bluuebunny/crossref_metadata_2025_split huggingface dataset:
RADI-20. RETROSPECTIVE OUTCOME ANALYSIS OF INTRAOPERATIVE RADIOTHERAPY (IORT) FOR SURGICALLY RESECTED BRAIN METASTASES: AN INTERNATIONAL COOPERATIVE STUDY.
Authors: Cifarelli Christopher , Vargo J Austin , Hack Joshua , Kahl K Henning , Brehmer Stefanie , Sarria Gustavo , Giordano Frank 
Published: August 2019

Abstract
BACKGROUND & OBJECTIVE: The ideal delivery of adjuvant radiation to the surgical cavity of brain metastases (BMs) remains the subject of debate. Risks of leptomeningeal dissemination (LMD), local failure (LF) and radiation necrosis (RN) have prompted a reappraisal of the timing and/or modality of this critical component of BM management. IORT delivered at the time of resection for BMs requiring surgery offers the potential for improved LC and decreased LMD afforded by the elimination of delay in time to initiation of radiation following surgery and the possibility of dose escalation beyond that seen in stereotactic radiosurgery (SRS). This study provides a retrospective analysis with identification of potential predictors of outcomes. METHODS: Retrospective data was collected on patients treated with IORT immediately following surgical resection of BMs at three institutions according to the approval of individual IRBs. All patients were treated with the Zeiss Intrabeam device (Carl Zeiss Meditech, Germany) using spherical applicators ranging from 1.5 to 4.0cm with 50kV output. Statistical analyses were performed using SPSS (IBM) with endpoints of LF, DBF, incidence of RN, and overall survival (OS) and p&lt; 0.05 considered significant. RESULTS: 54 patients were treated with IORT with a median age of 64 years. The most common primary diagnosis was non-small cell lung cancer (40%) with the most common location in the frontal lobe (38%). Median follow-up was 7.2 months and 1-year LC, DBF, and OS were 88%, 58%, and 73%, respectively. LMD was identified in 2 patients (3%) and RN present in 4 patients (7%). The only predictor of LC was extent of resection with 1-yr LC of 94% for GTR vs 62% for STR (p=0.049). CONCLUSIONS: IORT is a safe and effective means of delivering adjuvant radiation to the BM resection cavities with high rates of LC and low incidence of RN.
RADI-28. UP-FRONT SINGLE SESSION RADIOSURGERY FOR LARGE BRAIN METASTASES - VOLUMETRIC RESPONSES AND OUTCOMES
Authors: Benjamin Carolina , Mureb Monica , Nakamura Aya , Mullen Reed , Pacione Donato , Silverman Joshua , Kondziolka Douglas 
Published: August 2019

Abstract
OBJECTIVE: Patients presenting with large brain metastases (LBM), described in the literature as ≥2.5 cm in maximum diameter or ≥10cm3in volume, pose a management challenge. For patients not compromised by mass effect, corticosteroid therapy followed by SRS allows for efficient, minimal access care that facilitates immediate institution of systemic therapy. METHODS: We performed a volumetric-based analysis in order to determine the efficacy of single-session SRS in the treatment of LBM in comparison to other treatment modalities. Thirty patients over the age of 18 with systemic cancer and brain metastases (≥2.7cm in greatest diameter or ≥10cm3in volume) who underwent single session SRS were included. Serial tumor volumes, clinical outcomes, and medication requirements were studied. RESULTS: Among 30 patients, 70% of patients had either lung, melanoma, or breast cancer. Median initial tumor size (maximum diameter) was 32mm (range 28–43) and median initial tumor volume was 9.32cm3 (range 1.09–25.31). Median marginal dose was 16Gy (range 12–18). Average percent decrease in tumor volume was 50% on imaging at 4–8 weeks, 60% at 4–6 months, 48% at 6–8 months, and 67% at &gt;8 months compared to initial imaging. Only one patient required a subsequent craniotomy 4 years after SRS for an enlarging cyst which was granulation tissue consistent with radiation effects on pathology. There were no adverse events immediately following SRS. Median corticosteroid use after SRS was 21 days. There was no statistically significant difference in KPS score between treatment day and last follow up, suggesting relative safety and maintenance of function. CONCLUSION: Initial high dose corticosteroid therapy followed by prompt single session SRS is a safe and efficacious method of managing patients with large brain metastases (defined in our study as ≥2.7cm or ≥10cm3), if the clinical condition of the patient is acceptable at presentation.
RADI-37. CLINICAL RISK FACTORS FOR INTRACRANIAL HEMORRHAGE OF SOLID MELANOMA BRAIN METASTASES AFTER RADIOSURGERY
Authors: Okoukoni Catherine , LeCompte Michael , Hughes Ryan , McTyre Emory , Cramer Christina , Whitlow Christopher , Chan Michael 
Published: August 2019

Abstract
PURPOSE: Melanoma brain metastases (MBM) are among the most common solid tumors associated with intracranial hemorrhage (ICH). Our objective is to investigate risk factors for post-radiosurgery intracranial hemorrhage (PRH). METHODS: We collected demographic, clinical, treatment, toxicity, survival, and imaging data for patients with solid MBM who underwent SRS between 2000 and 2016 at our institution. Bleed free survival (BFS) and overall survival (OS) analyses were performed using Kaplan–Meier methods. Logistic regression was used to identify PRH risk factors. RESULTS: From 2000 to 2016, 107 patients with a total of 548 solid MBM received SRS. Median patient age at time of SRS was 63.2 years. Median MBM volume was 2.8 cm3 (range 0.01–21.3 cm3). MBM were in the cortex (n = 431), cerebellum (n= 85), basal ganglia (n= 23), and brain stem (n= 9). MBM were treated to a median dose of 20 Gy (range 14–20 Gy). Seventeen patients received immunotherapy (IT) within 1 year of SRS, 7 patients received concurrent immunotherapy (XR-IT). Median follow-up and OS was 13.5 months and 10.8 months, respectively. Median BFS was 8.3 months. PRH occurred in 123 MBM (22%). MBM volume (p= 0.0001), total MBM volume (p= 0.0006), IT (p= 0.04), and XR-IT (p= 0.03) were associated with increased PRH. PRH cumulative incidence within 24 mo of SRS was increased in MBM &gt; 2.8 cm3 compared with patients with smaller MBM: 27.5% verse 5.3%, respectively. Age, sex, hypertension, MBM location, total MBM number, and marginal dose (p &gt; 0.05) did not significantly impact risk of PRH. No significant difference in 6, 12, or 24 mo actuarial OS rates were observed in patients with PRH (p &gt; 0.05). CONCLUSIONS: Patients with larger MBM volume and IT within 1 year of SRS have the greatest risk of PRH. PRH did not significantly impact OS in this study.
RADI-40. STEREOTACTIC RADIOSURGERY FOR BRAINSTEM METASTASES: AN ANALYSIS OF SINGLE FRACTION AND MULTI FRACTION TECHNIQUES
Authors: Nack Elana , Iyengar Varun , Yu Esther , DiPetrillo Thomas , Kinsella Timothy , Wazer David , Cielo Deus , Toms Steven , Hepel Jaroslaw , Koffer Paul 
Published: August 2019

Abstract
PURPOSE: Utilization of stereotactic radiosurgery (SRS) for brainstem metastases (BSM) is increasing. Multi-fraction SRS (MF-SRS) is a potential means of obtaining therapeutic gain while limiting toxicity. However, most available data assesses only single-fraction SRS (SF-SRS). This study aims to evaluate the efficacy and safety of SF-SRS and MF-SRS for BSM. METHODS: Data was retrospectively collected for patients with BSM treated with SRS between 2003–2018 at a single institution. Kaplan-Meier method was used to evaluate overall survival (OS) and local control (LC). Independent t-test was used for correlations between groups. RESULTS: 29 patients (31 lesions) were identified; 13 patients (15 lesions) underwent SF-SRS and 16 patients (16 lesions) underwent MF-SRS. Median follow-up was 6.8 months (1–80.8 months). Post-SRS MRI was available for 78% of patients. Median dose was 16Gy (12–18 Gy) for SF-SRS and 24 Gy (18–30 Gy) for MF-SRS. MF-SRS was delivered in a median of 3 fractions (3–5). There was a trend toward larger mean tumor volume with MF-SRS (1.297 vs 0.302mL, p=0.055). OS was 64.8% at 6 months and 49.3% at 12 months. LC was 90.9% at 6 months and 69.9% at 12 months. LC was similar between SF-SRS and MF-SRS at 6 months (100% vs 79.5%, p=0.143) and 12 months (50.0% vs 79.5%, p=0.812). Among the 4 patients who experienced local recurrence, 3 received salvage whole brain radiation and median OS was 8.1 months after LF. Distant CNS failures occurred in 40.3% of patients at 6 months and 72.4% at 12 months. Tumor volume &gt;0.5 mL was associated with worse LC at 6 months (64.3% vs 100%, p=0.022). One patient developed symptomatic radiation necrosis (1/29 lesions, 3.4%) after MF-SRS. CONCLUSION: SRS is a safe and effective treatment for small BSM. Outcomes were not different between SF-SRS and MF-SRS but analysis is limited by small sample size.
RADI-43. ARTERIAL SPIN LABELING PERFUSION MR IMAGING FOR DIFFERENTIATION BETWEEN TUMOR RECURRENCE AND PSEUDOPROGRESSION IN INTRACRANIAL METASTASES FOLLOWING STEREOTACTIC RADIOSURGERY
Authors: Villanueva-Meyer Javier , Diaz Alex , Felix Alex , Braunstein Steve 
Published: August 2019

Abstract
Stereotactic radiosurgery (SRS) is a standard adjuvant treatment for patients with limited intracranial metastatic disease. Transient growth, increased peritumoral edema, and inflammation can be seen in up to a third of these cases following SRS. Unfortunately, this pseudoprogression is often indistinguishable from true progression by morphologic MR imaging thereby complicating patient management. The purpose of this study was to evaluate whether arterial spin labeling (ASL) perfusion can differentiate tumor recurrence from pseudoprogression after SRS. We reviewed patients treated between 2013 and 2018 and identified 24 patients with 43 intracranial metastases who had imaging suggesting progression following SRS and also had ASL perfusion acquired at time of MR imaging. Median imaging follow-up was 11 months (range 3–64 months). Outcome of tumor recurrence or pseudoprogression was confirmed in each case by pathology or subsequent MR imaging. 25 (58%) lesions were classified as tumor recurrence (13, 52% by pathology), while 18 (42%) were classified as pseudoprogression (3, 18% by pathology). ASL perfusion values (normalized cerebral blood flow) were higher in patients with tumor progression (2.1 vs 1.1 ml/min/100g, p=0.003). No significant difference was observed between histology, time from radiotherapy, marginal dose, volume of lesion, or instances of repeat SRS treatments between groups. In conclusion, elevated blood flow by ASL perfusion was closely associated with the diagnosis of tumor recurrence after SRS. Patients with intracranial metastases undergoing SRS may benefit from this short non-contrast sequence at time of follow-up MR imaging.
SURG-06. LASER INTERSTITIAL THERMAL THERAPY COMPARED TO CRANIOTOMY FOR TREATMENT OF RADIATION NECROSIS OR RECURRENT TUMOR IN BRAIN METASTASES FAILING RADIOSURGERY
Authors: Hong Christopher , Deng Di , Sujijantarat Nanthiya , Vera Alberto , Chiang Veronica 
Published: August 2019

Abstract
Many publications report laser-interstitial thermal therapy (LITT) as a viable alternative treatment to craniotomy for radiation necrosis (RN) and re-growing tumor occurring after stereotactic radiosurgery (SRS) for brain metastases. No studies to-date have compared the two options. The aim of this study was to retrospectively compare outcomes after LITT versus craniotomy for regrowing lesions in patients previously treated with SRS for brain metastases. Data were collected from a single-institution chart review of patients treated with LITT or craniotomy for previously irradiated brain metastasis. Of 75 patients, 42 had recurrent tumor (56%) and 33 (44%) had RN. Of patients with tumor, 26 underwent craniotomy and 16 LITT. For RN, 15 had craniotomy and 18 LITT. There was no significant difference between LITT and craniotomy in ability to taper off steroids or neurological outcomes. Progression-free survival (PFS) and overall survival (OS) were similar for LITT versus craniotomy, respectively: %PFS-survival at 1-year = 72.2% versus 61.1%, %PFS-survival at 2-years = 60.0% versus 61.1%, p = 0.72; %OS-survival at 1-year = 69.0% versus 69.3%, %OS-survival at 2-years = 56.6% versus 49.5%, p = 0.90. This finding persisted on sub-analysis of smaller lesions under &lt; 3cm in diameter. Craniotomy resulted in higher rates of pre-operative deficit improvement than LITT (p &lt; 0.01). On sub-group analysis, the single factor most significantly associated with OS and PFS was pathology of the lesion. About 40% of tumor lesions needed post-operative salvage with radiation after both craniotomy and LITT. LITT was as efficacious as craniotomy in achieving local control of recurrent irradiated brain metastases and facilitating steroid taper, regardless of pathology. Craniotomy appears to be more advantageous for providing symptom relief in those with pre-operative symptoms.
SURG-08. GASTROINTESTINAL STROMAL TUMOR WITH INTRACRANIAL METASTASIS: CASE REPORT AND SYSTEMATIC REVIEW OF LITERATURE
Authors: Patel Akash 
Published: August 2019

Abstract
BACKGROUND: Intracranial metastasis of Gastrointestinal Stromal Tumors (GIST) is rare but presents unique treatment challenges. We present a case of intracranial metastasis of GIST with a systematic review of the literature regarding this rare clinical scenario. METHODS: A systematic review of the literature was performed to identify cases of intradural GIST metastases to the brain. Additionally, a patient case of GIST is discussed. RESULTS: Out of the 18 articles included for analysis in this review and our present case, fifteen of nineteen patients were male, and mean age was 58 years old (range 15–80 years, median 60 years). The primary site of the GIST along with site of intraperitoneal metastasis was variable. There was a large predilection for brain metastasis to the cerebrum with only one to infratentorial elements. The tumors in seven of the cases involved the dura, and there was one case with metastasis to the pituitary. Eight patients died following treatment of their intracranial disease. CONCLUSIONS: Surgery remains the mainstay of intracranial metastatic GIST, however there are many reports of good responses to radiation or chemotherapy alone. More investigation is required to determine the best course of treatment for patients with this unusual sequela of GIST.
SURG-12. A COMPARISON BETWEEN PROGNOSTIC SCORES OF BREAST CANCER BRAIN METASTASES APPLIED TO A NEUROSURGICAL POPULATION
Authors: Bastos Dhiego , Prabhu Sujit , Sawaya Raymond , Joaquim Andrei , Liu Diane , Suki Dima 
Published: August 2019

Abstract
INTRODUCTION: Prognostic scores have been developed to predict overall survival (OS) in patients with brain metastasis from breast cancer, comprising different combinations of prognostic factors. A new prognostic score including the number of brain metastases has been proposed. We aimed to evaluate the use of these prognostic scores on a neurosurgical population. METHODS: Retrospective study with consecutive patients with brain metastasis from breast cancer treated in the neurosurgery department. Clinical end point is overall survival estimated by the Kaplan Meier method. Univariate and multicovariate Cox proportional hazard models are applied to estimate the effect of covariates of interest on OS. We employ Bootstrap validation method to estimate the bias-corrected or over fitting-corrected predictive accuracy of Cox models, which is presented by concordance index(C-index). RESULTS: 315 consecutive patients with brain metastasis from breast cancer. Median OS was 14 months(95% CI 11–16.9), KPS, number of brain metastases, biological subtypes, age and presence of extracranial metastases were significantly associated with improved OS on the univariate analysis. Multivariate analysis showed that KPS, biological subtype, age and number of brain metastases were statistically significant for OS. The recursive partitioning analysis(RPA) classes, the graded prognostic assessment(GPA) score, the diagnostic specific GPA(DS-GPA) and the modified DS-GPA identified individual subgroups with different OS. RPA and DS-GPA had OS statistical significant between all groups with a C-index of 0.561 and 0.586 respectively. DS-GPA had a c-index of 0.639 and modified DS-GPA had an c-index of 0.637. DS-GPA and modified DS-GPA had a better performance in terms of discrimination when compared to RPA(p&lt; 0.001) and GPA(p=0.01). CONCLUSIONS: DS-GPA and modified DS-GPA were able to better discriminate subgroups OS, which most likely reflects the use of biological subtype in the score calculation. The incorporation of number of BM by the modified DS-GPA improved the distinction between the higher score and the lower score group.
Neuro-Oncology Practice Clinical Debate: targeted therapy vs conventional chemotherapy in pediatric low-grade glioma
Authors: Cooney Tabitha , Yeo Kee Kiat , Kline Cassie , Prados Michael , Haas-Kogan Daphne , Chi Susan , Mueller Sabine 
Published: August 2019

Abstract
The treatment of children with low-grade glioma has evolved over the last several decades, beginning initially with focal radiotherapy, which has now been largely replaced by systemic treatment with conventional chemotherapy agents or more recently molecularly targeted therapeutics. A consensus standard of care is not well defined, leaving clinicians and parents to choose from an increasing number of options, often without complete information concerning the associated risks and benefits. Issues critical to this topic include timing of interventions (when to treat), preservation of neurological function (goals of treatment), choice of initial therapy strategy (conventional cytotoxic chemotherapy vs molecularly targeted therapy), duration of treatment (how long, and what clinical or imaging endpoints to consider), and perhaps most important, risk reduction relative to anticipated benefit. The groups from the University of California, San Francisco and Dana Farber Cancer Institute, moderated by Michael Prados, herein debate the merits of cytotoxic chemotherapy and targeted therapeutics as initial treatment strategies in pediatric low-grade glioma, a topic discussed daily in Tumor Boards across the United States and abroad. Prospective, randomized, phase 3 trials comparing the 2 strategies, conducted within homogenous disease settings, with consistently evaluated functional and imaging endpoints, are not available to guide the risks/benefit discussion. As is often the case in rare biologically diverse diseases, in a vulnerable population, therapy decisions are frequently based on incomplete data, physician experience, bias to some degree, and patient/family preference.
Nicotine Induced Neurocognitive Protection and Anti-inflammation Effect by Activating α 4β 2 Nicotinic Acetylcholine Receptors in Ischemic Rats
Authors: Han Tingting , Wang Qi , Lai Ruihe , Zhang Dalong , Diao Yao , Yin Yafu 
Published: August 2019

Abstract

Introduction
The main objective of this study was to explore the mechanism of nicotine improving cognitive impairments in ischemic rats.

Methods
Twenty adult male Sprague–Dawley (SD) rats underwent ischemic model surgery by injecting endothelin-1 into the left thalamus, which were classified into four different groups with different intervention: nicotine (1.5 mg/kg/d), dihydro-β-erythroidine (DHβE; 3 mg/kg/d), nicotine (1.5 mg/kg/d) + DHβE (3 mg/kg/d), or saline, after ischemic model surgery. Another five male SD rats also underwent same surgery, while not injecting endothelin-1 but saline, as the control group. Morris water maze (MWM) test was adopted to assess the cognition. All the rats underwent the MWM test, micro positron emission tomography imaging with 2-[18F]-A-85380, and messenger RNA (mRNA) test of α 4 nicotinic acetylcholine receptor (nAChR), β 2 nAChR, tumor necrosis factor-alpha (TNF-α), IL-1β, and IL-6.

Results
The MWM test showed the rats given nicotine showing better memory than ischemic rats (p &lt; .05), whereas the rats given DHβE or both nicotine and DHβE did not show any statistical difference from the ischemic rats (p &gt; .05). Micro positron emission tomography imaging showed higher uptake of tracer in the left thalamus and whole brain in rats given nicotine than in ischemic rats, but the rats given DHβE or both nicotine and DHβE did not. By real-time PCR test, the mRNA of α 4 nAChR and β 2 nAChR in rats given nicotine increased significantly compared with ischemic rats and decreased TNF-α, IL-1β, and IL-6 mRNA (all ps &lt; .05).

Conclusions
By activating α 4β 2 nAChRs, nicotine plays a role in inhibiting the inflammatory factors, which contributes to improving cognitive impairment in ischemic rats.

Implications
It is well acknowledged that vascular cognitive impairment (VCI) is the second most common cause of dementia after Alzheimer’s disease. Cholinergic agents have potential for the symptomatic treatment of the cognitive symptoms of dementia, but the exact mechanism still remains unclear. There are potential complex associations and interactions between VCI and inflammation. This study showed that nicotine had anti-inflammatory potency, which is most likely because of the activation of the nAChRs. By activating α4β2 nAChRs, nicotine played a role in inhibiting the inflammatory factors, which contribute to improving cognitive impairment in ischemic rats.
Timbre, Komplexeindruck, and Modernity Klangfarbe as a Catalyst of Psychological Research in Carl Stumpf, 1890–1926
Authors: Klotz Sebastian 
Published: August 2019

Abstract
The philosopher-psychologist Carl Stumpf studied Klangfarbe (timbre) as an integral part of his phenomenology. He combined novel experimental and observation techniques of timbre perception on both vowels and the sound of musical instruments with conceptual and logical work at the interface of physiology, psychology, and philosophy, outlining timbre as a complex impression (Komplexeindruck). This article argues that this approach is informed by an explicitly modern scientific framework that replaced Helmholtz’s earlier spectral model with concepts of distribution and multi-dimensionality, and with spatialization, embodied in formants (main and secondary). This refinement of the conception of timbre yielded insights into the structural laws of phenomena and into mental functions.
Transnational Precursors of American Realism
Authors: von Bardeleben Renate 
Published: August 2019

Abstract
This chapter concentrates on European realist innovators—Björnstjerne Björnson, Ivan Turgenev, Leo Tolstoy, Fyodor Dostoevsky, Honoré de Balzac, Gustave Flaubert, Guy de Maupassant—and their effect on the formative period of American realism. It studies in detail the transatlantic development of new techniques and discusses the ways in which these new methods were reflected in the works of American authors and critics. Inspired by the theories and practice of their precursors, American writers felt liberated to introduce new narrative strategies to represent America’s rising urbanism, the struggles of the social classes, and the increase of social mobility in the industrial age. They also dealt with the emancipated “New Woman” and the changing relationship between the sexes. The guiding principles on which writers on both sides of the Atlantic agreed were truth, sincerity, and frankness.
Ghetto Realism—and Beyond
Authors: Harrison-Kahan Lori 
Published: August 2019

Abstract
By focusing on the reception of Yekl, Abraham Cahan’s 1896 novel of immigrant life in New York, this chapter considers the turn-of-the-twentieth-century controversy surrounding depictions of Jews in ghetto literature, arguing that this debate illuminates not only the challenges of ethno-racial representation and self-representation but also the slipperiness of realism itself. The chapter also posits a more inclusive interpretation of Jewish American realism by demonstrating the importance of an overlooked late nineteenth-century realist writer, Emma Wolf. It explores how Wolf’s novels Other Things Being Equal (1892) and Heirs of Yesterday (1900), which focus on experiences of Jewish families in San Francisco during the Progressive Era, offer important alternatives to the New York–centric ghetto genre, expanding the parameters of Jewish American literature in terms of region, class, gender, and religion.