bluuebunny/crossref_metadata_2025_split huggingface dataset:
NQPC-08 Short-time intensive rehabilitation for patients with newly diagnosed glioblastoma
Authors: Matsutani Masao , Ideguchi Makoto , Maeda Takeshi , Okamura Daijiro , Muraya Shoichi , Katoh Momoka 
Published: November 2020

Abstract
PURPOSE: Many reports presented that patients with GBM had stable HRQoL during their remission time. However, there are few reports on the situation of ADL that is the basis of QOL. This prospective study was designed to evaluate the effectiveness of intensive rehabilitation for physically disabled patients with GBM after the initial treatment. PATIENTS and METHOD: Sixteen patients with newly-diagnosed glioblastoma presenting with severe physical disabilities were registered after the completion of postsurgical radiation therapy combined with TMZ. All patients were evaluated by means of a core set of clinical scales of Functional Independence Measure (FIM), Sitting Balance score, Standing Balance score, and Mini-mental State Examination (MMSE). Patients were evaluated before the beginning and at the end of rehabilitation treatment. The daily rehabilitation program consisted of individual 180-min. sessions of treatment, seven days a week, for four to six consecutive weeks. Speech therapy was included when aphasia was diagnosed. RESULTS: Fifteen of 16 patients presented with improved physical functioning score, and seven of 16 patients returned to their independent life at home, CONCLUSION: A short-time intensive rehabilitation (4 to 6seeks) is effective for GBM patients during TMZ withdrawal period after the postoperative radiation therapy. This effective program requires close teamwork with the medical cooperation teams in the medical and rehabilitation hospitals: explanation to patients of the significance of the short-term rehabilitation, which is different from stroke rehabilitation, adjustment of hospitalization date considering radiotherapy and chemotherapy schedule, and adjustment of MRI imaging or bevacizumab administration schedule during rehabilitation.
ML-02 Chemotherapy for patients with relapsed or refractory primary CNS lymphoma
Authors: Nagane Motoo , Sasaki Nobuyoshi , Kobayashi Keiichi , Saito Kuniaki , Shimada Daisuke , Matsumoto Yoshie , Iijima Shohei , Yamagishi Yuki , Shimizu Saki , Sasaki Yuta , Shiokawa Yoshiaki 
Published: November 2020

Abstract
BACKGROUNDS: Standard of care for patients with primary CNS lymphoma (PCNSL) has been high-dose methotrexate (HD-MTX)-based multiagent immunochemotherapy, particularly with R-MPV-A with or without whole-brain radiotherapy (WBRT), however, the optimal treatment for relapsed/refractory (r/r)PCNSL has not been established yet. Approval of a second-generation BTK inhibitor, tirabrutinib, for r/rPCNSL in Japan in March 2020, prompted us to evaluate retrospectively efficacy of R-MPV-A for r/rPCNSL to compare their activities. PATIENTS: Histologically proven PCNSL patients treated at relapse in our institution from April 2000 to November 2019 were analyzed. Outcomes were compared between those treated with RMPVA or other regimens. RESULTS: Among 148 PCNSL patients identified, 73 had at least one relapse, of whom 47 received salvage chemotherapy including 23 treated with RMPVA, 14 with HD-MTX monotherapy, and 11 with DeVIC (DEX, etoposide, ifosfamide, CDBCA). Median age/KPS were 69 yo (20–87)/ 80 (40–100), 27 patients had received prior WBRT. RMPVA was given at the first relapse in 11 patients, median number of RMPV cycles was 8 (1–4 cycles: 10; 8 cycles 13). CR/CRu were achieved in 19 (83%), response rate was 87%, while there were two PDs (9%). After median follow-up of 21.9 months, the median PFS after salvage RMPVA was 13.0 m (95%CI: 9.1–16.9), 1-year overall survival (OS) was 82%, median OS was 70.0 m (95%CI: 12.9–127.1), which were longer than those in 24 patients with salvage treatment other than RMPVA (mPFS 4.4 m, P=0.054; mOS 13.6 m, P=0.009). Median PFS and OS for HD-MTX monotherapy were 5.1m and 36.6 m, while those for DeVIC were 4.4 m and 9.1 m, respectively. Treatment was generally well-tolerated but there was one treatment-related death. CONCLUSIONS: Salvage RMPVA at relapses was active and associated with longer survival compared with other regimens, necessitating further development of salvage regimens incorporating tirabrutinib in the future studies.
ML-09 The REAL-WORLD of Elderly PCNSL Therapy in Tohoku and Niigata Area According to Retrospective Analysis: A Collaborative Investigation of the Tohoku Brain Tumor Study Group
Authors: Asano Kenichiro , Yamashita Yoji , Ono Takahiro , Natsumeda Manabu , Beppu Takaaki , Matsuda Kenichiro , Ichikawa Masahiro , Kanamori Masayuki , Matsuzaka Masashi , Kurose Akira , Saito Kiyoshi , Sonoda Yukihiko , Ogasawara Kuniaki , Fujii Yukihiko , Shimizu Kuniaki , Ohkuma Hiroki , Kitanaka Chifumi , Kayama Takamasa , Tominaga Teiji 
Published: November 2020

Abstract
Introduction: Recently, the number of cases of primary central nervous system lymphoma in elderly patients(EL-PCNSL) has been increasing. However, the treatment may be insufficient because of poor performance status and pre- and posttreatment complications. Therefore, we analyzed the risk factors for EL-PCNSL in the Tohoku and Niigata areas of Japan and clarified the REAL-WORLD of EL-PCNSL therapy. Materials & Methods: We investigated surgical and nonsurgical cases of patients aged 71 years or older from eight facilities during the last 8 years. We analyzed patient information, radiotherapy/chemotherapy or not, PFS, OS, RRs, second-line therapy, pre- and posttreatment complications, outcomes, and risk factors for poor prognosis. The log-rank test was used for univariate analysis, and Cox regression analysis was used for a multivariate analysis of risk factors. Results: Of the 142 cases registered, five differed from PCNSL pathologically, three receiving BSC were excluded, 31 were treated without biopsy, three were treated based on CSF-findings, and 100 were treated with biopsy. Total 134 cases were followed. The median age was 76 years, pretreatment KPS was 50%, and 118 cases(88%) had 217 pretreatment complications. The treatment contents consisted of various combinations depending on the attending physician. The retrospective overall PFS was 16 months and OS was 24 months. In the early treatment phase, out of 16 cases with dropout, four tumor and four complication deaths occurred. There were 77 deaths(58%), 39 internal tumor deaths(51%), and 33 complication deaths(43%). Poor prognostic risk factors were &lt;60% posttreatment KPS, complications involving pretreatment cardiovascular and central nervous system disease, posttreatment pneumonia or severe infection, and absence of radiation or chemotherapy. Conclusions: Pretreatment KPS did not affect poor outcomes, but posttreatment KPS &lt;60% and pre- and posttreatment complications did. Radiotherapy and chemotherapy are reportedly effective, but additional research to clarify the details of these modalities is needed.
ML-13 The primary treatment outcomes and future problems of PCNSL elderly patients in our institute
Authors: Kambe Atsushi , Amisaki Hidefumi , Kuwamoto Yuhei , Shimizu Tsuyoshi , Nakajima Sadao , Torihashi Koichi , Uno Tetsuji , Sakamoto Makoto , Kurosaki Masamichi 
Published: November 2020

Abstract
Background and purpose: Since the introduction of HD-MTX, cognitive symptoms after irradiation have become a problem mainly in elderly patients. In this study, we evaluated the treatment outcomes of over 70 years old PCNSL patients after HD-MTX introduction. Subjects and methods: From April 2009 to December 2019, there were 46 cases of PCNSL patients who had been treated in our institute. The HD-MTX treatment group had 42 cases and the R-MPV-A treatment group had 4 cases. In the HD-MTX treatment group, 30–40 Gy of whole brain irradiation was performed (n=32), but cases of SRS or no irradiation (n=10) were included due to poor PS. The R-MPV-A treatment group was performed with whole brain 23.4 Gy + local 21.6 Gy or no irradiation. The remission rate and outcome (mOS) were examined. Results: The background of all 46 patients was 28 males and 18 females, with an average age of 75.8 years (70–87 years). The pathological diagnosis was DLBCL in all cases. The remission rate after chemotherapy in the HD-MTX treatment group was 52.4% (22/42). The post-irradiation remission rate was 78.6% in cases of whole-brain irradiation (n=14) among non-remission cases (n=20). The mOS of the whole-brain irradiation cases was 58.5 months (n=18) in the remission cases (n=22), but was 38.7 months (n=14) in the non-remission cases (n=20). The mOS of patients with SRS or no irradiation (n=10) was 12.4 months. The R-MPV-A treatment group (n=4) had a remission rate of 100% after chemotherapy. Of the 26 cases whose cause of death could be identified in the HD-MTX treatment group, 58% (15/26) had tumor-related death and 30% (8/26) had pneumonia or suffocation. Conclusion: R-MPV-A has a high remission rate even in elderly patients, and if the irradiation dose can be reduced or avoided with R-MPV-A, ADL maintenance will be expected in elderly patients.
ML-20 Outcome of high-dose methotrexate-based chemotherapy with or without Rituximab for primary central nervous system lymphoma
Authors: Takezaki Tatsuya , Ota Kazutaka , Kuroda Junichiro , Shinojima Naoki , Takeshima Yuki , Matsuura Jin , Yamamoto Takahiro , Makino Keishi , Mukasa Akitake 
Published: November 2020

Abstract
High-dose methotrexate based chemotherapy(HD-MTX) improved outcome of primary central nervous system lymphoma(PCNSL), but the prognosis is still poor. Recent studies showing that Rituximab is very effective for systemic lymphoma, the role of Rituximab for PCNSL is unclear. 34 patients diagnosed PCNSL received HD-MTX chemotherapy adding rituximab. Response rates were 74%(20/27) for newly diagnosed PCNSL patients, 85.7%(6/7) for recurrent PCNSL patients. Major side effects were infusion reaction and respiratory infections disease. We have to compare the outcome of HD-MTX chemotherapy retrospectively.
ML-21 Tirabrutinib monotherapy for relapsed/refractory primary central nervous system lymphoma
Authors: Kobayashi Keiichi , Sasaki Nobuyoshi , Saito Kuniaki , Yamagishi Yuki , Matsumoto Yoshie , Sasaki Yuta , Shimizu Saki , Shiokawa Yoshiaki , Nagane Motoo 
Published: November 2020

Abstract
Backgrounds & purpose: Prognosis of patients with primary central nervous system lymphoma (PCNSL) remains poor despite multiagent immunochemotherapy, and standard of care for relapsed or refractory (r/r) PCNSL has not been established. Recent progresses on molecular genetics and biology of PCNSL have led to development of novel molecular targeted therapies, especially targeting Bruton’s tyrosine kinase (BTK), located in the B-cell receptor and Toll-like receptor signaling pathways. Tirabrutinb, a second generation BTK inhibitor, was approved for r/rPCNSL in March 2020 in Japan. Methods: Patients with r/rPCNSL treated with tirabrutinib since December 2017 were eligible for this retrospective study. Tirabrutinib was given orally at doses 320–480 mg/day daily until progression or unacceptable toxicity. Results: A total of 7 patients were enrolled (6 relapses, 1 refractory), 4 males, median age was 73 (range, 54–80 years), and median KPS was 70 (70–90). Three patients had received prior whole brain radiotherapy. Median number of prior therapies was 1 (1–2). Best overall response rate was 57.1%; 42.9% with a complete response (CR/CRu), 14.3% with a partial response (PR), while there were 3 PDs (42.9%). Four patients experienced PD and estimated median progression-free survival (mPFS) was 29.6 months. All patients were alive at the data cutoff with median follow up of 21.4 months (2–30.4). Common adverse events (AEs) include grade 4 neutropenia (n=1), grade 3 lymphopenia (n=3), and hepatic dysfunction (n=1). Toxic rash was observed in four patients (grade 3 in one, grade 2 in three) leading to discontinuation of tirabrutinib in two patients, while others continued on TIR with dose reduction and steroid use. The median time to rash presentation was 28 days (12–28). Conclusions: Tirabrutinib was well tolerated with frequent minor to moderate skin rash emerging within one month and active for r/rPCNSL. Long-term efficacy and safety profile need to be determined with a larger cohort.
ML-23 The outcome of malignant lymphoma of the central nervous system in a single institution
Authors: Kuwahara Kiyonori , Ohba Shigeo , Matsumura Kazuyasu , Higashiguchi Saeko , Kojima Daijiro , Muto Jun , Nakae Shunsuke , Nishiyama Yuya , Yamada Seiji , Adachi Kazuhide , Abe Masato , Hasegawa Mitsuhiro , Hirose Yuichi 
Published: November 2020

Abstract
Background: Although high dose-methotrexate therapy has been performed for primary central nervous system malignant lymphoma (PCNSL), R-MPV (rituximab, methotrexate (MTX), procarbazine and vincristine) therapy is currently the first line therapy for (PCNSL) in our hospital. This study examines the results of R-MPV therapy comparing with past treatment. Method/Subjects: Thirty-seven patients treated at our hospital from 2009 to 2020 were included. Overall survival time, progression free survival time, and toxicities were evaluated. Results: The average age of patients was 65.7 years. Patients included 21 males and 16 females. Thirty-six patients were diagnosed DLBCL by resected brain tumor tissues, and one was diagnosed DLBCL by vitreous biopsy. As initial treatment, rituximab±HD-MTX therapy (R±MTX group) was performed in 20 cases, HD-MTX therapy plus radiation (R±MTX+RT group) was performed in 12 cases, and RMPV therapy was performed in 5 cases (R-MPV group). Median OS of all cases was 69 months and median PFS was 38 months. Median OS was 69 months in R±MTX group and could not be calculated in R±MTX+RT, and R-MPV groups. Median PFS was 16 months and 56 months in R±MTX group and R±MTX+RT, respectively, and could not be calculated in the R-MPV group. Although the R-MPV group had a short follow-up period, the results were considered to be comparable to those of the R±MTX+RT group. On the other hand, grade 3/4 adverse events occurred in 50%, 25%, and 100%, respectively. Conclusion: R-MPV therapy may delay the timing of radiation and reduce the amount of radiation. On the other hand, the frequency of adverse events is high, and more strict management of treatment is required.
BT-09 Anhidrosis in neurohypophyseal germinoma treated with CBDCA and VP-16
Authors: Adachi Koji , Ansai Shinichi , Yamaguchi Fumio , Igarashi Yumi , Morita Akio 
Published: November 2020

Abstract
Introduction: Acquired generalized anhidrosis (AGA) is the disease with non-congenital, non-segmented diffuse sweating dysfunction and is associated with neurological signs and dysautonomia except for anhidrosis. Here we have experienced 2 cases of AGA in the patient with neurohypophyseal germinoma after carboplatin (CBDCA) plus etoposide (VP-16) (CARE) therapy. Relationship of AGA to neurohypophyseal germinomas and their treatment is discussed. Cases: We experienced two young (26 y/o and 27 y/o) female neurohypophyseal germinoma cases of anhidrosis. They received CARE as chemotherapy and whole ventricular irradiation. They showed heat retention 2 to 3 years after initial treatment without recurred germinoma. Because acetylcholine sweating test was negative and skin biopsy revealed normal sweat gland structure, the diagnosis of acquired idiopathic generalized anhidrosis (AIGA), idiopathic pure sudomotor failure subtype, was initially made. After steroid pulse therapy, sweat function recovered partially and completely. Discussion: AIGA and germinoma are both rare diseases. So, the present 2 cases have similar clinical settings, that anhidrosis may not be idiopathic but secondary. Affected responsible site of anhidrosis in the present cases is thought to be acetylcholine receptor in the sweat cells. The present cases did not have any known disease with anhidrosis and did not receive any medication which cause anhidrosis written in the statement of the virtues of a medicine. Commonly used drugs in both cases are infusion solutions, CARE and related drugs, hormone stimulating test agents. Recently anhidrosis is reported in a case of cancer of unknown primary tumor site after using CBDCA and PTX. Both of the present cases are used CBDCA, which may cause anhidrosis. Conclusion: CBDCA may attributed to the occurrence of AGA based on hypothalamic vulnerability.
COT-01 Experience of introducing alternating electric field therapy for an elderly glioblastoma patient living alone
Authors: Hayashi Nobuhide , Koyama Yoshiki , Tsuji Eisaku , Okada Hideo , Kuwata Toshikazu 
Published: November 2020

Abstract
Introduction: In December 2017, alternating electric field therapy (EFT) for glioblastoma was covered by insurance in Japan, but because of treatment complexity, the number of cases of introduction remains small, and the threshold for introduction is even higher for elderly patients living alone. Case presentation: The patient was an 84-year-old man, who are living alone, and an open biopsy was performed for a contrast-enhanced neoplastic lesion in the left frontal lobe. The clinical diagnosis was glioblastoma and Ki-67 was 60%. Following initial treatment, the tumor recurred within 1 month prior to the initiation of alternating EFT. Nonetheless, steroid was administered, he could not walk without aid and was forced get admitted on the day after the introduction, and rehabilitation treatment was instituted. Motor aphasia was slowly disappeared, and he could walk stably without help after 2 weeks and was discharged on day 28. Magnetic resonance imaging prior to discharge indicated that the tumor had shrunk and cerebral edema had ameliorated. Following discharge, the treatment could be continued with the help of a home-visiting nurse, and no adverse events were noted. Discussion: In the current case, treatment with temozolomide (TMZ) could not be conducted because of neutropenia, but alternating EFT may have been effective because of the high mitotic activity of the tumor. In Japan, from December 2017 to April 2020, alternating EFT was initiated in 440 patients, 5 (1.1%) of whom were patients living alone, including the current case. The other four were all men in their 50s and not elderly. Conclusion: In the case of elderly patients living alone, medical practitioners may be able to control the tumor by preparing the environment for alternating EFT for patients and keeping the patient willing to undergo treatment.
COT-02 The opening of tumor treating fields with online support system
Authors: Sadahiro Hirokazu , Sugimoto Kazutaka , Nomura Sadahiro 
Published: November 2020

Abstract
Background: EF-14 trial showed the efficacy of tumor treating fields (TTF), and TTF was approved as a standard therapy for glioblastoma. In TTF opening, Device Support Specialist (DSS) should explain how to use it for the patient and family. However no DSS does always stay in our Yamaguchi prefecture, and DSS has to come to our hospital across other prefectures. On the other hand, COVID-19 infection is still spreading and it is sometimes tough to move from a big city to countryside. Here, we would present the first experience of TTF opening with online DSS support. A case report: A 68 years old man had right hemiparesis. MRI showed multiple lesions in the left hemisphere, and biopsy showed glioblastoma. After 1 month from chemo and radiotherapy, TTF was introduced. DSS from Tokyo explained how to use TTF via PC camera with TV monitor. A skilled neurosurgeon and special nurse also helped them in front of him. His head and the attached array were well checked from DSS with PC camera moving around him. Everything was smooth and he started TTF. Conclusion: Online medicine should be absolutely spreading. In countryside, it is hard that DSS comes to our hospital from a big city. TTF opening could be favorable via online system with skilled medical stuffs.
COT-08 Analysis of prognosis of biopsy/partial resection cases of malignant glioma
Authors: Yamamoto Yohei , Teshigawara Akihiko , Takei Jun , Tanaka Toshihide , Akasaki Yasuharu , Murayama Yuichi 
Published: November 2020

Abstract
Introduction: Malignant glioma is the most common and aggressive primary brain tumor and requires multimodality treatment. Regarding surgical treatment, it is desirable to achieve maximum resection while considering function preservation. There is consensus that the survival prognosis is prolonged in gross or subtotal resection. However, there are cases in which biopsy or partial resection is performed due to the spread of lesions at the time of onset, underlying diseases, and social background. The purpose of this study was to retrospectively analyze the cases of malignant glioma at our university and to find out the factors related to the prognosis of cases in which removal was insufficient.
Target: 55 cases of malignant glioma treated at our university since 2013 who underwent biopsy or partial resection.
Method: Overall/progression-free survival period is the end point, and parameters are age, bevacizumab use, pathological diagnosis, photodynamic diagnosis use at operation, immunotherapy, ventricular invasion, contralateral invasion, sex, preoperative Performance Status (PS), postoperative PS, left or right, navigation use, steroid use, anticonvulsant drug type, radiation, IDH mutation, 1p19q co-deletion, MGMT methylation, TERT mutation, p53 mutation, biopsy or partial resection. After narrowing down the evaluation items by univariate analysis(Logrank test), multivariate analysis(Cox proportional hazard model)was performed.
Result: The univariate analysis was significant in 5 items including bevacizumab use, radiation therapy, levetiracetam use, postoperative PS70 or higher, and partial resection instead of biopsy. Multivariate analysis detected two statistically significant differences, bevacizumab use and post-operative PS70 and above. There was no difference in the timing of bevacizumab use.
Consideration: In poorly resection cases, the weight of postoperative treatment is high, so continuity of treatment and selection of postoperative treatment are important, and maintenance of ADL and use of bevacizumab are significant among them.