bluuebunny/crossref_metadata_2025_split huggingface dataset:
QOLP-35. OUTCOMES AND CORRELATIONS BETWEEN LEGACY QUALITY OF LIFE MEASURES (EORTC-C30/EORTC-BN20) AND THE ELECTRONIC QUALITY OF LIFE MEASURING SYSTEM NIH-PROMIS IN GLIOBLASTOMA PATIENTS
Authors: Walbert Tobias , Schultz Lonni , Snyder James , Suneja Aarushi 
Published: November 2019

Abstract

BACKGROUND
Health-related quality of life (QoL) and patient reported outcomes are essential to guide patient-care. The NIH sponsored electronic Patient-Reported Outcomes Measurement Information System (PROMIS) is well established in multiple cancers but not in Glioblastoma (GBM). The aim of this study was to analyze the association of the PROMIS measures with the European Organization for Research and Treatment of Cancer core instrument (EORTC-QLQ-C30) and the brain tumor specific EORTC QLQ-BN20 questionnaire (EORTC-BN20) in GBM patients.

METHODS
Newly diagnosed patients with GBM were enrolled prospectively to assess association between both tools. The PROMIS modules were selected to reflect the quality of life domains assessed in the EORTC- QLQ-C30 and EORTC-BN20 questionnaires. Pearson’s correlation coefficients were computed between the PROMIS and EORTC-C30/ EORTC-BN20 measures. Due to multiple responses over time, the p-values for the correlation coefficients were adjusted. Because of the large number of correlations computed and many with p-values less than 0.05, the magnitude of the correlation was considered. Correlations greater than 0.5 or less than -0.5 were consider to be “strong” associations, while correlations between 0.3 and 0.499 (or -0.3 and -0.499) were consider to be “moderate”.

RESULTS
43 patients with 124 PROMIS/EORTC responses were included in this analysis. The PROMIS measures had strong associations with the QoL functioning and fatigue measures from the EORTC-C30 and future uncertainty, communication deficit, motor dysfunction, social satisfaction and drowsiness from the EORTC-BN20 (all p< 0.001 and correlation >0.5).

CONCLUSIONS
There are strong and moderate correlations in the majority of PROMIS assessments and the EORTC tools. The PROMIS toolkit may be used to assess core features of the EORTC surveys. GI symptoms, seizures and itchy skin do not correlate. Given the prior documented shorter assessment time, the PROMIS toolkit may be a feasible alternative to established legacy tools to assess QoL in GBM patients.
QOLP-40. END-OF-LIFE CARE FOR GLIOBLASTOMA PATIENTS IN JAPAN
Authors: Omura Tomoko , Miyakita Yasuji , Ohno Makoto , Takahashi Masamichi , Fujimoto Kenji , Omura Takaki , Sato Hitomi , Narita Yoshitaka 
Published: November 2019

Abstract

BACKGROUND
Despite aggressive treatment with surgery and chemo-radiation therapy, it is difficult to cure patients with glioblastoma (GBM). The end-of-life (EOL) phase of patients with GBM, and related problems, have not yet been adequately studied. Unlike in other countries, most cancer patients died in the hospital (84%) in 2017, but the Japanese government has recommended palliative home care and the number of deaths at home has recently been increasing. This study explores the current situation of EOL care for GBM patients in Japan.

METHODS
We retrospectively examined the clinical course and EOL phase of 166 consecutive patients who were treated in our hospital between 2010 and 2017. RESULT: In total, 107 patients died; 27 (25.7%) at home, 24 (22.8%) in hospice care, 8 (7.6%) in nursing homes, 46 (43.9%) in hospitals (long-term care hospitals [LTCH; 19.8%], our hospital [13.3%], and other neurosurgical hospitals [10.4%]). According to our previous research, in 2001–2005, 6% of GBM patients died at home, 3% in hospice case, and 91% in the hospital. The KPSof patients who started palliative home care or transferred to another hospital was 50–60. The median survival time and length of EOL phase for patients who died at home were 498 and 76.5 days; 395 and 103 days in hospice care; 533 days and 149 days in LTCH; 374 days and 52 days in our hospital; 338 and 75.5 days in other neurosurgical hospital; and 557 days and 37 days in nursing homes, respectively.

CONCLUSION
The number of GBM patients who died at home in Japan is increasing, and we must consider the problems of the EOL phase and improve the quality of EOL care.
QOLP-41. ASSESSING CAREGIVERS’ OF PATIENTS WITH PRIMARY BRAIN TUMORS EXPERIENCES WITH AND NEEDS RELATED TO SEIZURE MANAGEMENT
Authors: Warren Paula , Ejem Deborah , Taylor Richard , Edwards Rebecca , Dionne-Odom James , Nabors Louis , Bakitas Marie 
Published: November 2019

Abstract
Family caregivers of persons with primary brain tumors report high levels of distress. Information is limited, however, regarding family caregivers’ experiences and needs concerning the risk and management of seizures in this population. In this qualitative descriptive study, we conducted one-on-one interviews to describe the experiences of family caregivers’ of persons with primary brain tumors who have had and who have not yet had a seizure. We sought information on how they coped with this issue and what information they needed regarding management of out-of-the-hospital seizures. We conducted 15 interviews using study-specific interview protocols; 10 caregivers with seizure experience and 5 caregivers without seizure experience. Caregivers were, on average, 52 years old, predominately white (93.3%), college graduates (66.7%), and were employed full-time (53.3%). The relationship between caregiver and care recipient was spouse (46.7%), other family member (46.7%), and friend (6.6%). Most caregivers provided care everyday (46.7%) and for more than 8 hours per day (33.3%). Themes emerged around three major domains: 1) caregiver challenges regarding seizures, 2) desired resources/information about seizures, and 3) timing of delivery of these resources. Caregivers often reported being fearful of seizures and the majority (93%) expressed difficulty with knowing when to call EMS. In terms of desired resources, opinions were split between preferring written materials versus online resources with most participants (87%) stating that videos or graphics detailing seizures would be helpful. In terms of delivery timing, most (66.7%) thought that training should come after diagnosis versus at the time of diagnosis citing reasons such as too much other information to absorb and overall inability to focus. Future studies will use this information to develop and pilot a seizure-focused supportive caregiver intervention that is tailored and caregiver-directed and that can be incorporated into standard neuro-oncology clinical practice.
RDNA-01. TUBULIN AND MICROTUBULES AS MOLECULAR TARGETS FOR TTFIELD THERAPY
Authors: Kalra Aarat , Patel Sahil , Bhuiyan Asadullah , Rezania Vahid , Lewis John , Shankar Karthik , Tuszynski Jack 
Published: November 2019

Abstract
TTField (Tumor-treating field) therapy utilizes low intensity intermediate frequency AC electric fields to reduce the spread of cancer. While it has attained FDA approval for the treatment of recurrent glioblastoma multiforme, the exact molecular targets of TTField therapy are not well understood. Microtubules are pipe-like polymers of the highly charged (–31 e) and strongly dipolar (dipole moment 1666 D) protein, α, β- tubulin. Studies on the electrical properties of microtubules have recently gained interest, with them being modelled as molecular targets of TTFields. Here, we experimentally show that while tubulin polymerized into microtubules leads to an increase in solution capacitance, unpolymerized tubulin has no appreciable effect. To the best of our knowledge, we present the first experimental quantification of the capacitance of a 20 μm-long microtubule. Using these results, we calculate the resonant frequency of a microtubule meshwork in a cell-like environment to be in the TTField regime. Our results utilize high ionic strength solutions and cell-like concentrations of tubulin to show the potential of microtubules as the targets of TTField action and as intracellular charge-storage devices. We conclude with a hypothesis of an electrically-tunable cell, where the dielectric properties of the cytoskeleton alter local and global charge storage and transport.
RDNA-05. RADIOTHERAPY PROMOTES ONCOPROGRESSIVE CROSSTALK BETWEEN GLIOBLASTOMA TUMOR CELLS AND M2 MACROPHAGES VIA THE NLRP3 INFLAMMASOME PATHWAY
Authors: An Shejuan , Rooney Michael K , Miska Jason , Lee Chang Catalina , Zhang Peng , Han Yu , Lopez-Rosas Aurora , Lesniak Maciej S , Sachdev Sean 
Published: November 2019

Abstract

PURPOSE
Radiotherapy (RT) is an essential component in the adjuvant treatment of glioblastoma (GBM); however, despite an initial benefit in tumor control, recurrence is nearly universal. The inflammasome is a multimeric cytosolic complex that has been shown to be activated in immune cells following RT. We investigated the relationship of inflammasome activation and disease progression after RT in GBM.

METHODS
We performed survival analysis for patients with recurrent GBM using the TCGA dataset, stratifying according to expression of inflammasome pathway molecules Caspase 1 (CASP1), IL-1β, and NLRP3. IL-1β expression and colocalization with CD11b+ myeloid cells were analyzed at different time points following RT in a murine glioma GL261 model. We detected the secreted IL-1β, CASP1 activity, and NLRP3 expression in both tumor and infiltrating immune cells, and the downstream effects of their interplay, including cellular apoptosis, proliferation, and viability.

RESULTS
High expression of CASP1, IL-1β, and NLRP3 are associated with poor survival in recurrent GBM. In a mouse model, recurrent tumors after treatment with RT display higher levels of the inflammasome effector molecule IL-1β, which colocalizes with infiltrating CD11b+ myeloid cells. Using a co-culture system of tumor cell and M2 macrophages, we found that RT enhances inflammasome activation in both cell types, and this interaction restores the proliferative capacity of surviving tumor cells following treatment. RT induces the inflammasome pathway activation in the setting of an associated immune microenvironment rich in tumor-associated macrophages and myeloid-derived suppressor cells (TAM/MDSCs) and not in tumor cells alone.

CONCLUSIONS
Inhibition of the oncoprogressive crosstalk between GBM tumor cells and M2 macrophages, possibly through disruption of the inflammasome pathway, might be a potential therapeutic strategy with RT.
RTHP-07. CYBERKNIFE HYPOFRACTIONATED STEREOTACTIC RADIOTHERAPY FOR THE PATIENTS OF RECURRENT GLIOBLASTOMA WITH BEVACIZUMAB TREATMENT FAILURE
Authors: Tabei Yusuke , Sato Kengo , Ichi Shunsuke 
Published: November 2019

Abstract

BACKGROUND
The prognosis for patients with recurrent glioblastoma after Bevacizumab (Bev) treatment is extremely poor. No effective treatment has been established.

PURPOSE
We retrospectively investigated the efficacy and safety of hypofractionated stereotactic radiotherapy with Cyberknife (CK-HSRT) for recurrent glioblastoma after Bev treatment in our institution.

METHODS
GTV (Gross tumor volume) was set in the FLAIR abnormal high signal area that resulted in the contrast lesion and invasive recurrence, and PTV (Planning target volume) = GTV + 2 mm. As aimed CK dose,30 Gray(Gy) in 5 fraction was performed on PTV. Bev(10mg/kg biweekly) was continued after CK. The case background, treatment effect, survival and adverse events were investigated for 21 cases from January 2013 to the end of May 2018.

RESULTS
The median age was 69 (range;31–85) years, and The D95% marginal dose was 27.5 (23–35) Gy in 5 (3–8) divisions. Median PTV was 112 (2–305) ml. The median time to progression after CK was 3.9 months, and the median overall survival after CK was 10.9 months. Early treatment-related adverse events included hair loss in the irradiated area, seizures, headache, nausea and vomiting. As late treatment-related adverse events, symptomatic cerebral radiation necrosis was not observed, but 2 cases of symptomatic cerebral infarction and a case of cerebral hemorrhage were observed. All cases were treated conservatively.

CONCLUSION
CK-HSRT may be well tolerated and effective as a salvage treatment for the patients with recurrent glioblastoma after Bev.
RTHP-08. FAILURE TO COMPLETE STANDARD RADIATION THERAPY IN GLIOBLASTOMA PATIENTS: PATTERNS FROM A NATIONAL DATABASE WITH IMPLICATIONS FOR SURVIVAL AND THERAPEUTIC DECISION MAKING
Authors: Yusuf Mehran , Gaskins Jeremy , Gilbert Mark , Woo Shiao , Burton Eric 
Published: November 2019

Abstract

BACKGROUND
Approximately 5%-10% of patients with newly diagnosed glioblastoma (GBM) will fail to complete standard radiotherapy (SRT). We sought to determine the impact on survival and to identify risk factors for failure to complete SRT.

METHODS
A cohort of 17,451 adults with GBM were identified from the National Cancer Database. The cohort was restricted to patients diagnosed between 2005 to 2012 that were started on conventionally fractionated RT of 1.8 to 2.0 Gy per fraction to a dose of < 66Gy and. Patients were stratified by RT dose achieved: (a.) completed RT > 58Gy, (b.) nearly completed RT > 50Gy - < 58Gy, and (c.) did not complete RT < 50Gy.

RESULTS
Radiotherapy completion rates correlated with survival, 87% of patients completed RT and had a median OS of 13.5 months, 4% were near completers (median OS 5.7 months), and 9% did not complete RT (median OS 1.9 months). Risk factors for not completing SRT were: older age, biopsy alone, government insurance, high comorbidity score and lower income zip code (all OR > 1 and p-values < 0.05). Twenty-eight percent of patients > 80 yrs did not complete SRT (OR 2.99, 95% CI 2.36–3.80, relative to 40–49 yrs) and 19% of 70-79-yrs did not complete SRT (OR 1.99, 95% CI 1.63–2.42).

CONCLUSIONS
Failure to complete SRT was associated with decreased survival in our cohort. Risk factors for failure to complete SRT, include older age, biopsy alone and substantial comorbidities. Other studies have shown SRT is discontinued primarily due to clinical deterioration and/or disease progression. Therefore, these patients should be considered for alternative therapeutic management such as hypofractionated radiotherapy.
RTHP-09. SINGLE INSTITUTION’S EXPERIENCE FOR PEDIATRIC INTRACRANIAL EPENDYMOMA TREATED WITH ADJUVANT RADIOTHERAPY
Authors: Lee Joongyo , Hee Choi Seo , In Yoon Hong , Woo Han Jeong , Lee Ikjae , seok Kim Dong , Suh Chang-Ok 
Published: November 2019

Abstract

PURPOSE
To investigate long term outcomes of pediatric intracranial ependymoma treated with maximal safe resection followed by radiotherapy in single institution.

METHODS
Between 1983 and 2016, 42 pediatric patients received adjuvant radiotherapy after surgery. There were 19 and 23 grade II and III ependymomas, and total resection could be performed in 50% of patients. There were 4 patients with initial leptomeningeal seeding, and craniospinal irradiation (CSI) was the component of adjuvant treatment in 5 patients including them. Local radiotherapy (median 54 Gy (range, 45–60 Gy) was performed in all the rest patients excluding three with whole-brain radiotherapy.

RESULTS
With a median follow-up of 89 months, 14 patients (33%) experienced recurrences after radiotherapy (m/c: intracranial, 79%, all within tumor bed). The 5- and 10-year progression-free survival (PFS) rates were 70% and 63%, and overall survival (OS) rates were 85% and 78%, respectively. The recurrence rates were significantly higher in patients younger than 3 years (64% vs. 23%, p = 0.024) or with subtotal resection (STR) (52% vs. 15%, p = 0.009). In multivariate analyses, age and STR were significant factors for PFS (p = 0.007 and 0.028, respectively). There was no independent prognostic factor for OS on multi-variate analysis. Fourteen patients experienced recurrence. Among them, all of 6 grade II cases showed local recurrence. Four grade II cases (67%) underwent aggressively salvage treatments such as resection, stereotactic radiosurgery were still under observation. However, 75% of 8 grade III recurrent cases were expired, despite aggressive salvage treatments. All 3 patients with seeding recurrent were grade III and died from disease.

CONCLUSION
Local adjuvant radiotherapy showed favorable survival in pediatric ependymoma. Even if recurrence occurs, aggressive salvage treatment would be needed for grade II ependymoma.
RTHP-14. PSEUDOPROGRESSION IN HIGH GRADE GLIOMA PATIENTS AFTER PROTON OR PHOTON THERAPY
Authors: Williams Vonetta , Halasz Lia , Rockhill Jason , Fink James 
Published: November 2019

Abstract
Pseudoprogression is defined as the appearance of false progression on MR imaging following radiation therapy. Proton therapy is thought to have increased relative biological effectiveness-the ratio of the doses required by two types of radiation to cause the same level of effect-near the edges of the high dose volume. This could lead to different rates of pseudoprogression for protons compared to photons. In our IRB approved study, a board-certified neuroradiologist reviewed serial imaging of 74 patients (photons: n=37, protons: n=37) treated from 2013–2018 with either proton or photon radiotherapy to 59.4–60 Gy in 30–33 fractions and temozolomide for high grade glioma. MR imaging was performed 1 month after completion of treatment and then every 3 months. True progression was scored based on updated RANO criteria. Pseudoprogression was determined if imaging improved without change in therapy. Cumulative incidences of these outcomes and survival were calculated utilizing Kaplan-Meier analyses. Patient and treatment factors were analyzed for their association with incidence of pseudoprogression. Median follow-up for alive patients in the proton and photon groups were 15 and 29 months, respectively. Median age was 49 years in the proton group and 54 years in the photon group (p=0.17). Among proton patients, 14 had grade III glioma and 23 had grade IV glioblastoma. Among photon patients, 1 had grade III glioma. Median survival was 23 and 35 months for the proton and photon groups, respectively (p=0.57). The cumulative incidence of pseudoprogression was 14.4% and 10.4% at 12 months for the proton and photon groups, respectively (p=0.53). Grade, extent of resection, age, and IDH status, were not significantly associated with development of pseudoprogression. MGMT methylated tumors showed a trend toward association with pseudoprogression compared to unmethylated tumors (p=0.058). We concluded that the incidence of pseudoprogression is similar regardless of whether proton or photon therapy was utilized.
RTHP-21. TREATMENTS FOR RECURRENT MALIGNANT GLIOMAS AND THEIR PROGNOSIS
Authors: Mori Kanji , Kumagai Tetsuya , Kobayashi Maki , Iwata Takamitsu , Nakagawa Kanji , Kudo Akira , Toyota Shingo , Kanemura Yonehiro , Taki Takuyu 
Published: November 2019

Abstract
For improvement of glioma therapy, advances in treatment after recurrence are essential, but no standard second line therapy has been estimated. Lately, bevacizumab (Bev) and BCNU wafer became available in Japan, we have more therapeutic choices. Since we took part in Kansai molecular diagnosis network for CNS tumors in 2013, we have referred molecular information. We retrospectively examined and report our experiment about recurrent malignant gliomas in Kansai Rossi Hospital. Twenty-two histopathologically proved grade 3 and grade 4 patients who were diagnosed as recurrence between January 2013 and December 2018 were included. We examined treatment and analyzed factors that influenced overall survival (OS) after recurrence. Glioblastoma were 14 cases (IDH wild 12 cases, IDH mutant one case, unknown one case) Median age and KPS at recurrence were 70 years old and 60%, respectively. Ten patients received any anti-cancer treatment and 2 received best supportive care (BSC). Radiation therapy (RT) with Bev were used in 9 patients (5 with gamma knife). Their median OS after first recurrence was 324 days and significantly longer than that of BSC patients (p=0.00174). Grade 3 gliomas were 8 cases (IDH-mutant 3 cases, IDHwild 5 cases, H2F3A mutant 1 case). Median age and KPS at recurrence were 45 years old and 70%, respectively. Five patients were treated with temozolomide (TMZ) and others were observed. In addition to TMZ, Bev were used for 4 patients and RT for 3. Median OS of these patients was significantly longer (p=0.0198). In both grade, patients with better KPS (>60%) statistically lived longer than poor KPS, but methylation status of MGMT promoter and IDH mutation did not influent their OS. Radiation with Bev for good KPS patients might improve prognosis. Further multicenter prospective study must be needed.
RTHP-23. PROSPECTIVE TRIAL OF CONVENTIONALLY FRACTIONATED DOSE CONSTRAINTS FOR RE-IRRADIATION OF PRIMARY BRAIN TUMORS
Authors: McGovern Susan , Luo Dershan , Johnson Michael , Nguyen Kham , Li Jing , McAleer Mary , Yeboa Debra , Grosshans David , Ghia Amol , Chung Caroline , Thall Peter , Sulman Erik , Brown Paul , Mahajan Anita 
Published: November 2019

Abstract

PURPOSE/OBJECTIVE
Dose constraints for re-irradiation of recurrent primary brain tumors are not well-established, especially for treatment volumes too large for stereotactic radiotherapy. This prospective trial was performed to test dose constraints for conventionally-fractionated re-irradiation of recurrent primary brain tumors

MATERIALS/METHODS
A single-institution, prospective trial of 21 adults with recurrent brain tumors was performed. Electronic dosimetry records from the first course of radiation (RT1) were obtained and deformed onto the simulation CT for the second course of radiation (RT2). Treatment plans for RT2 were developed that met protocol-assigned dose constraints for RT2 alone and the composite dose of RT1+RT2. Dose constraints were also based on histology and interval since RT1. The primary endpoint was the rate of symptomatic brain necrosis after RT2.

RESULTS
Twenty one adults enrolled from March 2017 to May 2018. Twelve had glioblastoma, four had oligodendroglioma, two had anaplastic astrocytoma, and one each had choroid plexus papilloma, hemangiopericytoma, and pleomorphic xanthroastrocytoma (PXA). Twenty patients were treated with VMAT and one was treated with proton CSI. Median RT1-RT2 interval was 45 months (range, 9–141 months). Median RT2 dose was 42.8 Gy (range, 17.5–60 Gy). Median PTV volume was 208 cc (range, 7–1537 cc). Median imaging followup was 9 months (range, 1–20 months). Two months after RT2, the patient with PXA developed a trapped temporal horn adjacent to the RT2 treatment volume; pathology from emergent resection revealed necrotic brain tissue. The patient recovered fully and lived another 18 months until dying of disease progression. No other patient developed symptomatic radionecrosis. Median overall survival from RT2 for all patients was 11 months (range, 3–20 months).

CONCLUSION
Re-irradiation can be performed with conventionally fractionated schemes. Given the low rate of symptomatic radionecrosis, the dose constraints described here are a starting point for future studies of conventionally fractionated re-irradiation.