bluuebunny/crossref_metadata_2025_split huggingface dataset:
OTHR-10. Diverse survival outcomes of HER2+ Breast Cancer Brain Metastases (BrCBM) presenting with isolated brain relapse compared to those with concurrent extracranial disease
Authors: Noteware Laura , Ramirez Luis , Alder Laura , Dalal Nicole , Herndon James E , Floyd Scott R , Van Swearingen Amanda E D , Anders Carey K , Sammons Sarah L 
Published: August 2021

Abstract

Background
In patients with isolated HER2+ BrCBM and no extracranial disease (ECD), there are no consensus guidelines on optimal treatment approaches following CNS-directed therapy. Our goal was to determine the implications of ECD at time of first HER2+ BrCBM on intracranial progression-free survival (PFS1) and overall survival (OS).

Methods
Retrospective analysis was performed on 77 patients with HER2+ BrCBM who received 1st CNS radiation from 2006–2020. Demographics, dates of metastatic and intracranial diagnosis, ECD status at 1st BrCBM, and outcomes were collected. The primary endpoint was PFS1 defined as time from first CNS radiation to the subsequent documentation of intracranial progression (RANO-BM). OS was defined as time from 1st CNS radiation and 1st metastatic disease to date of death/last known alive. ECD status was defined by RECIST1.1 from staging scans within 30 days of 1st BrCBM.

Results
In this patient cohort, 25% (19/77) had isolated brain relapse/no ECD. Median age was 50 years. Most patients (58%) developed first BrCBM during adjuvant or early-line metastatic therapy. All patients with no ECD presented with isolated brain relapse as first metastatic presentation. Patients with concurrent ECD presented with first BrCBM at a median of 16.6m (95% CI: 10.5 to 25.3) after initial metastatic presentation. Median OS from initial metastatic presentation to death was worse for patients with isolated brain relapse (25.3m, 95% CI: 16.8 to 35.3) compared to those with concurrent ECD (49.7m, 95% CI: 43.2 to 62; p=0.01). Median OS from first CNS involvement to death was not statistically different amongst groups.

Conclusions
Patients with isolated HER2+ BrCBM as their initial metastatic event have substantially worse OS compared to patients with concurrent ECD developing CNS metastases later in their disease course. This population with isolated brain relapse deserves investigation of novel treatment algorithms, including earlier introduction of brain-penetrable HER2-targeted agents.
RADI-04. Stereotactic radiosurgery in alveolar soft part sarcoma brain metastasis
Authors: Lim Jia Xu , Karlsson Bengt , Pang Angela , Balamurugan Vellayappan , Nga Vincent 
Published: August 2021

Abstract

Background
Alveolar soft part sarcoma (ASPS), although rare, has the highest incidence of brain metastasis amongst all sarcomas. Stereotactic radiosurgery (SRS) has been shown to be a well tolerated and effective treatment of intracranial sarcomatous metastasis. However, there is a paucity of published literature that guides radiation therapy in this condition.

Methods
This is a single centre retrospective review of all ASPS patients with intraparenchymal brain metastasis in our centre treated with stereotactic radiosurgery (SRS). SRS dosing is dichotomised into high and low dose (≥25 Gy and &lt;25 Gy respectively) and outcomes such as local recurrence (LR) and radiation effects are noted. Successful treatment was defined as a lesion that regressed, is stable, or has less than 25% increase in tumour volume. Local recurrence (LR) was defined as increase in tumour volume by more than 25% during follow up.

Results
There were three patients with 11 ASPS metastatic brain lesions, one of which underwent retreatment. Each lesion was followed up for a mean duration of 12 months (range: 5 – 22 months). Five lesions treated with a high dose regime and six lesions were given low dose. Lesions treated with high dose SRS experienced significantly less LR (20% vs 83.3%, OR 20.0 [95%CI 0.93 – 430), p = 0.036) with no increase in undue symptomatic radiation effects. Retreatment of lesions with LR after initial SRS using a low dose regime was successful, albeit only in the single recurrent lesion.

Conclusions
We conclude that SRS can be used as a first line treatment for ASPS brain metastasis that are not surgically accessible and that using a high dose for treatment is effective and safe. Multicentre collaborative studies can be performed to validate this claim.
RADI-05. Metastatic Neoplasm Volume Kinetics Following Two-Staged Stereotactic Radiosurgery
Authors: Damron Ethan , Dono Antonio , Chafi Hatim , Martir Magda , Yu Tse-Kuan , Khwaja Shariq , Amsbaugh Mark , Tandon Nitin , Esquenazi Yoshua , Blanco Angel 
Published: August 2021

Abstract

Introduction
Multisession staged stereotactic radiosurgery (2-SSRS) represents an alternative approach for management of large brain metastases (LBMs), with potential theoretical advantages over fractionated SRS and represents an alternative to surgery in poor surgical candidates. We aimed to investigate the clinical efficacy and safety of 2-SSRS in patients with LBMs.

Methods
LBMs of patients treated with 2-SSRS between 2014 and 2020 were evaluated. Demographic, clinical, and radiologic information was obtained. Volumetric measurements at first SSRS, second SSRS, and follow-up imaging studies were obtained.

Results
Twenty-six patients with 28 LBMs were included in the study. Fifteen patients (58%) were male. Median age at 2-SSRS was 61 years (range: 31–84). Median marginal doses for first and second SSRS were 15 Gy (range: 12–18 Gy) and 15 Gy (range: 12–16 Gy), respectively. Median duration between sessions was 32 days. Two patients (8%) failed to receive their second SSRS due to local progression. Median tumor volumes at first SSRS, second SSRS, 3-month follow-up, and 6-month follow-up were 8.7 cm3 (range: 1.5–34.7 cm3), 3.3 cm3 (range: 0.8–26.1 cm3), 1.7 cm3 (range: 0.2–10.1 cm3), and 1.4 cm3 (range: .04–20.7 cm3), respectively. The median absolute and relative decrement between S-SRS sessions was 3.7 cm3 (range: 2.8–16.5 cm3) and 49.5% (range: 17.1- 87.1%), respectively. Overall, 26 of the 28 lesions (93%) demonstrated early local control following the first SSRS with 18 lesions (69%) demonstrating a decrease in volume of &gt;30% and 3 lesions (12%) remaining stable. Six lesions (23%) showed disease progression. There were no grade 3 adverse events.

Conclusions
Our study supports the effectiveness and safety of 2-SSRS as a treatment modality for patients with large, symptomatic brain metastases, especially in non-surgical candidates. The local failure rate and low occurrence of adverse effects are comparable to other staged radiosurgery series.
RADI-09. Clinical factors associated with death after radiotherapy for brain metastases
Authors: Natesan Divya , Carpenter David , Giles William , Oyekunle Taofik , Niedzwiecki Donna , Reitman Zachary , Kirkpatrick John , Floyd Scott 
Published: August 2021

Abstract

Introduction
It can be challenging to accurately identify patients with brain metastases who have very poor prognosis and are unlikely to benefit from radiation (RT). We characterized factors of patients who died within 30 days of receiving RT for brain metastases.

Methods
Patients who received whole brain RT (WBRT) or stereotactic radiosurgery (SRS) for brain metastases between 1/1/2017–9/30/2020 at a single institution were identified. Patient, tumor, treatment, and death variables were collected. Characteristics between those who did and did not die within 30 days were compared using the Wilcoxon Rank-Sum or Chi-Square test. Survival was estimated with Kaplan-Meier method.

Results
636 patients received WBRT (n=117) or SRS (n=519). Median age was 61. Median survival was 6 months (95% CI 5–7 months). 75 (12%) died within 30 days of RT. Patients who died within 30 days had worse median KPS (50 vs 80, p&lt;0.001). A higher proportion who died within 30 days had innumerable intracranial metastases (45% vs 11%, p&lt;0.001), leptomeningeal disease (16% vs 5%, p&lt;0.001), and higher burden of neurologic symptoms at presentation (seizures (12% vs 4%, p=0.003); cranial neuropathies (32% vs 9%, p&lt;0.001); motor/sensory deficits (51% vs 29%, p&lt;0.001); altered mentation (60% vs 26%, p&lt;0.001); headaches (48% vs 30%, p&lt;0.001); steroid use (68% vs 48%, p&lt;0.001)). Patients who died within 30 days had progressive extracranial disease (intrathoracic: 87% vs 50%; spinal: 57% vs 18%; liver/adrenal: 60% vs 24%), p&lt;0.001. More patients who died within 30 days received inpatient RT (39% vs 4%, &lt;0.001) and did not complete RT (24% vs 1%, p&lt;0.001).

Discussion
Patients who died within 30 days of RT had worse KPS, intracranial/extracranial disease burden, and neurologic symptoms. Future analyses will assess whether these factors can inform a prognostic model to identify patients with poor prognosis who may be appropriate for supportive care alone.
RADI-15. Radiotheranostic Approach in Brain Tumor
Authors: Nemati Reza , Rekabpour Seyed Javad , Jokar Narges , Ahmadzadehfar Hojjat , Shooli Hossein , Jafari Esmail , Assadi Majid 
Published: August 2021

Abstract

Purpose
The aim of this study is feasibility and potential treatment of targeted radionuclide theranostic approach for patients with brain tumors.

Methods
For the period 2020–2021, 6 child and adult patients who had been diagnosed with brain tumors were treated using theranostic approach followed by refractory to conventional therapy. Two patients that were presented with HER-2 positive, ER and PR negative breast cancer and brain metastases as well as a history of several cycles of chemotherapy sessions and radiotherapy using gamma knife were treated with 177Lu-Trastuzumab (Herceptin). Three other patients with primary brain tumor underwent peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE. The last case was a patient with refractory primary cerebral lymphoma to standard therapy with confirmed CD20-positive B-cell lymphoma who underwent 177Lu-Rituximab.

Results
A two women with HER-2 positive breast cancer and brain metastasis underwent two cycles of 177Lu-trastuzumab. Post-therapy assessment showed some improvement. Next, a man with a high-grade glioma tumor in the left frontal lobe with history of debunking surgery in combination with chemoradiation received 177Lu-DOTATATE that resulted in a short-term stable situation. Another patient presented with a right cerebellopontine angle meningioma underwent PRRT with 177Lu-DOTATATE. She had a stable disease with some improvement in the clinical status. Also, a girl with an astrocytoma in suprasellar cistern underwent 2 cycles of 177Lu-DOTATATE. The complete response was designed. Finally, a patient with refractory primary cerebral lymphoma received 177Lu-Rituximab.

Conclusion
Nuclear oncology in the field of neuro-oncology (neuroradiotheranostics) has been toward a personalized approach, effective and safe therapy. These preliminary studies might demonstrate feasibility and therapeutic potential of theranostics in patients with primary, relapsed or metastasis brain tumors. Further studies preferentially well-designed multicenter international clinical trial is warranted.
RADI-16. Efficacy of WBRT among the Sub-types of Metastatic Breast Cancer
Authors: Mathew Shija , Udaykrishna A S , Lokesh V 
Published: August 2021

Abstract

Objectives
To understand the effect of Whole Brain Radiation (WBRT) in terms of Age, Neurological performance, Radiological Improvement and the Overall Survival.

Methods
34 Patients [Median Age: 45 years (31- 65)] with Metastatic Breast Carcinoma who presented with Brain metastasis to the Department of Radiation Oncology at Kidwai Memorial Institute of Oncology and subjected to Whole Brain Radiotherapy/ Focal RT were taken into the study. The efficacy of WBRT was assessed among the four subtypes of MBC.

Results
39% of the patients belonged to Luminal A, 25%, 22% and 14% belonged to Luminal B, Her2 amplified and Basal respectively. Patients under Luminal A, presented with brain metastases by 25 months after the diagnosis of the primary. 60% presented with single lesion, amenable to resection and 58% underwent surgery followed by WBRT and OS fared better as compared to patients with WBRT alone with no distant recurrences on imaging and improvement in KPS. Patients with Luminal B/ HER2 amplified subgroup had predominantly oligometastatic lesions (65%), presented with brain metastases at 15 months after diagnosis of Carcinoma Breast,18% received Herceptin and Lapatinib and 33% and 22% received Herceptin and Lapatinib alone. OS was superior over WBRT alone with exaggerated radiation necrosis in those who took concurrent biological therapy and RT.In patients with Basal subtype,75%had multiple metastatic brain lesions, presented with symptoms by 10 months of diagnosis of the primary with poor KPS and OS remained poor despite WBRT.

Conclusions
Lesions being amenable for surgery, focal RT to post op cavity alone may be considered in patients with Luminal A. WBRT plus boost for those unfit for surgery. Addition of TKI +/- oral chemo for all patients with Luminal B and HER 2 amplified to Focal RT or WBRT. Triple Negative patients present with poor KPS can be considered for BSC/WBRT on case basis.
SURG-02. Stereotactic Laser Ablation (SLA) followed by consolidation stereotactic radiosurgery (SRS) as a treatment strategy for brain metastasis that recurred locally after initial radiosurgery (BMRS): a collaborative institutional experience
Authors: Pena-Pino Isabela , Ma Jun , Hori Yusuki , Fomchenko Elena , Dusenbery Kathryn , Reynolds Margaret , Wilke Christopher , Yuan Jianling , Barnett Gene , Chiang Veronica , Mohammadi Alireza , Chen Clark 
Published: August 2021

Abstract

Introduction
In independent clinical trials, ~30% of brain metastases recur locally after radiosurgery (BMRS). For these lesions, treatment with stereotactic laser ablation (SLA, also known as laser interstitial thermal therapy (LITT)) alone achieves a 12-month local control (LC12) of 54–85% while repeat SRS achieved LC12 of 54–79%. Here, we report favorable outcomes for BMRS treated with SLA followed by consolidation radiosurgery (SLA/cSRS).

Methods
Clinical outcome of 18 patients with 19 histologically confirmed BMRS treated with SLA followed by consolidation SRS and &gt;3 months follow-up were collected retrospectively across three institutions. Local control was defined as stability or decrease in contrast-enhancing (CE) and FLAIR volume.

Results
SLA achieved ablation of 73–100% of the BMRS CE volumes. Consolidation hypo-fractionated radiosurgery (5 Gy x 5 or 6 Gy x 5) was carried out 16–40 days post-SLA (median of 26 days). With a median follow-up of 185 days (range: 93–1367 days) and median overall survival (OS) of 185 days (range: 99–1367 days), 100% LC12 was achieved. 13/18 (72%) patients that required steroid therapy prior to SLA/cSRS were successfully weaned off steroid by three months post-SLA/cSRS. Post-SLA, KPS declined for 3/19 (16%) patients and improved for 1/19 (5%) patients. No KPS changes occurred subsequent to consolidation SRS. There were no 30-day mortalities or wound complications. Two patients required re-admission within 30 days of SRS (severe headache that resolved with steroid therapy (n=1) and new-onset seizure (n=1)). Except for two patients who suffered histologically confirmed, local failure at 649 and 899 days, all other patients are either alive (n=5) or died from systemic disease progression (n=11). None of the treated patients developed symptomatic radiation necrosis.

Conclusions
This collaborative institutional experience support efficacy and safety of SLA followed by consolidation SRS as a treatment for BMRS. The treatment strategy warrants further investigations.
SURG-04. Surgical resection of symptomatic brain metastasis in patients with non-small cell lung cancer irrespective from lesion count
Authors: Jünger Stephanie T , Reinecke David , Meißner Anna-Katharina , Goldbrunner Roland , Grau Stefan 
Published: August 2021

Abstract

Background and Purpose
Current guidelines primarily suggest the resection in case of a limited number of brain metastases (BM). With an increasing number of local and systemic treatment options this approach needs reconsideration. Therefore, we aimed to evaluate the role of metastectomy in patients with non-small cell lung cancer (NSCLC) treated in a comprehensive setting disregarding lesion count.

Patients and Methods
In this monocentric retrospective analysis, patients receiving surgery for 1–3 BM with available demographic, clinical, and tumor-associated parameters were included. Prognostic factors for local control (LC) and overall survival (OS) were analyzed by Log rank test and Cox proportional hazards.

Results
Two-hundred-sixteen patients were included: 129 (59.7%) with single/solitary, 64 (29.6%) with 2–3, and 23 (10.6%) with more than three BM. Resection of the symptomatic BM(s) improved the patients’ Karnofsky performance index (KPI) significantly (p&lt;0.001), enabling adjuvant radiotherapy in 199 (92.1%) and systemic treatment in 119 (55.1%) patients.
After a mean radiological follow-up of eight (1–79) months, LC was observed in 83 (38.4%) patients and was not significantly influenced by BM count (p=0.064). After a mean OS after surgery of 12.7 (0–88) months, 120 (55.6%) patients had died.
In univariate analysis, BM count showed no impact on OS (p=0.844), while age ≥/&lt; 65 years (p=0.007), pre- and postoperative KPI ≥70 (p=0.002 and p=0.005, respectively), extra-cranial metastases (p=0.004), adjuvant radiation therapy (p&lt;0.001), and adjuvant systemic treatment (p&lt;0.001) did. In regression analysis the presence of extra-cranial metastases (HR 2.30 95%CI 1.53–3.48; p&lt;0.001), adjuvant radiation therapy (HR 0.97 95%CI 0.23–0.86; p=0.016), and adjuvant systemic treatment (HR 0.37 95%CI 0.25–0.55; p&lt;0.001) remained independent factors for survival.

Conclusions
The indication for resection of symptomatic BM in patients with NSCLC is justified even in case of multiple lesions to alleviate their neurological symptoms and to enable further treatment.
SURG-12. MALIGNANT BREAST NEOPLASM AND BRAIN METASTASES: SERIES OF CASES AND MAIN APPROACHES IN A HOSPITAL COMPLEX IN BRAZIL
Authors: de Lima Frederico Tavares , Medeiros Nataly Regina , Filho Luiz Domingues Vasconcelos , Leimig Bruno , Matias Walter , Silva Joacil Carlos , de Mello José Roberto Vieira 
Published: August 2021

Abstract

Introduction
With the advancement of clinical and surgical oncology, patients with breast cancer had an increase in survival. In this context, up to 30% of patients affected with metastases from this site will develop brain tumors. The latter is an important impacting factor for life quality and expectancy, therefore, it’s clinical and surgical management is essential in public health. We present some rare cases and their outcomes.

Methods
We describe a case series of 07 patients with breast cancer metastases to the brain, involving large portions of the dura, bone or skin. There were 64 surgical interventions of the disease in the period, but only those with more exuberant and atypical presentations were selected. The interventions were carried out in a hospital oncology complex in northeastern Brazil between 2016 and 2020.The diagnosis was based on the clinical description, laboratory and image exams, histopathology and surgical performance of the patients.

Results
The mean age of the patients was 49.7 years, with all patients being female. Rare presentations were observed, such as bone and skin meninges. Clinical presentations demonstrated advanced stages of the disease with a large tumor volume. Extra axial involvement was verified. All patients underwent neurosurgery for tumor removal and decompression. Biopsies were submitted to anatomopathological and immunohistochemistry examination. Corticotherapy was instituted in the immediate postoperative period and some cases had genetic analysis due to an important family history. There was a reduction in symptoms in most cases.

Conclusion
Although brain metastases are still a challenge for medical practice, their proper management can prolong and improve patients’ lives. Metastatic breast cancers seem to have a predilection for the central nervous system and their detection and intervention, even in an advanced clinical stage, sound as determinant for the control and severity of symptoms.

Keywords
Brain Neoplasms, Neoplasm Metastasis, Breast Neoplasms
Substance Use and Mental Health Outcomes from a Text Messaging-Based Intervention for Smoking Cessation Among Young People Experiencing Homelessness
Authors: Pedersen Eric R , Linnemayr Sebastian , Shadel William G , Zutshi Rushil , DeYoreo Maria , Cabreros Irineo , Tucker Joan S 
Published: August 2021

Abstract

Introduction
Cigarette smoking and associated high-risk behaviors are prevalent among youth experiencing homelessness (YEH), making appropriately tailored interventions targeting smoking behavior important for this group. We pilot tested a brief text-messaging intervention (TMI) as an adjunct to standard care for YEH who smoke and found promising preliminary effects of the intervention on smoking cessation. The purpose of the present study was to test the TMI’s effect on the secondary outcomes of other substance use (including use of other tobacco/nicotine devices) and mental health symptoms.

Methods
A total of 77 participants completed the pilot randomized controlled trial, with 40 receiving the TMI (174 automated text messages plus a group smoking counseling session and provision of nicotine patches). They completed an assessment at baseline and another three months later that evaluated use of other tobacco/nicotine devices, alcohol, marijuana, and anxiety and depression symptoms.

Results
We found that the TMI helped to reduce secondary substance use behaviors and mental health symptoms among the participants; mainly there were medium effects of the intervention on changes in other tobacco/nicotine use, drinking, and anxiety and depression symptoms. The intervention did not have an effect on number of marijuana use days in the past month; however, past 30-day marijuana users who received the intervention benefited by reducing the number of times they used marijuana per day.

Conclusions
In addition to helping reduce cigarette smoking, we found that a TMI for YEH was helpful in improving secondary outcomes, suggesting the promise of the TMI on benefiting YEH even beyond targeted smoking behavior.

Implications
This pilot study demonstrates that by targeting cigarette smoking using a text message-based intervention among youth experiencing homelessness, effects may be seen in other areas of functioning such as other substance use and mental health.

Trial registration
ClinicalTrials.gov Identifier NCT03874585. Registered March 14, 2019, https://clinicaltrials.gov/ct2/show/record/NCT03874585.