined IDH mutation through DNA sequencing, and MGMT promoter methylation through quantitative methylation-specific polymerase chain reaction (PCR).

RESULTS
A threshold of MGMT promoter methylation of 1.0% was significantly associated with tumor/normal tissue (T/N) ratio. The T/N ratio in samples with MGMT promoter methylation ≥1.0% was higher than that in samples with MGMT promoter methylation &lt;1.0%, and the difference was statistically significant (p = 0.011). Reliable prediction of MGMT promoter methylation (&lt;1.0% vs ≥1.0%) was possible using the T/N ratio under the receiver operator characteristic (ROC) curve with a sensitivity and specificity of 75% each (cut-off value = 1.6) (p = 0.0226, AUC = 0.76172). Conversely, the T/N ratio had no association with IDH mutation (p = 0.6). The ROC curve revealed no reliable prediction of IDH mutation using the T/N ratio (p = 0.606, AUC = 0.60577).

CONCLUSION
11C-methionine PET parameters can predict MGMT promoter methylation but not IDH mutation status. 11C-methionine uptake may have limited potential to reflect DNA methylation processes in grade II and III gliomas.
NI-04 WHICH RADIOLOGICAL IMAGING IS BEST TO DISCRIMINATE RADIATION NECROSIS FROM TUMOR PROGRESSION? - SUBANALYSIS OF SYSTEMATIC REVIEW FOR RADIOLOGICAL DIAGNOSIS OF RADIATION NECROSIS
Authors: Furuse Motomasa , Nonoguchi Naosuke , Yamada Kei , Shiga Tohru , Combes Jean-Damien , Ikeda Naokado , Kawabata Shinji , Wanibuchi Masahiko , Kuroiwa Toshihiko , Miyatake Shin-Ichi 
Published: December 2019

Abstract

BACKGROUND
It is challenging to discriminate radiation necrosis from tumor progression, especially in malignant glioma. Therefore many radiological imaging studies have been reported. In this study, we performed a systematic review of radiological diagnosis for radiation necrosis and analyzed the best radiological imaging for malignant glioma.

METHODS
We divided diagnostic approaches into two categories as follows-CT and MRI (conventional radiological imaging studies), and SPECT and PET (nuclear medicine studies). Our librarians conducted a comprehensive systematic search on Pub Med, Cochrane Library, and the Japan Medical Abstract Society up to March 2015. The searching keywords included radiation necrosis, recurrence, imaging modalities such as MRI, diagnosis, and differential. In a meta-analysis, diagnostic odds ratio (DOR) was calculated. A subanalysis was performed, dividing into tumor types, gliomas and metastatic brain tumors.

RESULTS
Of 188 and 239 records extracted from the database, 20 and 26 studies were included in the meta-analysis after exclusion of case reports and studies with incompatible content and insufficient information. Gd-enhanced MRI exhibited the lowest sensitivity (63%) and DOR (2.2). On the other hand, combined multiple imaging studies including MRS and perfusion image displayed the highest sensitivity (96%) and DOR (5.9). In the subanalysis for glioma, Gd-enhanced MRI and 18F-FDG-PET revealed low DORs (1.7 and 2.3). Conversely, 18F-FET-PET and combined multiple imaging studies showed high DORs (6.8 and 5.9).

CONCLUSIONS
Gd-enhanced MRI had low diagnostic ability for differentiation of radiation necrosis. In glioma patients, 18F-FDG-PET was not useful to discriminate radiation necrosis from tumor progression. Combined multiparametric imaging including lesional metabolism and blood flow could enhance diagnostic accuracy and be useful to differentiate radiation necrosis from tumor progression even in glioma patients.
NI-09 CLINICAL SIGNIFICANCE OF T2-FLAIR MISMATCH SIGN IN LOWER GRADE GLIOMAS
Authors: Deguchi Shoichi , Mitsuya Koichi , Kakuda Yuko , Oishi Takuma , Hayashi Nakamasa 
Published: December 2019

Abstract
Lower grade glioma is classified based on genetic information of mutation of IDH1/2 gene and co-deletion of chromosome 1p19q. Knowledge of these genetic information preoperatively is useful for making surgical planning, treatment strategy and prognostication. Recently, T2-FLAIR mismatch sign has been reported to be specific for astrocytoma with IDH mutation (mut) / non-1p19q co-deletion (co-del). This study aims to verify it in our patients. We retrospectively analyzed 152 patients aged over 15 years who were pathologically diagnosed with WHO grade 2 or 3 gliomas from April 2003 to December 2018. We excluded 88 patients without genetic information or without T2-weighted and FLAIR images. T2-FLAIR mismatch sign was defined as in the original description, namely, with homogeneously hyperintense signal on T2-weighted image and a peripheral hyperintense signal with central hypointensity signal on FLAIR image. Among 22 patients with IDH mut / non-1p19q codel, 10 were positive for T2-FLAIR mismatch sign. On the other hand, only one patient was positive for T2-FLAIR mismatch sign respectively in 19 with IDH mut / 1p19q codel and 23 patients with IDH wild-type. Sensitivity, specificity, positive predictive value, and negative predictive value of T2-FLAIR mismatch for the patients with IDH mut / non-1p19q codel are 0.46 (95% confidence interval: 0.24–0.68), 0.95 (0.84–0.99), 0.83 (0.52–0.98). and 0.77 (0.63–0.88), respectively. In 22 patients with IDH mut / non-1p19q codel, we compared 10 patients with and 12 without T2-FLAIR mismatch sign. Median age was 35 and 39 years old. WHO grade 3 was 3 patients each. Tumor location was frontal lobe in 9 (90%) and 10 patients (83%). A statistically significant difference was not found in these factors. PFS and OS were not reached in both groups. The specificity of the T2-FLAIR mismatch sign for astrocytoma with IDH mut / non-1p19q codel was very high, which may be helpful as preoperative imaging marker.
NI-23 ULTRA-HIGH-RESOLUTION CT ANGIOGRAPHY FOR BRAIN TUMOR SURGERY
Authors: Saito Kuniaki , Kobayashi Keiichi , Iijima Shohei , Matsumoto Yoshie , Shimada Daisuke , Koyanagi Masamichi , Gomyo Miho , Shiokawa Yoshiaki , Nagane Motoo 
Published: December 2019

Abstract

BACKGROUND
Preoperative accurate evaluation of arteries and veins can help avoid ischemic complication of brain tumor surgery. The latest ultra-high-resolution CT (UHRCT) angiography (Aquilion PrecisionTM; Canon Medical Systems) has recently become available for clinical testing of the main arteries and critical perforating arteries by brain CTA, compared to conventional CT.

METHODS
UHRCT provides slice collimation of 0.25 mm x 160 and matrix size of 1024 x 1024 or 2048 x 2048. Major features of this CT scanner include an improved detector system (the minimal slice thickness, 0.25 mm; the maximal channel number, 1792) and a small x-ray focus (the smallest size, 0.4 x 0.5 mm) compared to a standard multi-detector CT (MDCT) scanner (the minimal slice thickness, 0.5 mm; the maximal channel number, 896; the smallest x-ray focus size, 0.8 x 0.9 mm).

RESULTS
Until July 2019, 168 patients with brain tumor underwent UHRCT angiography. As high resolution image could visualize cortical arteries and cortical veins clearly, it helped to decide approach route to the tumor and achieve accurate biopsy of even small lesion. Identification of tumor feeders and passing arteries allowed for efficient feeder coagulation and preservation of passing artery, avoiding the ischemic change of surrounding brain. Improved image reconstruction could visualize perforating arteries, which helped to preserve perforator by predicting the location during tumor removal.

CONCLUSION
UHRCT angiography can visualize even tiny arteries and veins around the tumor, and contributes to avoid the risk of ischemic complication.
NQPC-03 PROGNOSTIC SIGNIFICANCE OF QUALITY-OF-LIFE EVALUATION OVER TIME IN CLINICAL PRACTICE FOR PATIENTS WITH GLIOBLASTOMA
Authors: Yamagishi Yuki , Taku Mikiko , Hanayama Naomi , Saito Kuniaki , Kobayashi Keiichi , Yamada Shin , Okajima Yasutomo , Shiokawa Yoshiaki , Nagane Motoo 
Published: December 2019

Abstract

BACKGROUNDS
Evaluation of quality of life (QOL) has been considered as an indispensable modality for assessment of treatment impact for patients with malignant brain tumor, especially glioblastoma. However, changes in patients’ QOL under clinical practice with current standard of care (SOC) have not been clearly and routinely explored, so that solid baseline QOL data under SOC are not available for reliable comparison with those with novel treatments. Here we retrospectively examined changes in QOL during SOC in glioblastoma patients.

PATIENTS AND METHODS
Patients with histologically confirmed glioblastoma treated in our institute from April 2016 to April 2019, who underwent QOL evaluations using EORTC QLQ-C-30/BN-20 were eligible. Outcomes were assessed with clinical factors including therapeutic regimens.

RESULTS
Forty-two patients, median age 64 yo (25–87), male/female 26/16, were identified having longitudinal QOL data along with medical records. Median initial KPS and mini-mental state examination (MMSE) score were 70 (20–90) and 27, respectively, suggesting this cohort containing those in good performance status. In four patients whose QOL queries were answered by a family, median MMSE was 16, indicating the impaired NCF affect self-report ability. Long term survivors without progression remained at an adequate functional scale level, while those who recurred declined in functional scale after progression, often accompanied with an increase in symptom scales associated with tumor location. The domains of declined functional scales varied among patients, and there was no clear tendency associated with patients’ backgrounds such as age and gender. The functional scale level improved in most cases when the recurrent disease was successfully treated, but it gradually declined in a stepwise fashion by repeated recurrences.

CONCLUSIONS
Changes in QOL in patients with glioblastoma were found to associate with disease status. The small number of patients who could be evaluated for QOL over time prevented extracting significant factors affecting QOL outcomes.
NQPC-06 FUNCTIONAL OUTCOMES OF INITIAL TREATMENTS FOR PATIENTS WITH PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA ASSESSED BY ADL AND NEUROCOGNITIVE FUNCTION
Authors: Taku Mikiko , Kobayashi Keiichi , Yamagishi Yuki , Saito Kuniaki , Shimada Daisuke , Matsumoto Yoshie , Kikuchi Hana , Yamada Shin , Shiokawa Yoshiaki , Nagane Motoo , Okajima Yasutomo 
Published: December 2019

Abstract

BACKGROUNDS
Primary central nervous system lymphoma (PCNSL) frequently causes severe damage of activities of daily living (ADL) and neurocognitive function (NCF) due to extensive brain infiltration, necessitating their appropriate assessment and measures even in clinical practice. Since few studies have focused on the changes in the level of ADL and NCF in the course of PCNSL treatment, we retrospectively analyzed the effect of initial treatment of PCNSL in view of ADL and NCF.

METHODS
Among 55 patients (13 male/9 female) with newly-diagnosed PCNSL treated in our institution from January 2014 to June 2019, 22 were evaluated with both ADL and NCF. Remission induction therapies consisted of high-dose methotrexate alone (two patients), R-MPV (rituximab, methotrexate, procarbazine, and vincristine)(17 patients), and R-MPV+radiaotherapy (three patients), according to the patients’ conditions. Rehabilitation staffs intervened from the beginning, providing specific exercises and periodically evaluating scores of Karnofsky Performance Status (KPS) and Mini Mental State Examination (MMSE).

RESULTS
Mean age was 68.4 yo (range 34 to 85). After induction therapies, there were 11 complete responses (CRs), eight partial responses (PRs), and three progressive diseases (PDs). Both KPS and MMSE scores improved after induction therapy, from median 70 (40–90) to 80 (50–90), and from 24 (0–30) to 27(0–30), respectively. Among three patients who underwent RT, MMSE declined in two (one CR/one PR).

CONCLUSIONS
Case-adjusted induction therapies resulted in significant radiographical responses, and the longitudinal evaluation of ADL and NCF by rehabilitation staffs could validate their maintenance or improvement over time through effective treatments and early rehabilitation intervention. However, three was difficulty in assessing patients with higher brain dysfunction such as aphasia and social adjustment disorder. Further study is needed to include more patients and to explore more appropriate evaluation batteries and timings during and after completion of induction therapy for PCNSL.
NQPC-13 THE EFFICACY OF RAVEN’S COLORED PROGRESSIVE MATRICES FOR PATIENTS WITH BRAIN TUMOR
Authors: Yahiro Sachiko , Matsuoka Aiko , Miyakita Yasuji , Ohno Makoto , Takahashi Masamichi , Narita Yoshitaka 
Published: December 2019

Abstract

BACKGROUND
Mini-Mental State Examination (MMSE) and Raven’s Colored Progressive Matrices (RCPM) are cognitive function tests used to assess speech and visual cognitive functions in patients with brain tumor and aphasia, respectively. We investigated the distribution and correlation between MMSE and RCPM scores in patients with brain tumor, who underwent tumor resection, to identify the test characteristics.

METHOD
Among the 122 patients who underwent tumor resection in our hospital from April 2018 to March 2019, and potentially required rehabilitation, 43 patients (i.e., 19 men and 24 women) who underwent pre- and post-operative MMSE and RCPM were further investigated. Median age during surgery was 54 years (20–86 years). Relationship between the pre- and post-operative MMSE and RCPM scores were evaluated using the Spearman’s rank correlation coefficient. Additionally, we investigated the characteristics of patients who scored low on either of the tests.

RESULTS
Median pre- and post-operative MMSE scores were 29 points (14–30) and 29 points (21–30), respectively. Median pre- and post-operative RCPM scores were 33 points (25–36) and 35 points (18–36), respectively. The pre- and post-operative correlation coefficient between MMSE and RCPM scores were 0.376 and 0.699, respectively. Among the 12 patients with lower pre-operative scores on MMSE, as compared to RCPM, 8 patients had impaired attention and 4 patients had aphasia. One patient who scored lower on RCPM test, as compared to MMSE, had reduced analogical reasoning ability. Postoperatively, no patient scored low on MMSE as compared to RCPM, and one patient who scored lower on RCPM than MMSE had left hemi-spatial neglect.

CONCLUSION
The pre-operative cognitive functions of patients with impaired attention and aphasia can be evaluated with RCPM using visual tasks without interference caused by these impairments. Minute pre- and post-interventional cognitive changes can be assessed with both MMSE and RCPM together.
10070: MET-02 NON-SMALL-CELL LUNG CANCER WITH SYNCHRONOUS BRAIN METASTASIS IN THE ERA OF MOLECULAR TARGETED DRUGS: TREATMENT OUTCOME AND RISK FACTORS
Authors: Uzuka Takeo , Higuchi Fumi , Kim Phyo , Ueki Keisuke 
Published: December 2019

Abstract
Brain metastasis is associated with worse prognosis in patients with non-small cell lung cancer (NSCLC). However, recent advances in molecular targeted therapy are rapidly changing the treatment strategy for NSCLC. Here, we conducted a retrospective study to clarify the prognosis and risk factors in NSCLC patients with synchronous brain metastasis. Seventy-four patients who were treated at our institute between Jan 2013 and Apr 2019 were included. The association between overall survival (OS) and clinicopathological features, such as neurological symptoms at diagnosis, histology, EGFR and ALK mutation status, number of intracranial metastases, extracranial systemic metastasis, Karnofsky performance status (KPS) at diagnosis, and initial therapy, were examined. OS was calculated from the day of diagnosis with brain metastasis or NSCLC. Of the 51 men and 23 women enrolled (median 70.0 years of age, range 40–84), 26 patients (35.1%) exhibited neurological symptoms at diagnosis. EGFR and ALK mutations were present in 24 (32.4%) patients. The median OS for all patients was 23.0 months. Factors significantly associated with worse OS in univariate analysis were symptomatic lesions and the absence of a driver mutation. Driver mutation status was only an independent prognosis factor in multivariate analysis. On lung-mol GPA score, the patients greater than or equal to 2.5 were significantly better prognosis compared with less than 2.5 (median OS: 40.0 VS 10.0 months, respectively). Our cohort of 74 NSCLC patients with synchronous brain metastasis had a median OS of 23.0 months. This much longer OS may reflect recent advances in treatment, particularly the availability of molecular targeted drugs. Lung-mol GPA score was considered as a useful tool to estimate the prognosis; thus, the information of KPS score, extracranial metastasis, brain metastases numbers, and driver mutation status are essential to build a treatment strategy for synchronous brain metastasis from NSCLC.
MET-04 EVALUATION OF PERITUMORAL BRAIN PARENCHYMA USING CONTRAST-ENHANCED FIESTA IMAGING FOR DIFFERENTIATING METASTATIC BRAIN TUMORS AND GLIOBLASTOMAS
Authors: Yamamoto Junkoh , Kakeda Shingo , Korogi Yukunori , Saito Takeshi , Nakano Yoshiteru 
Published: December 2019

Abstract
Introduction: Metastatic brain tumors and glioblastomas commonly revealed heterogenous enhancement lesions with peritumoral brain edema on magnetic resonance imaging (MRI). In particular, distinguishing solitary metastatic brain tumors from glioblastomas is difficult on conventional MRI. Fast imaging employing steady-state acquisition (FIESTA) can emphasize the water content signal with a high spatial resolution. In this study, we evaluate a role of contrast-enhanced FIESTA(CE-FIESTA) by focusing on the peritumoral brain parenchyma between metastatic brain tumors and glioblastomas. Materials and Methods: We included patients who underwent initial surgery and were histologically diagnosed with metastatic brain tumor (43 cases) or glioblastoma (14 cases) between November 2008 and May 2016. We evaluated CE-FIESTA findings of peritumoral brain parenchyma. Next, we performed an observer performance study with neuroradiologists based on the findings of peritumoral brain parenchyma using conventional MRI and CE-FIESTA. Results: CE-FIESTA revealed hyperintense rim in peritumoral brain parenchyma. We classified hyperintense rim in three groups, as follow: type A, no hyperintense rim; type B, partial hyperintense rim; and type C, extended hyperintense rim. Regarding the diagnosis of metastatic brain tumors, the observer performance demonstrated high sensitivity (95.3%), specificity (85.7%) and accuracy (93.0%) of type C on CE-FIESTA, and thus, CE-FIESTA could distinguish metastatic brain tumors from glioblastomas with high accuracy. Conclusions: CE-FIESTA may provide useful information for distinguish metastatic brain tumors from glioblastomas, focusing on the differences in the peritumoral brain parenchyma.