bluuebunny/crossref_metadata_2025_split huggingface dataset:
RTHP-31. EMERGENCY RADIOTHERAPY IN INTRACRANIAL GERM CELL TUMORS (GCTS) PATIENTS WITH KPS≤ 40: ARETROSPECTIVE ANALYSIS OF 27 CASES
Authors: Cai Linbo , Lai Mingyao , Li Juan , Zhou Cheng , Hu Qingjun , Zhou Zhaoming 
Published: November 2019

Abstract

OBJECTIVES
To evaluate the potential role of emergency radiotherapy in intracranial germ cell tumors GCTs) patients with KPS ≤ 40.

METHODS
A total of 27 primary intracranial germ cell tumors (GCTs) patients with KPS ≤ 40 between Jan 2007 and Dec 2018 were retrospectively evaluated. The median age at initial diagnosis was 15 years (range, 528 years). Among those, 11 patients were germinoma and 16 patients were nonseminomatous germ-cell tumors (NGGCTs). There were 9 solitary pineal, 5 suprasellar, 3 basal ganglia and 10 multifocal and disseminated tumors. All patients received emergency radiotherapy (2 Gy/fx/d). Prior to radiotherapy, 11 patients were manifested with hydrocephalus, 10 with hypopituitarism and 5 with intracranial tumo apoplexy.

RESULTS
The average follow up time was 44.4 months. The 5 year progression free survival rate and overall survival rate were 29.6% and 33.3%. The median overall survival time was 38 months. In particular, the median intracranial hypertension symptoms relief time was 2 days. The median KPS following radiotherapy was 80 comparing to 30 prior to radiotherapy (P < 0.05). A significant improvement on KPS of 46.7±27.3 was observed in this study.

CONCLUSION
Emergency radiotherapy is implicated as a promising intervention for GCTs patients with elevated intracranial pressure (ICP). These advantages can be interpreted as direct cell killing effect and fast tumor shrinkage by ionizing radiation. However, to substantiate our findings, further investigations were highly warranted.
RTHP-35. RE-IRRADIATION USING PULSED REDUCED DOSE RATE RADIATION THERAPY IN PATIENTS WITH GRADE 2 GLIOMAS
Authors: Harari Colin , Burr Adam , Ian Robins H , Howard Steven 
Published: November 2019

Abstract

BACKGROUND
The time course of progressive grade 2 glioma can span nearly a decade. However, much less is known about re-irradiation in this cohort than in high grade patients. Pulsed reduced dose rate (PRDR) radiation therapy is a method of radiation delivery, which may spare normal tissues by slowing the rate of radiation delivery to allow repair.

METHODS
We identified consecutive patients from an institutional database initially diagnosed with grade 2 glioma from 2001 to 2017 who underwent pulsed reduced dose rate radiation therapy. Radiation was delivered in 20 cGy pulses every three minutes, most commonly with a 3D conformal, three field technique, encompassing gross disease with a 1–2 cm margin. Kaplan Meier method was utilized to analyze patient outcomes.

RESULTS
35 patients with grade 2 glioma were identified. The median survival from the date of the first surgery was 103 months (95% CI 78–129 mo). 71% underwent at least a second resection and 86% of patients receiving chemotherapy. 80% of patients underwent transformation to grade 3 (51%) or grade 4 (29%) glioma. Overall survival from PRDR was 9.8 months (95% CI 4.5–14.5mo) and progression free survival was 6.2 months (95% CI 5.1–7.4) in all patients. Overall response rate was 37%. In patients who remained grade 2 histology, overall survival was 13.3 months and two patients remain disease free at 83 and 34 months with overall response of 71%. Four seizures were documented, otherwise treatment was well tolerated.

CONCLUSIONS
Progressive grade 2 glioma can progress and evolve over nearly the course of a decade. This study demonstrates the efficacy of re-irradiation in prolonging survival in these patients by delaying progression. In patients who remain with grade 2 disease, prolonged salvage of their disease appears possible.
RTHP-38. THE FEASIBILITY OF PSYCHOLOGICAL INTERVENTIONS FOR REDUCE THE NEED OF ANESTHESIA DURING RADIOTHERAPY IN < 5 YR PEDIATRIC PATIENTS WITH CNS MALIGNANCIES
Authors: Cai Linbo , Li Juan , Lai Mingyao , Hu Qingjun , Zhang Xing 
Published: November 2019

Abstract

OBJECTIVES
The aim of this study was to explore the psychological intervention to reduce the use of sedatives in children when undergoing radiotherapy.

METHODS
From January 2017 to December 2018, 53 pediatric patients, without limited consciousness, from 3 to 5 years old diagnosed with brain tumors and admitted to radiotherapy at the oncology centers of Guangdong Sanjiu Brain Hospital, received the systematic intervention (including desensitization, simulation play practice, distraction, etc.) to reduce medical fear for radiotherapy. A case-control study of semi-structured and play-based interventions was undertaken for psychological preparation of young children during radiotherapy.

RESULTS
After receiving interventions, 49 children were willing to cooperate with treatment, with the success rate of 92.45%. There were 19 children behaving cooperative in the 3-year-old group, while there were both 17 patients showing compliance in the 4-year-old group and 5-year-old group. Compared with the success rate of the 3-year-old group (84.21%), psychological interventions were more appropriate for the 4-year-old group (94.12%) and 5-year-old group (100%). For those failed cases, 2 children aged 3 used anesthesia during the whole radiotherapy sessions; 2 children aged 3 and 4 took sedatives in the early session of radiotherapy.

CONCLUSION
This study suggested that psychological intervention was able to improve the adherence of pediatric patients to the whole treatment course and reduce the occurrence of drug resistance due to non-compliance.
RTHP-42. OUTCOMES AFTER FRACTIONATED STEREOTACTIC RADIOSURGERY FOR BRAIN METASTASES
Authors: Anderson Rebecca , Bonestroo Liberty , Spencer Christopher 
Published: November 2019

Abstract

PURPOSE
To examine outcomes in patients undergoing linear accelerator (LINAC) based fractionated stereotactic radiosurgery (fSRS) to 30 Gy in 5 fractions.

METHODS
We completed a retrospective review of patients with brain metastases treated with 5-fraction LINAC fSRS at Phelps Health. All patients with CNS metastatic disease treated with fSRS were included in the study. Incidence of symptomatic radionecrosis (sRN), local brain failure (LBF), time to death, target volume and dose, prior whole brain radiotherapy (WBRT), prior surgical resection, and concurrent immunotherapy were assessed. sRN was defined as grade 2 or higher per CTCAE v4.0.

RESULTS
From 2016–2019, 28 patients and 60 lesions were treated. The most common metastasis histology was non-small cell lung cancer (n = 22), renal cell carcinoma (n = 12), and melanoma (n = 11). Median follow-up time was 6.49 months (range 0.33 – 23.96). Of 60 lesions, three lesions developed sRN and one asymptomatic patient developed radiographic evidence of radiation necrosis. Mean GTV was 1.03cm3 in patients with sRN. Of 57 lesions without sRN, median GTV was 1.45cm3 (range 0.11 - 20.1). Mean time to sRN was 3.17 months. Two symptomatic patients received prior WBRT. One symptomatic patient received concurrent immunotherapy. No symptomatic patients had surgical resection prior to fSRS. Among 24 lesions without prior radiation, 1 (4.2%) developed sRN. 10 lesions underwent surgical resection prior to fSRS with none developing sRN. 34 lesions were treated with concurrent immunotherapy and one developed sRN (2.9%). Local failure occurred in 9 lesions (15%). Median time to death for all patients was 4.50 months (range 1.02 - 19.40).

CONCLUSIONS
fSRS to 30 Gy in 5 fractions has promising efficacy with low incidence of sRN in treatment of CNS metastatic disease. Further investigation is required to determine predictors in patient outcome.
RBTT-01. A PHASE 2 TRIAL WITH ABI-009 (NAB-SIROLIMUS) AS SINGLE-AGENT AND COMBINATIONS IN RECURRENT HIGH-GRADE GLIOMA (rHGG) AND IN NEWLY DIAGNOSED GLIOBLASTOMA (ndGBM)
Authors: Kesari Santosh , Juarez Tiffany , Carrillo Jose , Truong Judy , Nguyen Minhdan , Heng Annie , Gill Jaya , Nguyen Hanh , Nomura Natsuko , Grigorian Berta , Hou Shihe , Schmid Anita , Desai Neil 
Published: November 2019

Abstract

BACKGROUND
The mTOR pathway is frequently activated in patients with GBM and is associated with reduced survival, making this pathway a promising target. However, mTOR inhibitors, including everolimus and temsirolimus, have poor brain penetration, limiting their potential use for GBM. ABI-009 is a novel albumin-bound mTOR inhibitor that has a distinct PK profile and biodistribution, including CNS penetration. The goal of this prospective, multi-cohort open-label phase 2 study is to evaluate the efficacy and safety of ABI-009 monotherapy and combination therapy in rHGG and ndGBM.

METHODS
Eligible patients are ≥18 years old, KPS score ≥70, and have histologically confirmed rHGG or ndGBM. Arm A has 5 cohorts in patients with rHGG, naïve to mTOR inhibitors: 1) ABI-009 single agent IV 100 mg/m2; 2–5) ABI-009 60mg/m2 plus TMZ 50mg/m2 or BEV 5mg/kg or marizomib 0.8mg/m2 or CCNU 90mg/m2. In Arm B for patients with ndGBM, ABI-009 100mg/m2 is given weekly for 4 weeks (Induction) after surgery, followed by ABI-009 at 60mg/m2 plus RT/TMZ. Up to 19 patients per cohort will be enrolled: initial 9 patients with a stopping rule that only if there are ≥2 responses will the study proceed to further enrollment of the next 10 patients (Simon’s 2-stage design). Treatment will continue until disease progression or unacceptable toxicity. The primary endpoint for all cohorts is overall response rate per RANO criteria; secondary endpoints are median PFS and OS, 6-month and 12-month PFS, 12-month OS, and safety. This study is open and actively enrolling patients. The anticipated enrollment period is 24 months. NCT03463265
RBTT-04. DGM1 MAY SERVE AS A NOVEL GENETIC BIOMARKER OF RESPONSE TO ENZASTAURIN IN GLIOBLASTOMA
Authors: Butowski Nicholas , Zhang Lei , Sun Hong , Han Isabel , jivani Manoj , Li Ling , Luo Wen 
Published: November 2019

Abstract

BACKGROUND
No significant progress has been made over the last decade in therapies available for glioblastoma (GBM) with survival remaining poor. Meaningful advances in treating this deadly malignancy may rely on precision medicine. A novel pharmacogenomic biomarker, Denovo Genomic Marker 1 (DGM1), for enzastaurin (enz) in treating lymphoma was discovered. It was evaluated to predict enz response in GBM.

METHODS
Biomarker discovery was performed by a genome-wide screen using DNA extracted from blood samples of a ph 3 enz lymphoma trial and confirmed in an independent ph 2 lymphoma trial. The biomarker was evaluated for its predictability in GBM using the archived DNA samples from a ph 1/2 enz GBM trial.

RESULTS
DGM1, a germline polymorphism on chromosome 8, was found to be highly correlated with response to enz in the two lymphoma trials. Using DNA extracted from pts blood of the single-arm ph 1/2 study with newly diagnosed GBM receiving enz added to radiation and temozolomide (tmz), we found median OS for DGM1+ pts treated with enz was 18 mon vs 12.8 mon for DGM1- pts, HR (95% CI) 0.68 (0.25, 1.81), p = 0.12. Pts receiving a mean daily dose of enz ≥ 245 mg had an OS of 19.8 mon vs 14.9 mon for pts receiving a mean daily dose of < 245 mg [HR (95% CI) 0.55 (0.34, 0.90)].

CONCLUSION
These data are supportive of DGM1 as a potentially predictive biomarker for enz response in both lymphoma and GBM. There is an ongoing biomarker-driven pivotal study in lymphoma. DGM1 in GBM will be further evaluated in a planned randomized ph 2b study in newly diagnosed GBM with 500 mg/day of enz in combination with tmz.
RBTT-06. TESSA JOWELL BRAIN MATRIX STUDY: A BRITISH FEASIBILITY STUDY OF MOLECULAR STRATIFICATION AND TARGETED THERAPY TO OPTIMIZE THE CLINICAL MANAGEMENT OF PATIENTS WITH GLIOMA
Authors: Watts Colin , Apps John , Ansorg Olaf , Savage Josh , Fox Richard , Chalmers Anthony , Short Susan C , Thompson Gerard , Waldman Adam , Capper David , Hargrave Darren , Brennan Paul , Smith Stuart , Ashkan Keyoumars , Wykes Victoria , Kurian Kathreena , Jamal-Hanjani Mariam , Swanton Charles , Buckle Peter , Bulbeck Helen , Stead Lucy F , Vivanco Igor , Bowden Sarah 
Published: November 2019

Abstract
In 2016 there were 5250 brain cancer deaths in the UK. Standard treatment is surgical resection followed by chemo-radiotherapy. In most cases of diffuse glioma, complete tumour resection is not feasible. Many chemotherapy drugs have untested penetration through the blood brain barrier, potentially leading to sub-therapeutic concentrations in the tumour. There is need to refine current treatment strategies in relation to the understanding of tumour biology, and rapidly introduce and evaluate novel therapeutic approaches and agents through delivering rigorous clinical trials. The TESSA JOWELL BRAIN MATRIX Study will evaluate the feasibility of delivering precision medicine for brain cancer patients within the NHS. A multicentre, platform feasibility study of 1200 patients with diffuse glioma will build on the 100,000 genome project to develop and evaluate an infrastructure to collect and integrate: 1) real time comprehensive integrated molecular analysis, including whole genome sequencing and epigenetic classification; 2) serial sampling and annotation of tumours; 3) collection of matched clinical data; 4) assessment of patient quality of life; 5) centralised radiological review and response assessment as per RANO criteria. Once developed this will allow rapid introduction of therapeutic trials to specific patient groups. Secondary objectives include: understanding the association between extent of resection and molecular stratification to refine the role of surgery; optimisation and harmonisation of protocols to best collect, manage and store tissue, clinical data, and radiological images in order to provide a resource for researchers, both within and outside of the study. Improve patient recruitment by identifying and removing recruitment barriers and improve the information and consent processes for patients. Promote the development of a national network with expertise in brain cancer. Enrolment of the first patient is expected in late 2019. For further information, please contact the Brain Matrix Trial Office BrainMatrix@trials.bham.ac.uk.
RARE-14. STRUCTURAL BRAIN PLASTICITY OF THE GRAY MATTER IN PATIENTS WITH BASAL GANGLIA GERM CELL TUMORS: A VBM STUDY
Authors: Li Yanong 
Published: November 2019

Abstract

OBJECTIVE
To assess the whole brain structural plasticity in case of unilateral basal ganglia germ cell tumors (BGGCTs).

METHODS
To detect changes in gray matter volume of the whole brain from structural Magnetic Resonance Imaging (MRI), we used voxel-based morphometry (VBM) in a sample of 41 patients with BGGCTs invading the left basal ganglia (BasalG_L group; n = 22) or the right basal ganglia (BasalG_R group; n = 19) and a sample of 16 patients with GCTs arising in pineal or suprasellar regions, comparing these groups with 16 age-matched normal controls (NCs) by two-sample t test after that.

RESULTS
To left BGGCTs patients, the regions of whole brain VBM analysis emphasized a large cluster of voxels with gray matter volume increase in left para hippocampal (k = 529 voxels, T=4.18, p< 0.01) and decrease in left thalamus (k = 527 voxels, T=-4.88, p< 0.01). At the same time, the cluster of voxels with gray matter volume increase in right middle cingulate cortex (rMCC) (k = 172 voxels, T=3.96, p< 0.01), and decrease in right inferior frontal gyrus (rIFG), pars opercular (k = 495 voxels, T= -4.29, p< 0.01) in right BGGCTs patients. Furthermore, gray matter volume showed no significant difference between groups of patients with GCTs arising in pineal or suprasellar regions and NCs by two-sample t test. And the results were corrected by family-wise-error correction.

CONCLUSIONS
The revealed results demonstrate that slow-growing but destructive lesion of the BGGCTs markedly and asymmetrically atrophies the gray matter volume in specific brain regions and shows compensatory plasticity in each side of cerebral hemisphere. Our findings direct focus on the whole cerebral adaptation that perhaps be a physiologic basis for the high level of functional compensation and partially explain the relationships between gray matter remodeling and cognitive disturbances observed in patients with BGGCTs.
RARE-17. PRIMARY DIFFUSE LEPTOMENINGEAL GLIOMATOSIS OF HIGH GRADE TUMORS
Authors: Kwon Ji-Eyon , Ko Gyung-Oh , Hwan Hwang Gi , Ah Kim In , Woo Wee Chan , Jung Kim Yu , Choe Gheeyoung , Choi Byung-Se , Ho Han Jung , Kim Chae-Yong 
Published: November 2019

Abstract
Primary diffuse leptomeningeal gliomatosis(PDLG) of high grade glioma(HGG) is a rarely documented phenomenon observed in less than 5% of glioblastoma(GBM). Purposes of this study are to investigate the clinical outcomes of PDLG of HGG and to analyze the results according to the procedures of operations. We retrospectively reviewed the medical records of 469 patients of HGG at our institute between 2004 and 2019 and 9 of who with PDLG were enrolled in our study. These 9 patients satisfying the condition of Karnofsky performance status ≥70 and Eastern Cooperative Oncology Group performance status ≤2 were conducted the primary surgical biopsy with or without intracranial pressure control. All patients finished the surgery within about 11 days after the detection of leptomeningeal seeding(LMS) on preoperative MRI images and completed the concurrent chemoradiotherapy(CCRT) with temozolomide(TMZ). Among 9 patients, 7 patients started adjuvant temozolomide and 3 patients completed the six cycles of it. 7 patients had done ICP control operation such as ommaya reservoir insertion, extraventricular drainage, and ventriculoperitoneal shunt within 23.3 days after defined as PLDG and survived nearly 10 months. Their pathologic findings were turned out to be seven glioblastomas and two anaplastic astrocytomas. Their median overall survival was 14 months and the 1- and 2-year overall survival rates were 50.8±17.7% and 16.9±15%, respectively. Compared to the 10-year study of GBM in the same institute between 2004 and 2011, in which 67 patients finished with CCRT with TMZ, the median overall survival was 19 months and the 1- and 2-year overall survival rates were 78.3% and 41.7%. The results indicate that PLDG has a worse outcome and overall survival rate is lower than GBM without LMS, so the earlier start of standard CCRT right after aggressive control of increased ICP like conducting CSF diversion might be helpful for the elongation of life expectancy.
RARE-20. ANALYSIS OF CLINICAL FEATURES ON DEATH FROM INTRACRANIAL GERM CELL TUMORS (GCTS): ARETROSPECTIVE COHORT STUDY
Authors: Cai Linbo , Li Juan , Lai Mingyao , Zhou Cheng , Hu Qingjun , Zhou Zhaoming , Wang Lichao 
Published: November 2019

Abstract

OBJECTIVES
The present study aimed to investigate the clinical features associating with intracranial germ cell tumors(GCTs) of poor prognosis.

METHODS
We retrospectively analyzed the death data cohort based on 47 patients (30 males and 17 females) who had been diagnosed with GCTs between 2005 and 2018 in our hospital. The median age at initial diagnosis was 16 years (range, 3¬60 years). Among those, 18 patients were germinoma and 29 patients were non¬seminomatous germ-cell tumors (NGGCTs).

RESULTS
According to Kaplan-Meier survival analysis, children aged ≤ 10 years were observed with a very short survival compared to patients aged > 10 years, indicating a 5-year survival rate of 0 and 50%, respectively (P < 0.001). To be more specific, disseminated tumors were found to be the most prominent factor for prognosis in children aged ≤ 10 years: the 1-year survival for MR positive versus MR negative of disseminated tumors were 0 and 62.5%, respectively (P < 0.05). On the other hand, the pre¬treatment serum alpha-fetoprotein (AFP) level was found to be an important surrogate for prognosis. In the subgroup of patients > 10 years, the 5-year survival for AFP > 1.5ng/ml was 25%, in comparison to 66% for AFP ≤ 1.5ng/ml (P < 0.05). Further, solid survival advantages were found in patients received stereotactic radiosurgery (SRS) compared to none. The 5¬year survival for SRS versus non-SRS patients were 62% and 29%, respectively (P < 0.05).

CONCLUSION
Our data highlights a number of critical factors that may facilitate the prognosis stratifications of GCTs. What’s more, neither the locations of the primary tumors nor the numbers of lesions are associated with the prognosis of GCTs. These results warrant further investigation via randomized prospective studies.
RARE-25. CLINICAL FEATURES OF PINEAL PARENCHYMAL TUMOR OF INTERMEDIATE DIFFERENTIATION (PPTID): A SINGLE INSTITUTION REVIEW
Authors: Kunigelis Katherine , Kleinschmidt-DeMasters Bette , Ryan Ormond D 
Published: November 2019

Abstract
Pineal parenchymal tumors of intermediate differentiation (PPTID) are rare. Even in the most recent WHO 2016, definitive histological criteria to distinguish grade II from III lesions remain to be defined. While no single institution has large numbers of cases, our experience has been that the clinical course is more varied and complicated than reported. The University of Colorado Health pathology database was queried for cases diagnosed as PPTID, 2006 – 2019, inclusive. Twelve adult patients were identified. Mean age at diagnosis was 40 years (range 26–78). There were 9 female and 3 male patients. Seven patients had well-documented clinical courses at our primary institution. At initial diagnosis, all were treated with surgery and 3/6 documented a gross total resection (GTR). Adjuvant radiation therapy to the resection bed in was administered in 5 of 7 (71%) of patients (4 IMRT, 1 SRS). Mean follow-up time was 71 months (range 13–195); 5/7 (71%) of patients developed a recurrence. Median progression free survival was 37 months (range 13- 73 months), with tendency to be longer for male gender (57.5 versus 17 months in females, p=0.17), and GTR (40 months versus 16 months in subtotal resection, p=0.49). Eighty percent of first recurrent disease had leptomeningeal dissemination. First recurrences were treated with radiation alone in 3 (60%) patients (1 SRS, 1 IMRT), craniospinal radiation with multi-agent chemotherapy in 1 (20%) patient, and surgery with radiation therapy in 1 (20%). At last follow-up, 2 patients (28.5%) had died, with median OS of 168.5 months. Although PPTIDs have a known potential for local recurrence and craniospinal dissemination (quoted as 22% and 10%, respectively in WHO 2016), our data show a more dismal experience with 71% recurrence and 80% dissemination at first recurrence. Lack of standardized therapies results in challenges in individual patient management.