bluuebunny/crossref_metadata_2025_split huggingface dataset:
NCOG-03. FACTORS ASSOCIATED WITH ADJACENT LEVEL TUMOR PROGRESSION IN PATIENTS RECEIVING SEPARATION SURGERY FOLLOWED BY SPINE STEREOTACTIC RADIOSURGERY FOR METASTATIC EPIDURAL SPINAL CORD COMPRESSION
Authors: Chakravarthy Vikram , Khan Hammad , Srivatsa Shaarada , Knusel Konrad , Emch Todd , Krishnaney Ajit 
Published: December 2020

Abstract

INTRODUCTION
Separation surgery followed by spine stereotactic radiosurgery (SSRS) has been shown to achieve favorable rates of local tumor control and patient-reported outcomes in patients with metastatic epidural spinal cord compression (MESCC). If left untreated, MESCC causes severe pain, progressive neurological impairment, and eventual paraplegia with a median survival of 3-6 months. The present study aimed to identify factors associated with adjacent level progression and examine its impact on overall survival (OS) in this population.

METHODS
This study included 39 patients who received separation surgery followed by SSRS for MESCC. Preoperative, postoperative, and post-SSRS MRIs were used to measure amount of epidural disease, amount of local bone marrow involvement, and adjacent level epidural (AEP) and osseous (AOP) progression. Factors associated with AEP and AOP were examined using the log-rank test and cox proportional hazards modeling.

RESULTS
Median OS in our cohort was 14.7 mo (2.07-96.3). AEP and AOP were observed in 4/39 (10.3%) and 16/39 (41.0%) patients at a mean of 6.1±5.4 mo and 5.3±5.3 mo post-SSRS, respectively. AEP (7.52 vs. 17.1 mo, p = 0.014) and AOP (13.0 vs. 17.1 mo, p = 0.047) were each significantly associated with decreased OS. Factors associated with AEP included primary tumor histology, low-dose hypofractionated SSRS, increased time from surgery to SSRS, and greater amount of local epidural disease preoperatively (p &lt; 0.05). Factors associated with AOP included greater amount of local bone marrow infiltration by tumor pre- and postoperatively and greater amount of local epidural disease postoperatively (p &lt; 0.05). Primary tumor histology and increased time from surgery to SSRS were associated with AOP by trend (p &lt; 0.10).

CONCLUSION
This study identifies factors associated with adjacent level progression and shows that AEP and AOP are associated with shorter OS in patients receiving separation surgery followed by SSRS for MESCC.
NCOG-05. MANAGEMENT OF BRAIN METASTASIS IN TRIPLE NEGATIVE BREAST CANCER
Authors: Medikonda Ravi , Srivastava Siddhartha , Kim Timothy , Xia Yuanxuan , Patel Mira , Jackson Christopher , Theodros Debebe , Kim Jennifer , Kleinberg Lawrence , Redmond Kristin , Weingart Jon , Mukherjee Debraj , Bettegowda Chetan , Gallia Gary , Brem Henry , Lim Michael 
Published: December 2020

Abstract
Brain metastasis is common in patients with breast cancer, and those with triple negative status have an even higher risk. Stereotactic radiosurgery (SRS) is preferred to whole brain radiation therapy (WBRT) in most patients. However, triple negative status is currently not considered when determining optimal radiation therapy. Given the aggressive nature of triple negative breast cancer, we evaluated a role for WBRT for all patients in this cohort. We conducted a single-institution retrospective cohort study to determine whether triple negative patients with brain metastases have a higher burden of intracranial disease and whether type of initial radiation therapy affects overall survival for this cohort of patients. 85 patients met the inclusion criteria for this study. 25% of patients had triple negative breast cancer, of which 91% received SRS and 53% of patients received WBRT. The average number of new brain metastases from time of initial brain imaging to radiation therapy was 0.67 (St.Dev:1.1) in the non-triple negative status patients and 2.6 (St. Dev:3.7) in the triple negative status patients (p=0.001). Using a cox proportional hazards model, it was found that whole brain radiotherapy does not significantly affect overall survival in patients with triple negative breast cancer (p = 0.96). Our findings highlight the highly aggressive intracranial nature of triple negative breast cancer. Indeed, the rate of increase in brain metastases is significantly higher for triple negative patients compared to non-triple negative patients. As a result, we evaluated whether triple negative patients would benefit from whole brain radiation regardless of findings on initial brain imaging. Despite 53% of patients receiving WBRT, our investigation found that there is no additional benefit to WBRT in triple negative breast cancer patients. These results suggest a need to re-evaluate the role of WBRT in the management of triple negative breast cancer.
NCOG-10. ASSESSMENT OF SURVIVAL AND SAFETY FOLLOWING INTRATHECAL CHEMOTHERAPY VIA OMMAYA RESERVOIR FOR LEPTOMENINGEAL DISEASE
Authors: Shah Shiv , Butterfield Richard , Bendok Bernard , Lyons Mark , Ariete John , Yancey Eric , Mrugala Maciej 
Published: December 2020

Abstract

INTRODUCTION
Leptomeningeal disease (LMD) is an aggressive, late-stage complication of systemic cancers that maintains a poor prognosis with an average survival of 3-6 months. Ommaya reservoirs (OR) are an accessible alternative to serial lumbar punctures for the delivery of intrathecal chemotherapy in the treatment of LMD. However, widespread use of OR has been limited by reports of complications, limited physicians trained in their use, and the stigma of brain surgery. Here, we assess survival and complication rates for patients who received intrathecal chemotherapy through OR for LMD treatment.

METHODS
After IRB approval, chart review of patients who received at least one administration of intrathecal chemotherapy through OR for LMD treatment between 2017- 2020 at Mayo Clinic in Phoenix, Arizona was conducted. Charts were reviewed for demographics, treatment type, complications, and outcomes.

RESULTS
A total of 10 patients were included. The median overall survival from date of first OR injection was 110.5 days (95% CI: 64 – not estimable). The median time to progression from the first injection was 55.5 days (95% CI: 45 – 753). A total of 82 OR injections were conducted for an average of approximately 8 injections per patient. Two patients (20%) experienced mild adverse events – grade 2 or lower by Common Terminology Criteria for Adverse Events with a single injection. The majority of injections involved no adverse events with the overall risk of any complication at 2.4%. None of the patients experienced infection, a commonly reported complication of OR use.

CONCLUSIONS
Our results support the inclusion of intrathecal chemotherapy via OR into the treatment paradigm in patients with leptomeningeal malignancies. This approach is feasible, safe, and median survival is comparable with data reported in published series. The overall complication rate in patients receiving intrathecal chemotherapy through OR is very low including the risk of infection.
NCOG-23. PATTERNS OF DISTRESS IN OLDER PATIENTS WITH GLIOBLASTOMA: A FOLLOW-UP TO A SINGLE INSTITUTION CROSS-SECTIONAL STUDY OF DISTRESS IN PRIMARY BRAIN TUMOR PATIENTS
Authors: Johnson Margaret , Herndon James , Lipp Eric , Affronti Mary , Desjardins Annick , Bhattacharya Manisha , Friedman Henry , Ashley David , Peters Katherine , Randazzo Dina 
Published: December 2020

Abstract

INTRODUCTION
We previously reported to SNO, high levels of psychosocial distress in adult patients with primary brain tumors (PBTs), particularly during the first 6 months following diagnosis. The purpose of this follow-up study was to identify patterns of distress among older (≥ 65 years) patients with glioblastoma (GBM) compared to their younger (ages 18-64) counterparts.

METHODS
In our initial cross-sectional study, we collected the National Comprehensive Cancer Network’s Distress Thermometer (NCCN-DT) and problem list from adult patients with PBTs (WHO grades I-IV) seen at our institution between December 2013 and February 2016. We performed subsequent analyses on a subset of patients with GBM.

RESULTS
We identified 343 patients with GBM from the original dataset, of which 23.0% (n= 78) were ≥ 65 years old. The proportion of patients ≥ 65 years old with elevated distress (i.e. DT ≥ 4) was greater than the proportion of younger patients reporting elevated distress (47.4% vs 30.6%; p= 0.0068). Elevated distress was significantly greater during the first 6 months post diagnosis for all ages (p= 0.008). In subgroup analyses, a decrease in distress beyond 6 months was seen in younger patients (45.7% vs 27.4%; p= 0.021), but not in older patients. In older patients, a greater number of problems were selected on the NCCN DT and problem list tool: emotional and physical concerns were reported more frequently compared to their younger counterparts. Older patients were more likely to report difficulty with “bathing” and “getting around” (p= 0.009, p&lt; 0.001, respectively). There were no differences in older versus younger GBM patients with regard to housing, transportation, treatment decisions, depression, fatigue, or memory.

CONCLUSIONS
In contrast to their younger counterparts, older patients with GBM experienced elevated levels of distress and a greater absolute number of specific psychosocial problems, mostly related to emotional and physical concerns.
NCOG-25. EFFICACY OF ANTICONVULSANT THERAPY IN GLIOMA PATIENTS
Authors: Medikonda Ravi , Patel Kisha , Saleh Laura , Srivastava Siddhartha , Jackson Christina , Mohan Aditya , Shah Pavan , Weingart Jon , Bettegowda Chetan , Gallia Gary , Brem Henry , Lim Michael 
Published: December 2020

Abstract
Gliomas account for 30% of primary brain tumors and can frequently present with seizures. There are few guidelines for usage of anticonvulsant therapy in glioma patients. Some clinicians utilize anticonvulsant therapy in all glioma patients as a means of prophylaxis, whereas other clinicians prescribe anticonvulsant therapy only in patients that experience seizures. In this single-institution retrospective cohort study, we evaluate the effect of commonly prescribed anticonvulsant levetiracetam on incidence of post-operative seizures and overall survival in primary glioma patients. 436 patients met the inclusion criteria for this study. 35% of patients presented with a pre-operative seizure and 63% of patients received pre-operative Levetiracetam. The incidence of a seizure within 1 year of tumor resection was 31%. On multivariate logistic regression analysis of patient pre-operative clinical and imaging characteristics, it was found that only a pre-operative seizure (p = 0.02) significantly increased the odds of a post-operative seizure within 1 year of tumor resection. Neither pre-operative levetiracetam (p = 0.31), intra-operative levetiracetam (p = 0.59), or post-operative levetiracetam (p = 0.75) significantly reduced the odds of a post-operative seizure. Using a cox proportional hazards model, pre-operative levetiracetam (p = 0.11), intra-operative levetiracetam (p = 0.34), and post-operative levetiracetam (p = 0.88) do not significantly affect overall survival. Our findings reveal that glioma patients are often prescribed anticonvulsant medication regardless of whether they have had a pre-operative seizure. Most patients also receive anti-convulsant medication in the peri-operative and post-operative setting regardless of whether they have had pre-operative or immediate post-operative seizures. Use of pre-operative or intra-operative levetiracetam as a prophylactic measure does not impact the incidence of post-operative seizures. Furthermore, anti-convulsant therapies do not demonstrate a survival benefit in our study. These results provide a rationale for re-evaluating the use of anti-convulsant medications in glioma patients that do not have seizure symptoms.
NCOG-33. HEMATOLOGIC PREDICTORS OF OUTCOMES IN GLIOBLASTOMA TREATED WITH SURGERY AND CHEMORADIATION
Authors: Damico Nicholas , Elder Theresa , Kharouta Michael , Sloan Anthony , Kerstetter-Fogle Amber , Harris Peggy , Kumar Aryavarta , Mansur David , Machtay Mitchell , Bhatt Aashish , Buerki Robin , Sloan Andrew E , Choi Serah 
Published: December 2020

Abstract

BACKGROUND
There are conflicting reports regarding the prognostic value of platelet and other blood counts in glioblastoma. However, few series have looked at all hematologic parameters simultaneously.

METHODS
We performed a retrospective chart review of patients diagnosed with supratentorial glioblastoma from 2014-2019 who started conventional chemoradiation following initial surgical biopsy and/or resection. Hematologic parameters were collected at baseline, in the preoperative and postoperative periods and at the initiation and completion of chemoradiation. This included platelet counts, hemoglobin levels, white blood cell counts (WBC), neutrophil and lymphocyte counts with neutrophil:lymphocyte (NLR) and platelet:lymphocyte ratios (PLR) calculated at each time point. Cox regression was performed to assess the association between each hematologic parameter and both overall survival (OS) and progression free survival (PFS). A multivariate Cox proportional hazards model adjusted for all hematologic parameters, age, sex, race and KPS was generated for each time point. All hematologic parameters were modeled as continuous variables.

RESULTS
A total of 58 patients met inclusion criteria. 18 were female and 40 male. The median age was 59.5 (range 43-82). Median follow up for all patients was 15.3 months. A total of 52 patients completed radiation therapy and 18 completed 6 cycles of adjuvant chemotherapy. Hemoglobin and neutrophil counts at the conclusion of chemoradiation were associated with OS and PFS on univariate and multivariate analyses. The HR for OS were 0.74 (95% CI 0.5807-0.9313) and 1.28 (1.143-1.441) respectively. The HR for PFS were 0.70 (0.5531-0.8881) and 1.16 (1.05-1.271) respectively. Postoperative lymphocyte and platelet counts at initiation of chemoradiation were both associated with OS with unadjusted HR of 3.2 (1.037-9.960) and HR of 0.99 (0.9898-0.9999) respectively, which remained significant on multivariate analysis. However, neither were associated with PFS.

CONCLUSION
Several hematologic parameters are associated with glioblastoma outcomes in these initial analyses. Further analyses with additional patients are ongoing.
NCOG-35. PREDICTORS OF POSTOPERATIVE SEIZURES IN PATIENTS WITH GLIOBLASTOMA MULTIFORME
Authors: Zhang Yue , Dincer Alper , Feld Noah , Carr Matthew , Zhang Lily , Opalak Charles , Rock Andrew , Broaddus William 
Published: December 2020

Abstract

INTRODUCTION
Seizures are a major cause of morbidity in patients with GBM, resulting in neurocognitive deficits and reduced QOL. There are limited studies on the predictors of postoperative seizures in these patients. Furthermore, there is no consensus among neurosurgeons on the timing of perioperative use of antiepileptic drugs (AEDs). The objective of this study is to determine patient- and tumor-related factors associated with postoperative seizures in GBM patients who undergo surgical resection.

METHODS
Our patient data registry was queried for adult patients treated for GBM at VCU from 2005 to 2014. Univariate and multivariable logistic regression analyses were performed to identify patient and tumor factors associated with postoperative seizure within a 12 month period. Cox proportional hazards regression analysis was used to evaluate the overall risk of postoperative seizure.

RESULTS
146 patients met the criteria for the study. Of these, 39 patients (27%) experienced a postoperative seizure within 12 months. On univariate analysis, factors significantly associated with postoperative seizure within 12-months included percent (%) of FLAIR volume resected (OR: .81; CI: 0.65-0.99; p=.046), history of AED use (OR: 2.51; CI: 1.20-5.25; p = 0.015), and history of seizure (OR: 2.26, CI: 1.07-4.76; p=0.033). On multivariate analysis, % FLAIR resection maintained significance. (OR of 0.79; CI: .63-.99; p = 0.044). The increased overall risk of postoperative seizure was associated with preoperative seizure &lt; 30 days before surgery. (HR:6.65, CI: 1.02-43.36, p=0.048).

DISCUSSION
Our study found that the increased extent of resection of FLAIR volume correlates with decreased odds of seizure occurrence in the 12-month postoperative period. Epileptogenesis of GBM seizures within this time period may be due to tumor-related edema or infiltrative tumor cells. Evaluation of FLAIR imaging postoperatively may be a useful clinical tool to guide AED management in high-risk patients.
NCOG-36. FIRST HEALTH UTILITIES OF GLIOBLASTOMA PATIENTS USING TTFIELDS TREATMENT
Authors: Chavez Gordon , Proescholdt Christina 
Published: December 2020

Abstract

BACKGROUND
Despite the importance of Health State Utilities for health policy and medical decision making, there are no publications that provide high quality utility values estimated from glioblastoma multiforme (GBM) patients. Published health economic evaluations for GBM treatments rely on utilities determined by Garside et al. (2007), which used the standard gamble method in healthy panel members of the UK National Health System. There are no published utilities for GBM estimated from a general population sample, and there are no utility estimates whatsoever for Tumor Treating Fields (TTFields) users.

METHODS
We designed a study to remedy this major deficit by eliciting utilities directly from GBM patients using the EuroQol 5-Dimension (EQ-5D) survey. The EQ-5D is a widely used and NICE-recommended tool for the estimation of health state utilities. The survey is composed of a questionnaire that asks patients to specify their health state along 5 dimensions: Mobility, Self-Care, Usual Activities, Pain/Discomfort, and Anxiety/Depression. Statistical models provided by EuroQol’s network of researchers convert this data into health state utility estimates.

RESULTS
The EQ-5D questionnaire is administered to active patients using TTFields treatment during the study duration, allowing the elicitation of health preference measures for different glioblastoma health states based on: progression status (progressed vs. non-progressed), current treatments (TTFields only vs. TTFields + others) and time-from-diagnosis (0-12 months vs. &gt; 12 months)

CONCLUSION
These results are important for understanding the patient preferences using TTFields treatment and communicating these preferences to decision makers. This study is the first to provide direct, high quality utility measures in glioblastoma patients using TTFields treatment.
NCOG-45. FIRST-LINE ANTIEPILEPTIC DRUG TREATMENT IN GLIOMA PATIENTS WITH EPILEPSY: LEVETIRACETAM VERSUS VALPROIC ACID
Authors: van der Meer Pim , Dirven Linda , Fiocco Marta , Vos Maaike , Kouwenhoven Mathilde , van den Bent Martin , Taphoorn Martin , Koekkoek Johan 
Published: December 2020

Abstract

BACKGROUND
Levetiracetam and valproic acid are two of the most commonly prescribed antiepileptic drugs (AEDs) in patients with a glioma and epilepsy. This study aimed at estimating the cumulative incidence of treatment failure of first-line monotherapy levetiracetam versus valproic acid in glioma patients with epilepsy.

METHODS
In this retrospective observational study, a competing risk model was used to estimate the cumulative incidence of treatment failure, from AED treatment initiation, for the two AEDs with death as competing event. Patients were matched on baseline covariates potentially related to treatment assignment and/or outcomes of interest according to the nearest neighbour propensity score matching technique. Secondary outcomes were the cumulative incidence of recurrent seizure, from AED treatment initiation (estimated with a competing risk model), and severity of adverse effects. Maximum duration of follow-up was 36 months.

RESULTS
In total, 776 patients using levetiracetam and 659 using valproic were identified. Matching resulted in two equal groups of 429 patients, with similar covariate distribution. The cumulative incidence of treatment failure (any reason) at 12 months for levetiracetam and valproic acid was equal to 33% (95%CI=29-38%) versus 50% (95%CI=45-55%), respectively (p&lt; 0.001). The cumulative incidence of treatment failure due to uncontrolled seizures was significantly lower for levetiracetam compared to valproic acid (12 months: 16% [95%CI=12-19%] versus 28% [95%CI=23-32%]; p&lt; 0.001), but no differences were found for treatment failure due to adverse effects (12 months: 14% [95%CI=11-18%] versus 15% [95%CI=11-18%]; p=0.636). The cumulative incidence of recurrent seizure of levetiracetam was significantly lower compared to valproic acid (12 months: 54% [95%CI=49-59%] versus 67% [95%CI=62-71%]; p&lt; 0.001). No significant differences were found for level of toxicity.

CONCLUSION
Our results suggest that levetiracetam has superior efficacy compared to valproic acid, while showing a similar level of toxicity. Therefore, levetiracetam seems the preferred choice for first-line AED treatment in glioma patients.
NCOG-47. CAN YOUNG CHILDREN WITH RELAPSED MEDULLOBLASTOMA BE SALVAGED AFTER INITIAL IRRADIATION-SPARING APPROACHES?
Authors: Erker Craig , Larouche Valérie , Aguilera Dolly , Margol Ashley , Cacciotti Chantel , Perreault Sébastien , Cohen Kenneth J , AbdelBaki Mohamed , Hukin Juliette , Rassekh Shahrad Rod , Eisenstat David D , Wilson Beverly , Hoppman Anna L , Dhall Girish , Holly Taylor , Knipstein Jeffrey , Sandler Eric S , Klawinski Darren , Dorris Kathleen , Fay-McClymont Taryn B , Salloum Ralph , Harrod Virginia L , Crooks Bruce , Ramaswamy Vijay , Finlay Jonathan , Bouffet Eric , Lafay-Cousin Lucie 
Published: December 2020

Abstract

INTRODUCTION
Irradiation-sparing approaches are used in young children with medulloblastoma (MB) given the vulnerability of the developing brain to neurocognitive impairment. Limited data are available following relapse for these patients. We aimed to describe the management and outcomes of young children with MB who relapsed after initial treatment without craniospinal irradiation (CSI).

METHODS
International retrospective study including patients with MB diagnosed between 1995-2017, ≤ 72 months old, initially treated without CSI, who subsequently relapsed.

RESULTS
Data are available for 66 patients. The median age at initial diagnosis was 27 months (range, 6-72). At diagnosis, 27 patients had metastatic disease. Initial therapy included conventional chemotherapy or with high-dose chemotherapy (HDC) in 30 and 36 patients, respectively. Eight (12.1%) received upfront focal irradiation. Molecular subgrouping was available for 27 (41%) patients. Ten were SHH, five group 3, six group 4 and six others were non-WNT/non-SHH. The median time from initial diagnosis to relapse was 13 months (range, 3-63). Relapse was local, disseminated, or combined in 39%, 32%, and 29%, respectively. The median time to death from relapse was 18 months. Curative intent therapy was given in 53 patients with irradiation (81%), conventional chemotherapy without HDC (40%), and HDC (25%). For patients who received irradiation, 85% received CSI (median dose 33 Gy, 18-41.4) and 15% focal irradiation. Ten patients received chemotherapy without salvage irradiation. The median follow-up time was 44 months (range, 4-255), 33 (62%) patients who underwent curative-intent therapy were alive, including 8/10 SHH, 2/3 group 3, 2/6 group 4, and 4/5 non-WNT/non-SHH. Three of four patients with SHH and treated without salvage radiotherapy are survivors. The 5-year OS for curative intent was 70%.

CONCLUSION
A substantial proportion of young children who relapse following irradiation-sparing strategies can be salvaged. A proportion of children with SHH MB can be salvaged without salvage radiotherapy.