bluuebunny/crossref_metadata_2025_split huggingface dataset:
MET-02 Neoadjuvant fractionated stereotactic radiotherapy followed by surgery for large brain metastasis with difficulty in en-block resection
Authors: Mitsuya Koichi , Deguchi Shoichi , Onoe Tsuyoshi , Yasui Kazuaki , Ogawa Hirofumi , Asakura Hirofumi , Harada Hideyuki , Hayashi Nakamasa 
Published: November 2020

Abstract
BACKGROUND: Large brain metastases which require resection are treated with surgery followed by whole brain radiation therapy or postoperative stereotactic radiosurgery (SRS). Recently a novel strategy using neoadjuvant stereotactic radiosurgery (Na-SRS) followed by surgery was reported, demonstrating lower rates of postoperative leptomeningeal dissemination (LMD) and symptomatic radiation necrosis (sRN). However, local control rate was not significantly improved. We treated with neoadjuvant fractionated stereotactic radiotherapy (Na-frSRT) followed by surgery for large brain metastasis with difficulty in en-block resection.
METHODS: Nine patients received Na-frSRT followed by surgery between July 2019 and June 2020. Na-frSRT dose was based on lesion size and was standard dosing. Surgery generally followed within 7 days after radiotherapy.
RESULTS: The mean age was 64 years (55–78). Eight men and one woman. Median follow-up period was 5.3 months (1.7–12.5). Primary cancers were non-small cell lung cancer 2, esophageal cancer 2, colon cancer 1, melanoma 1, hepato-cellular carcinoma 1 and recurrence of BM from small cell lung cancer and renal cell cancer. The median maximum tumor diameter was 4.3cm (2.6–4.9). The median SRT dose was 30Gy/5fr, and the median time from SRT to surgery was 4 days (1–7). Median PTV was 15.4ml (5.6–49.7), and median GTV was 21.7ml (8.6–61.4). As preoperative adverse event, intracranial hypertension grade2 (CTCAE ver.4.0) was occurred one patient, but controlled with steroid and osmotic diuretics. Grade 3 and more adverse events were not occurred. Gross total resection with intra-tumoral decompression and piece-meal technique was performed in all cases as planning. Event cumulative incidence as follows: surgical site recurrence 0%; local recurrence 11.1%; distant brain failure 11.1%; LMD 0%; and sRN 0%. The median overall survival was not reached.
CONCLUSIONS: Na-frSRT followed by surgery is safety and feasible, and may have therapeutic value for large brain metastasis. Further prospective investigations in multi-institutional settings are warranted.
MET-04 A case of Brain Metastases with repeated bleeding from Esophageal carcinoma
Authors: Mikai Masataka , Abe Mitsuyoshi , watanabe Yo , Nakada Chie , Huchinoue Yutaka , Terazono Sayaka , Uchino Kei , Ando Syunpei , Masuda Hiroyuki , Kondo Kosuke , Harada Naoyuki , Miyazaki Chikao , Onagi Atsuo , Sugo Nobuo 
Published: November 2020

Abstract
Brain metastases from esophageal cancer is rare and the incidence has been reported at approximately 5%. We report a case of brain metastases with repeated bleeding from Esophageal carcinoma. The case is a 76-year-old man. Three years ago he was diagnosed with small cell carcinoma of the esophagus by endoscopic biopsy. Metastasis was found only in the cervical lymph node, but the condition was stable by chemoradiotherapy and no metastases were found throughout the body before 1 month. He was admitted to the hospital because of a sudden convulsion, and CT scan revealed cerebral hemorrhage in the right frontal lobe. We performed conservative treatment, but rebleeding was observed from the same site repeatedly after 1 month and 2 months. Due to the influence of bleeding, it was difficult to distinguish cerebral hemorrhage from brain tumor by contrast MRI. After surgery, the cause of bleeding was diagnosed as metastatic brain tumor of esophageal small cell carcinoma. Postoperative radiation therapy was performed in another hospital, but rebleeding was observed 3 months after the operation. A reoperation was performed at another hospital, and a recurrence of metastatic brain tumor was diagnosed. In the case of highly malignant metastatic brain tumors, it was considered necessary to frequently follow the images.
MET-05 Clinical investigation of treatment results and recurrence patterns of metastatic brain tumors from the viewpoint of postoperative irradiation
Authors: Hashiba Tetsuo , Kawano Haruka , Ueno Katsuya , Lee Qiang , Isozaki Haruna , Lee Yi , Kamei Takamasa , Takeda Junnichi , Yoshimura Kunikazu , Nonaka Masahiro , Asai Akio 
Published: November 2020

Abstract
While whole brain radiation therapy (WBRT) had been the standard postoperative radiation therapy for metastatic brain tumors for long time, recently local radiation therapy (LRT) has be become to be a new standard due to the accumulation of clinical evidences. Treatment results and pattern of recurrence were retrospectively analyzed from view point of postoperative radiotherapy. In this study, totally 69 patients were included and they were divided into WBRT group or LRT group. We analyzed the number of lesions, treated era, overall survival after diagnosis of metastasis (OS), recurrence free survival after RT (RFS), and patterns of recurrences. The subjects consisted of 37males and 32 females and average age was 61.7 years old. There were 49 cases in the WBRT group and 20 cases in the LRT group. While all cases before November 2017 had WBRT performed, LRT was adopted mainly in cases with a small number of metastases since December 2017. Although there was a difference in the observation period between the two groups, OS tended to be longer in the LRT group (P=0.08), while RFS tended to be shorter in the LRT group (P=0.08). Radiological recurrence after RT was observed in 7 cases in both groups, and in WBRT group, all cases were local recurrence, whereas in LRT group, all cases were new lesions or disseminated recurrence. Although there are biases such as the difference in observation period between the two groups and the tendency to adopt WBRT in cases with a large number of metastases, there is a possibility that postoperative LRT is not inferior to WBRT, especially for cases with a small number of metastases. However, we have experienced some cases of disseminated recurrence, and so it is necessary to consider the resection fashion such as whether en-bloc resection or piece meal resection when selecting postoperative RT.
MET-08 Air in cistern or ventricle after brain metastasis surgery is a predictor of early postoperative intracranial recurrence
Authors: Ikeuchi Yusuke , Nishihara Masamitsu , Ashida Noriaki , Sasayama Takashi , Hosoda Kohkichi 
Published: November 2020

Abstract
INTRODUCTION: The operations of brain metastasis are on the increase as a result of more routine diagnostic imaging and improved extracranial systemic treatment strategies. Opening of the cistern or ventricle during tumor resection may promote local recurrence and cerebrospinal fluid dissemination. We investigated whether the air found in the cistern/ventricle on postoperative Computed tomography (CT) was a predictor of postoperative recurrence.
METHODS: Between 2012 and 2019, 27 patients with single brain metastasis were treated with gross total resection at our hospital. The patients in which air was found in the cistern or ventricle of the head CT on the day after surgery was designated as air(+) group, and the patients without air was designated as air(-) group. The primary outcome was the local recurrence, as diagnosed with neuroimaging. The death due to other than brain metastasis was defined as competing risk.
RESULTS: CT air(+) group was 17 patients, whereas CT air(-) group was 10 patients. There was no significant difference between the two groups, such as age and sex. Estimated 1-year brain tumor recurrence rate was 70% in the air(+) group and 5.9% in the air(-) group. (p = 0.004). On the other hand, no significant difference was observed in estimated 1-year competing risk between in the air(+) group (10%) and in the air(-) group (2.4%).
CONCLUSION: En bloc resection of brain metastasis is effective, but there was no report on the risk of opening the cistern or ventricle. Our results indicate that postoperative air presence in the cistern or ventricle could be a predictor of early postoperative recurrence. In metastatic brain tumor removal, the cistern and ventricle should not be opened, and close follow-up should be done if air in the cistern or ventricle is detected on postoperative CT.
MET-09 Prognosis prediction study of using Susceptibility-weighted imaging in metastatic brain tumors
Authors: Iida Tomoko , Sakamoto Daisuke , Uchida Kazutaka , Yoshimura Shinichi 
Published: November 2020

Abstract
Background and purpose: MRI is a very useful tool especially for metastatic brain tumor. It can grasp the status of treatment and progress of primary lesion. In this study, we investigated the prognosis by using SWI (Susceptibility-weighted imaging) or T2 *sequences in MRI. Materials and methods: The study includes 69 patients who took a surgical treatment at our hospital from March 2014 to June 2020. Grade ranged from 0 to 2, with 0 defined as high signal intratumor, 1 defined as within 10 dark spots, 2 as almost consists with dark spot intratumor. Results: The median age of the patients was 66 years and 38 males (55%). The primary tumors were lung cancer in 28 cases (40.7%), breast cancer in 12 cases (17.4%), gastrointestinal cancer in 11 cases (15.9%), kidney cancer in 5 cases (7.2%), and others in 13 cases (18.8%). The SWI or T2 star images showed that grade 0 was 23 cases (33%), grade 1 was 18 cases (26%), grade 2 was 28 cases (41%). There were 16 deaths in grade 0 (69.6%), 10 deaths in grade 1 (55.6%), 15 deaths in grade 2 (53.5%). Conclusions: In this study, there was no statistically significant difference in the SWI or T2*-positive group. However, there was a tendency for many long-term survivors in the SWI or T2*-positive group.
MET-10 Preliminary report of radiotherapy for brain metastases from breast and kidney using mask system of Leksell Gamma Knife Icon
Authors: Kawabe Takuya , Sato Manabu 
Published: November 2020

Abstract
Object: Leksell Gamma Knife Icon enables us to apply new methods of immobilization using mask fixation and the option of fractionated treatment. This provides exceptional accuracy and precision of radiosurgery, making it a possibility for many more disease types and many more patients to be treated.
Methods: We retrospectively analyzed 97 patients (140 times) with brain metastases from breast (B group) and 26 patients (33 times) with brain metastases from kidney (K group) and who underwent Gamma Knife Icon using mask fixation between September 25th, 2017 and June 30th, 2020 at Rakusai Shimizu Hospital. Patients with small, few, newly diagnosed, and non-eloquent area tumors were treated in a single session. If the tumor volume was larger than 5.0 ml, recurrence, or the location was in an eloquent area, we applied a fractionated schedule. If the tumor number was large, we selected a multisession schedule. Median tumor number was three (1–64) in B group and two (1–31) in K group. Median tumor size was 2.7 (0. 01-58.8) ml in B group and 2.8 (0.02–123.5) ml in K group. We selected fractionated schedules as follows; 7.0 Gy x 5Fr (5–10 ml), 4.2Gy x 10Fr (10-20ml), 3.7Gy x 10Fr (20-30ml), 3.2Gy x 10Fr (30ml-).
Results: 32 (B) and 14 (K) cases were treated in a single session, 80 (B) and 17 (K) with fractionation, and 28 (B) and 2 (K) with multiple sessions. Median survival times after Icon treatment was 28.2 (B) and 15.5 (K) months. Local control rates were 89 % (B) and 85% after 12-month Icon treatment. Qualitative survival rates were 91% (B) and 86% (K) after 12-month Icon treatment. There were no statistically differences between two groups.
Conclusions: Although these results are limited to short periods, survival rates, local control rates and qualitative survival rates were within the acceptable ranges.
CS-03 BRAF V600E mutation mediates FDG-methionine uptake mismatch in polymorphous low-grade neuroepithelial tumor of the young
Authors: Hayashi Takahiro , Tateishi Kensuke , Ikegaya Naoki , Udaka Naoko , Sasame Jo , Miyake Yohei , Okabe Tetsuhiko , Minamimoto Ryogo , Murata Hidetoshi , Utsunomiya Daisuke , Yamanaka Syoji , Yamamoto Tetsuya 
Published: November 2020

Abstract
We present a case of a 14-year old boy with tumor-associated refractory epilepsy. Positron emission tomography imaging demonstrated a region with heterogeneous high 11 C-methionine uptake and a region with homogenous low 18 F- fluorodeoxyglucose uptake within the tumor. Histopathological and genomic analyses confirmed the tumor as BRAF V600E-mutated PLNTY (polymorphous low-grade neuroepithelial tumor of the young). Within the high-methionine-uptake region, we observed increased protein levels of L-type amino acid transporter 1 (LAT1) and constituents of the mitogen-activated protein kinase (MAPK) pathway. We also found that LAT1 expression was linked to BRAF V600E mutation and subsequent activation of MAPK signaling. Pharmacological inhibition of the MAPK pathway suppressed LAT1 expression and cell viability in PLNTY cells. Collectively, our results indicate that BRAF V600E mutation-activated MAPK signaling induces specific metabolic alterations in PLNTY, and may represent an attractive target in the treatment of the disease.
CS-09 Extra-parenchymal (Peripheral) Atypical Teratoid / Rhabdoid Tumors
Authors: Oka Hidehiro , Kusumi Mari , Koremura Masafumi , Kondo Koji 
Published: November 2020

Abstract
AT/RT is a malignant embryonal tumor reported by Rorke in 1996. Authors reported first AT/RT in Japan in 1998. This tumor entity was included as new malignant embryonal tumor in WHO 2000, and tumors of Japanese patients has been reported more than 80 cases in the past. This AT/RT is a tumor in the brain parenchyma that a medulloblastoma and PNET and the possibility that it has been misdiagnosed have had pointed out. On the other hand, it is reported that there is the type that we should call peripheral AT/RT which rarely occurs in extra-parenchyma. We want to propose that there is such special tumor group. In the results, age: 17 infants were main (2nd - 14 years old after birth). tumor location: 22 sellar or parasellar regions, 8 CP angles, 7 oculomoter nerves, and 3 petrous bone, treatment: duration of survival significantly improved all macroscopic tumor resection by the operation, but, in small pontine part AT/RT, an outcome tended to be poor. On the other hand, in AT/RT which occurred in the sellar region, all cases adult woman tended to have good prognosis. It is necessary for AT/RT (central AT/RT) in the brain to recognize that there is extra-parenchymal AT/RT (peripheral AT/RT) tumor which we reported this time which came to be recognized widely.
COT-07 Cerebrovascular complications in adult patients with malignant brain tumor
Authors: Mineharu Yohei , Arakawa Yoshiki , Tanji Masahiro , Nakajima Kohei , Terada Yukinori , Miyamoto Susumu 
Published: November 2020

Abstract
Background: According to the development of new treatment modalities, patients with malignant brain tumor have longer survival and they have more chances to have stroke.
Study Population: We retrospectively reviewed 509 patients with ischemic stroke and 445 patients with hemorrhagic stroke who visited Kyoto University Hospital between January 2010 and December 2019 and the association with malignant brain tumor was analyzed. The frequency of stroke in 287 patients with primary glioblastoma and 217 patients with metastatic brain tumor was also analyzed.
Results: Twenty one (4.1%) patients with ischemic stroke and 26 (5.1%) patients with hemorrhagic stroke patients had malignant brain tumor, and most tumors were either malignant glioma or metastatic brain tumor. A medical history of cranial irradiation was seen in 66.7% of patients with ischemic stroke, and 80% of hemorrhagic stroke occurred within the tumor before starting the treatments. Either ischemic or hemorrhagic stroke occurred in 9.1% of patients with glioblastoma and 4.1% of patients with metastatic brain tumor, and the number of ischemic and hemorrhagic were almost the same. In patients with glioblastoma, nearly half of the stroke cases were associated with bevacizumab. Half of the cases of bevacizumab-related stroke were asymptomatic, while asymptomatic cases were seen in 21.4% for non-bevacizumab cases.
Discussion: Stroke is not an uncommon complication in patients with malignant brain tumor but only a restricted number of cases were preventable. Including the cases of bevacizumab-related stroke, which is often asymptomatic, accurate diagnosis and the second prevention would be important.
COT-13 Current situation and problems of cancer genomic profiling test in Kyoto University Hospital
Authors: Arakawa Yoshiki , Suga Junko , Terada Yukinori , Nakajima Kohei , Tanji Masahiro , Mineharu Yohei , Muto Manabu , Miyamoto Susumu 
Published: November 2020

Abstract
Objective: Kyoto University Hospital has introduced the cancer genomic profiling tests, Oncoprime in 2015, Guardant360 in 2018, which are not under insurance coverage, FoundationOne CDx(F1CDx) and OncoGuide NCC Oncopanel system(NCC OP) in 2019, which received approval for insurance coverage for the first time in Japan. We investigated the results of cancer genomic profiling test under insurance coverage in our hospital. Methods: A special facility for the cancer genomic profiling tests was produced. To perform the cancer genomic profiling test, an outpatient must visit the facility three times (learning, ordering of the test, and getting the results). The expert panels decide the final test results and treatment options with the all information of the patients. Results: From November 2019 to March 2020, 51 and 9 patients were tested with F1CDx and NCC OP, respectively. 16 patients (31%) of F1CDX and 2 patients (22%) of NCC OP got treatment recommendations from the expert panels. However, only 5 patients (9.8%) of F1CDX and 1 patient (11%) of NCC OP received the treatments. The secondary finding suspecting germline mutations was found in 8 patients of F1CDX. Conclusion: After the approval the cancer genomic profiling tests with insurance coverage in Japan, it becomes easy for the patients to perform the test and get the genetic information of the tumor. However, it remains not easy to receive the recommended drugs because of several limitations of their usages.
COT-17 Cancer genomic medicine at Kobe University Hospital
Authors: Tanaka Kazuhiro , Toyoda Masanori , Kimbara Shiro , Hashiguchi Mitsuru , Fujita Yuichi , Minami Hironobu , Sasayama Takashi 
Published: November 2020

Abstract
Approximately one year has passed since the Japanese government approved a new plan to fight cancer by promoting the use of genomic medicine in June 2019. Our hospital plays an important role among 6 hospitals to serve cancer genomic medicine for cancer patients in Hyogo Prefecture. Here, we evaluated the system and the current status of cancer genomic medicine in our hospital, and examined future issues and problems. Consecutive 145 patients, who received outpatient treatment for cancer genomic medicine from July 2019 to June 2020 in Kobe University Hospital, were analyzed to examine patients’ background, implementation status, gene profile, and the number of subjects for treatment and clinical trials. The final result of gene profile was obtained in 93 cases, of which 49 cases (52.7%) showed the actionable gene changes to be treated. Six cases of brain tumor were 2 cases of glioblastoma, 2 cases of oligodendroglioma (recurrence), and 2 cases of AT/RT and CNS embryonal tumor. In one case the test was cancelled because Performance Status (PS) of the patient decreased. In another case the actionable gene mutation (PTEN, CDKN2A) was obtained, but the patient lived too far to visit clinical trial site. Almost half of genetic panel tests revealed genomic changes related to treatment, but the number of patients actually targeted for treatment or clinical trials was extremely small. It is necessary to consider the rapid progression of illness and access to facilities conducting clinical trials.
COT-18 Prognosis and problems about secondary intracranial neoplasm in childhood cancer survivors: a single-institution retrospective cohort study
Authors: Kagawa Naoki , Yokota Chisato , Hirayama Ryuichi , Kijima Noriyuki , Nakagawa Tomoyoshi , Miyamura Takako , Kinoshita Manabu , Kishima Haruhiko 
Published: November 2020

Abstract
Objective: As childhood cancer survivors gradually increased, late complications of treatment have been at issue and risk of secondary neoplasm is increasing cumulatively. We retrospectively analyzed clinical outcome and problems of treatment for secondary intracranial neoplasm. Patients and Methods: 497 patients (children, adolescents and young adults) with malignant central nervous system neoplasm were treated in our institution from 1971 to 2015. 188 cases (37.8%) were enrolled in this follow-up study. Diagnosis of primary neoplasm included low grade glioma (29%), embryonal tumor (23.5%), germ cell tumor (24.5%), ependymoma (8%), other (15%). Results: Fourteen cases of them were diagnosed as secondary intracranial neoplasm. Twelve cases were operated and histopathological diagnosis included 6 glioblastomas, 1 anaplastic astrocytoma, 1 anaplastic ependymoma, 4 meningiomas. In all cases, histopathological finding and molecular profile of secondary intracranial neoplasm differed from that of primary malignant brain tumors. Duration from the first operation of primary tumors to diagnosis of secondary intracranial neoplasm ranged from 5 to 36 years (average: 29.3). In malignant glioma cases except meningioma cases, origin of them was contained in high irradiation field (&gt;40Gy). In malignant glioma cases, Chemotherapies using temozolomide and bevacizumab were selected after tumor removal. In 3 cases of them, reirradiation was performed. Response for treatment was poor or transient in most cases, median survival time was 12 months. Of late complications, such as endocrinological problem needed replacement (55%), cerebrovascular event (15.9%), secondary neoplasm (7.4%), secondary neoplasm was importantly related with prognosis. Conclusion: It is difficult to plan therapeutic strategies against second malignant neoplasm because of lack of information in case of long-term survivors and restriction for first radiation. Clinical outcome of them is poor and new treatment targets should be developed. It is important to plan clinical trials to reduce treatment intensity and usable long-term follow-up system.