bluuebunny/crossref_metadata_2025_split huggingface dataset:
SURG-24. MAXIMAL SAFE RESECTION OF INSULAR GLIOMAS: AN EVALUATION OF SURGICAL AND PROGNOSTIC OUTCOMES IN 461 CASES
Authors: Al-Adli Nadeem N , Young Jacob S , Li Jing , Quintana Daniel , Dada Abraham , Menna Grazia , Gerritsen Jasper K W , Morshed Ramin A , Hervey-Jumper Shawn L , Berger Mitchel S 
Published: November 2024

Abstract

INTRODUCTION
Insular gliomas are challenging to resect due to nearby functional cortical/subcortical structures and delicate Sylvian/sub-insular vascularity. Motor/language mapping and surgical experience are necessary for maximal safe resection (MSR).

METHODS
Outcomes were retrospectively evaluated following MSR in the largest single-institution series to date. 461 cases, between 1997 and 2022, were classified according to the Berger-Sanai system. Contrast-enhancing (CETV) and non-contrast-enhancing (nCETV) tumor volumes were calculated manually.

RESULTS
The final cohort comprised 226 high-grade (IDH-mutant, n=82) and 226 low-grade (IDH-mutant, n=101) tumors. Median nCETV was 47.7ml (grade 2, n=226), 72.6ml (grade 3, n=136), and 46.8ml (grade 4, n=90). Median CETV was 22ml for grade 3 and 13.6ml for grade 4 tumors. Most were classified as Zone I (37%), IV (8.6%), or I+IV (15%). For high-grade tumors, median CE-EOR was 96.1% (range, 29.7-100), which was highest in Zone I (100%), and supra-maximal resection was achieved in 5 cases. For low-grade tumors, median nCE-EOR was 82.4% (range, 28.4-100), which was highest in Zone 4 (85%). Additionally, initial nCETV in low-grade tumors was not associated with nCE-EOR, even when controlling for location. New postoperative motor deficits by discharge were significantly higher in Zones II (24%), I+II (22%), and III (23%). For dominant-hemisphere tumors, language deficits were highest in Zone I+II (44%), Giant (32%), and Zone II+III (29%) tumors. At 3 months, language deficits persisted in Giant (7.1%) tumors and motor deficits persisted in Giant (6.4%) and Zone II (5.9%) tumors. Median overall survival (OS) was 114.6 (grade 2), 108.6 (grade 3), and 14.7 (grade 4) months. In primary high-grade tumors, OS was longer with CE-EOR &gt; 97.1% (36.8 vs.14.7 months, p=.04) and nCE-EOR of &gt; 80.8% (91.3 vs. 20.2 months, p&lt;.001).

CONCLUSIONS
In a high-volume academic center, surgical resection of insular gliomas with cortical/subcortical mapping can achieve excellent EOR with minimal language and motor morbidity.
SURG-31. HYBRID THERAPY FOR NEWLY DIAGNOSED AND RECURRENT GLIOBLASTOMA: STAGED PROCEDURE INTEGRATING OPEN SURGICAL RESECTION WITH LASER INTERSTITIAL THERMAL THERAPY
Authors: Berke Chandler , Khalafallah Adham , Lu Victor , Gurses muhammet , Ivan Michael , Komotar Ricardo , Shah Ashish 
Published: November 2024

Abstract

BACKGROUND
Glioblastoma (GBM) is the most common and aggressive primary malignant brain tumor in adults with a median overall survival (OS) of 15.6 months. Despite advancements, 5-year survival rates have not significantly improved. Laser interstitial thermal therapy (LITT) has been employed to treat both newly diagnosed (nGBM) and recurrent GBM (rGBM) with demonstrable safety and efficacy. Traditionally, LITT has been limited to smaller lesions given physical and thermal constraints.

OBJECTIVE
We present two case examples of a novel, hybrid treatment approach to GBM, utilizing both surgery and laser ablation as part of a single-staged procedure.

METHODS
Two geriatric (&gt;65 years) patients with nGBM or rGBM were treated with surgical resection followed by LITT the subsequent day. Both patients underwent preoperative magnetic resonance imaging (MRI) showing multifocal disease with a dominant component, causing mass effect in the second case, and an unresectable component.

RESULTS
The first case underwent surgical resection of a large, multicentric rGBM in the parieto-occipital region, followed by LITT of an unresectable lesion in the inferior temporal gyrus. The second patient underwent surgical resection of the dominant temporal lobe component, and LITT of the insular component. Neither patient had intraoperative or ablation complications. Both patients had stable postoperative neurological exams and were discharged on the day after ablation, with no new deficits at follow-up.

CONCLUSION
The prognosis for GBM remains dismal despite significant research and attempts at advancements in patient management. Surgical resection is a critical component of the GBM treatment paradigm. However, surgery alone is not sufficient in many patients. LITT has shown promise for improving GBM outcomes, mainly due to its minimal invasiveness, enhanced immune responses, BBB disruption, and cytoreductive potential. We demonstrate a novel, hybrid approach to GBM using hybrid surgical resection and LITT in a single-staged procedure to overcome traditional constraints of LITT.
SURG-37. ADVANCING GLIOBLASTOMA RESEARCH THROUGH RESECTION MODELS
Authors: Hurtado Thenzing Judá Silva , Yong Raymund , Tsankova Nadejda 
Published: November 2024

Abstract
Regardless of its cellular and molecular heterogeneity, glioblastoma (GBM) tumors share a common hallmark: an infiltrative growth pattern that poses challenges to surgical resection and leads to incomplete tumor removal. As part of the current standard-of care treatment, patients undergo surgery in addition to temozolomide and radiation therapy. In GBM research, mice are often used to replicate tumor development and test treatments, but this approach typically omits the crucial aspects of surgical intervention, and thus fails to recapitulate important aspects of human GBM disease progression at the surgical margin. Here we address this challenge by developing a technique for tumor resection in mice. First, we implant the infiltrative patient derived GBM cell line Akaluc G16302 in the frontal cortex, specifically at anteroposterior 2mm, mediolateral 0.5mm, dorsoventral 1mm starting from bregma. After 6 weeks, we anesthetize the mouse and do a craniotomy at the injection site, approximately 3-4mm in diameter. We perform a circumferential cut using a curved Fukushima scissor at the edges of the craniotomy area and scoop the tumor core, mimicking surgical resection. Mice survive the surgery and are alive up to 37 days post-resection. Histology confirms resection of tumor cells and a surgical tumor margin remaining in the xenograft animal. In our pilot study, mice undergoing resection displayed significantly increased overall survival compared to mice without surgery (log-rank p-value = 0.0448; n=6; survival range of 91-100 days for control and 97-107 days for resected mice), recapitulating survival benefit also seen in humans. This preliminary data demonstrates the feasibility of the technique and resection-associated survival benefit. Such advancements enable researchers to more accurately replicate the biology of GBM progression and treatment response observed in human patients, bringing us closer to modeling the clinical scenario in mice. Key words: Glioblastoma, resection, biopsy
SURG-39. LONG-TERM RESULTS OF INTERVENTION FOR GROWING INCIDENTAL MENINGIOMAS OR CONTINUED ACTIVE SURVEILLANCE, A PROSPECTIVE COHORT STUDY
Authors: Strømsnes Torbjørn , Lund-Johansen Morten , Behbahani Maziar , Skeie Geir Olve , Skeie Bente Sandvei 
Published: November 2024

Abstract
Incidental meningiomas are common findings. They represent a clinically challenging cohort, without a detailed consensus on their management. The risk of tumor progression and that of intervention must be considered. Long-term prospective data on incidental meningiomas are sparse. We aimed to evaluate the long-term effect of Gamma Knife Radiosurgery (GKRS), surgical resection and continued observation for growing incidental meningiomas. A prospective database of 62 patients (70 tumors) commenced under active surveillance was established in 2009. Radiological and clinical data was obtained until sept 2023. The results of long-term observation (group 1) and intervention with GKRS (group 2) or surgery (group 3) at progression was analyzed. Due to growth, 41 (58.6%) tumors were treated. The mean growth rate was higher prior to GKRS (2.1 cm 3 /y) and surgery (0.4 cm 3 /y) than during long-term active surveillance (0.009 cm 3 /y) (p &lt; 0.001). The meningiomas became in mean 31.3% and 99.1% smaller after GKRS and resection, respectively. In comparison, tumors under long-term surveillance increased in mean 27.2% (p &lt; 0.001). According to the RANO response criteria, the complete, partial, and minimal response versus stable disease rates were higher following intervention, the overall progressive disease rates were similar (Group 1; 20.7%, group 2: 11.4% and group 3: 16.7%) (p = 0.232). Treatment versus no-treatment did not affect overall survival (Group 1; 10.3 y, group 2: 11.8 y and group 3: 13.5 y (p = 0.264). No symptom development was registered in group 1. In group 2, 2.9% experienced transient (grade 2) adverse events, and in group 3, 50% suffered permanent (grade 4) adverse events according to the Common Terminology Criteria for Adverse Events (CTCEAv5). Intervention reduces tumor volume; however, the clinical significance remains uncertain and side effects are not negligible. Active surveillance is safe, saves &gt; 40% of patients from unnecessary interventions and does not compromise future treatments. The optimal timing of intervention should be further explored.
SURG-41. OPTIMIZING PATIENT OUTCOMES IN PETROCLIVAL MENINGIOMA TREATMENT: EVALUATING SURGICAL, RADIOSURGICAL, RADIOTHERAPY AND COMBINED TREATMENT APPROACHES
Authors: Nasta Shagun , Persad Amit , Shaghaghian Elaheh , Hori Yusuke , Emrich Sara Coleman , Ustrzynski Louisa , Tayag Armine , Park David , Chang Steven 
Published: November 2024

Abstract
Petroclival meningiomas pose a formidable challenge due to their proximity to critical neurovascular structures, necessitating complex surgical interventions with a high risk of complications. Stereotactic radiosurgery (SRS) offers an alternative or complementary treatment option, yet the optimal treatment strategy remains undefined. We aimed to evaluate the local control rates following surgical resection, radiotherapy, and SRS for petroclival meningiomas and to assess the incidence of cranial nerve palsies associated with each treatment modality. This retrospective study reviewed medical records of patients treated for petroclival meningiomas at Stanford University between 1980-April 2024. Pre- and post-treatment radiological data were analyzed to assess local control. Cranial nerve function was evaluated pre- and post-treatment, and at last follow-up. A total of 171 patients (129 females; median age 54.65 years) diagnosed with petroclival meningioma were identified. Treatment modalities included: 31 patients underwent surgical resection alone, 27 received SRS alone, 11 received radiotherapy alone, 36 underwent combined surgical resection and SRS, 28 received combined surgical resection and radiotherapy, 9 were treated with a triad of surgical resection, SRS, and radiotherapy, and 29 were managed with serial imaging alone. The percentage change of tumor volume from diagnosis to follow-up for these groups was -55.6%, 28.9%, 73.0%, -64.9%, -12.0%, 35.3%, and -8.8%, respectively. The incidence of new cranial nerve palsies was highest (68%) in patients who underwent surgical resection. The percentage of worsening pre-existing palsies was greater in patients receiving single-modality non-surgical treatment. Surgery, radiotherapy, and SRS demonstrated promising local control rates for specific patient cohorts with petroclival meningiomas. Patients receiving combination therapies generally fared better than those receiving single-modality treatments, with surgery followed by SRS yielding the best outcome. The incidence of cranial nerve palsies was lower following SRS and radiotherapy compared to surgery. Future research should focus on refining multi-modal treatment strategies to minimize complications and improve patient quality of life.
SURG-44. TO PROCEED OR NOT TO PROCEED: THE IMPACT OF FROZEN SECTION PATHOLOGY ON INTRAOPERATIVE BRAIN BRACHYTHERAPY IMPLANTATION FOR RECURRENT GLIOBLASTOMA
Authors: Zeller Sabrina , Soldozy Sauson , Spirollari Eris , Rao Divya , Floyd John , Zhu James , Hanft Simon 
Published: November 2024

Abstract

BACKGROUND
Glioblastoma (GBM) is a highly aggressive malignancy that recurs in up to 90% of patients following standard-of-care therapy, including surgical resection, concurrent chemoradiotherapy, and subsequent adjuvant chemotherapy. In cases of prior radiation therapy (RT) use, one option for localized, recurrent GBM (RGBM) is STaRT (Surgically Targeted Radiation Therapy) (GammaTile, GT Medical Technologies, Tempe AZ USA), a form of brachytherapy utilizing cesium-131 seeds implanted at the time of re-resection. One of the potential concerns with STaRT implantation for RGBM is that intraoperative frozen section pathology may demonstrate only necrosis, in which case further RT may not be advisable. This concern is often cited as a deterrent to offering an intraoperative brachytherapy treatment in RGBM cases. Herein we review the frequency of intraoperative frozen section diagnosis returning radiation necrosis leading to aborted GammaTile placement.

METHODS
The GammaTile Registry, a prospectively enrolling multi-center phase 4 study (NCT04427384), was assessed for all patients receiving intraoperative brachytherapy for RGBM from 10/2020 to 3/2024. Data regarding patient demographics, procedure details, and pathology were extracted and analyzed.

RESULTS
A total of 122 RGBM patients with a median age of 59 years (range 28-86) were scheduled for STaRT. Of these, 109 (89.3%) patients had confirmed prior radiation with a median RT dose of 60.0Gy (range 16-75). Only two (1.6%) planned cases of GammaTile placement were aborted after intraoperative frozen section pathology demonstrated extensive radiation necrosis without viable tumor. The patients had received fractionated RT to 55.8Gy and 60.0Gy, respectively. While both frozen samples were predominantly necrosis, the final pathology demonstrated foci of residual glioblastoma in both cases.

CONCLUSIONS
While it is uncommon in RGBM to abort STaRT due to intraoperative pathology indicating only radiation necrosis, careful consideration should be given when aborting the procedure as in this series final pathology ultimately demonstrated viable tumor cells.
SURG-45. OUTCOMES OF PATIENTS RECEIVING SURGICAL RESECTION AND STEREOTACTIC RADIOSURGERY VS. STEREOTACTIC RADIOSURGERY ALONE FOR MOTOR CORTEX METASTASES
Authors: Juncker Ryan , Finger Guilherme , Weber Matthieu , Wu Kyle , Damante Mark , Kreatsoulas Daniel , Elder James Bradley 
Published: November 2024

Abstract

BACKGROUND
Local therapy for brain metastases typically involves stereotactic radiosurgery (SRS), with surgical resection considered for larger and/or symptomatic tumors. For lesions in eloquent areas, surgical management is controversial given the risks of neurologic deficits. This study compared clinical outcomes in patients with motor cortex metastases who received surgery + SRS or SRS alone.

METHODS
Patients treated for motor cortex metastases from 1/2018 – 12/2022 were identified. Demographic/preoperative variables included age, gender, race, tumor histology, adjuvant therapies, pre-treatment neurological exam, and Karnofsky Performance Scale. Treatment variables included the number of brain metastases, maximum tumor diameter, and radiation dose/number of fractions. Outcome measures included post-treatment neurological exam, seizures, and overall survival (OS).

RESULTS
351 charts were identified – 80 surgery + SRS and 271 SRS alone. 50 consecutive patients in each group were included in this analysis. Surgery + SRS patients were younger (59.0 vs. 63.9; P=0.020) with larger tumors (2.8 vs. 0.83cm; P&lt;0.001), while the SRS only group had more brain metastases per patient (2 vs. 6; P&lt;0.001). No differences were seen in the remaining demographic/preoperative variables. Pre-treatment, surgery + SRS patients had significantly increased frequency (45/50, 90% vs. 25/50, 50%; P&lt;0.001) and severity (4 vs. 5; P=0.001) of motor deficits, and a higher likelihood of seizures (25/50, 50% vs. 8/50, 16%; P&lt;0.001). Despite the surgery + SRS group being more symptomatic pre-treatment, the frequency and severity of motor deficits and seizures was similar between cohort’s post-therapy. Surgery + SRS patients also demonstrated higher rates of pre- to post-treatment improvement in motor function (29/45, 64% vs. 3/25, 12%; P&lt;0.001) and longer OS from the date of treatment (7.5 vs 4 months; P=0.021).

CONCLUSION
Given the equivalent neurological outcomes, higher rates of functional improvement, and improved oncologic outcomes, surgery should be a consideration for patients with brain metastases in eloquent areas, particularly those with symptomatic lesions.
SURG-46. ENDOLYMPHATIC SAC TUMORS: A CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Turner Scott , Carillo Jose , Anker Lars , Stelling Adam 
Published: November 2024

Abstract
Endolymphatic sac tumors are rare, histologically benign tumors that pose a danger of local bony destruction. Definitive treatment is complete surgical resection but the use of subsequent radiotherapy remains controversial and is typically used for residual or recurrent disease. Additionally, these tumors are associated with von-Hippel-Lindau (VHL) syndrome and are present in 10-30% of patients with this autosomal dominant disorder. We present the case of a 69 year-old woman who presented with cranial nerve 7 and 8 palsies that had started in the 1990s and was found to have a left CPA mass. She underwent pre-operative embolization followed by 2 stage craniotomy and post-operative radiotherapy. Testing for the VHL mutation was negative.
SURG-53. LONG TERM FOLLOW-UP OF RESECTION PLUS CESIUM-131 BRACHYTHERAPY FOR PREVIOUSLY IRRADIATED RECURRENT BRAIN METASTASES
Authors: Yacoub Irini , Young Robert J , Reiner Anne S , Gantini-Larsen Alexandra , Yamada Yoshiya , Pike Luke R G , Krebs Simone , Damato Antonio , Aramburu-Nunez David , Yu Kenny Kwok Hei , Brennan Cameron , Tabar Viviane , Moss Nelson S , Imber Brandon S 
Published: November 2024

Abstract

BACKGROUND
Recurrent brain metastases (rBM) after previous radiosurgery present a clinical dilemma, as the advantages of reirradiation need to be weighed against the potential of significant radiation toxicity. Salvage resection with Cs-131 brachytherapy offers improved dosimetry due to reduced integral dose to healthy brain compared to repeat radiosurgery. We previously reported initial results of rBM treated with resection and salvage Cs131 brachytherapy; we present an updated analysis of tumor control with extended follow-up.

METHODS
We analyzed consecutive patients with rBM previously treated with radiosurgery, who underwent salvage resection plus implantation of Cs131 seeds (GammaTile, GT Medical Technologies). The prescribed brachytherapy dose was 60 Gy at 5mm from the cavity. Median follow-up was calculated using reverse Kaplan-Meier. Local recurrence was defined by new nodular contrast enhancement with hyperperfusion within 5mm of the resection cavity. Marginal recurrence was defined as &gt;5mm but not beyond 1cm from the cavity. Local control and overall survival (OS) from brachytherapy were analyzed using Kaplan-Meier.

RESULTS
Twenty-five patients underwent Cs131 implantation in 30 tumor cavities. The median presurgical rBM maximal diameter was 2.95 cm (range 1.1-6.3). The most common histology was lung adenocarcinoma (n=8, 27%) followed by breast (n=7, 23%) and renal cell (n=3, 10%). Radiographic gross- or near-total resection was achieved in 80% of lesions. The median number of Cs131 seeds implanted was 17, (range 6-30), (median strength 3.5 U/seed). With median follow-up of 37 months (95%CI:29-45), twelve and 24-month OS was 55% and 41%, respectively. Four tumors recurred (3 in-field, one marginal) for a 1- and 2-year local control rate of 87% and 81%, respectively. Data for adverse radiation effects is under analysis and will be presented.

CONCLUSIONS
With over 3 years of follow-up, intraoperative brachytherapy with collagen-embedded Cs131 implants was associated with durable local control for this challenging clinical scenario. A randomized Phase II trial of Cs131 vs. standard of care for rBM (NCT04690348) is actively accruing.
SURG-54. RECURRENT BRAIN METASTASES (RBM) TREATED WITH SURGICALLY TARGETED RADIATION THERAPY (START): PRELIMINARY SAFETY EVALUATION FROM A MULTI-INSTITUTIONAL PROSPECTIVE REGISTRY
Authors: Kotecha Rupesh , Lee Stuart , Peach Matthew S , Patel Toral , Wardak Zabi , Floyd John , McGinity Michael , Hanft Simon , Robin Adam , Lee Ian , Sloan Lindsey , Shen Colette , Rodriguez Analiz , Bojanowski-Hoang Kimberly , Wanebo John , Smith Kris , Shah Mitesh , Richardson Angela , Chamoun Roukoz , Camarata Paul , Milligan Brian , Leng Lewis , Seid Patricia , Wasilewski Andrea , Monyak David , Nowlan Adam , McCracken David , Dunbar Erin , Ranjan Tulika , DiNapoli Vincent , Pham Huong , Ryan Robert , Mercado Catherine , Avgeropoulos Nicholas , Choutka Ondrej , Patel Akash , Jalali Ali , Haydon Devon , Deb Nimisha , Zhu James , Piccioni David , Hoeprich Mark , Ansari Michelle Aizenberg , Baskin David , Sevak Parag , Brachman David , Garcia Michael , Patel Sita 
Published: November 2024

Abstract

BACKGROUND
Resection and intraoperative brachytherapy for operable recurrent brain metastasis allows for pathologic confirmation of recurrent disease, mass effect relief, and immediate initiation of radiotherapy (RT). In this analysis, we report patterns-of-use and treatment-related adverse events (AEs) for rBM patients treated with Cs-131 collagen tiles, an FDA-cleared intracranial brachytherapy device.

METHODS
Patients with rBM who underwent resection and surgically-targeted radiation therapy (GammaTile, GT Medical Technologies Inc., Tempe, AZ USA) on a prospectively enrolling phase 4 registry study (NCT04427384) were analyzed. AEs were graded per CTCAE v5.0.

RESULTS
Between 11/2020 and 2/2024, 56 rBM in 51 consecutive patients underwent STaRT at 19 centers, with 5 patients having 2 metastases implanted concurrently. 44 patients (86%) had prior same-site RT (median interval 14.5 mo, range 3-56). Primary tumor histologies were lung (27), melanoma (8), breast (7), renal (4), colon (2), and “other” (3). Median pre-operative maximum diameter was 3.0 cm (range 1.4-5.7); age 63 (range 28-81); 53% females; KPS median 90 (range 40-100); and median implantation time 3 minutes. 26 patients were implanted at a 1st, 15 at a 2nd, and 10 at ≥ 3rd same-site recurrence (range 1-9). At a median follow-up of 6.2 months (range &lt;1-35.1), 6/51 patients (11.8%) experienced ≥Gr 3 AEs at a median of 12 (range 1-69) days postoperatively (POD). No radiation necrosis (RN) events were observed, and no AEs occurred in multi-implant cases or where STaRT was the initial form of RT.

CONCLUSIONS
In this prospective multi-institutional study, STaRT demonstrated an excellent safety profile in a cohort of larger rBM, even in the setting of multi-recurrent disease. Accrual and follow-up are on-going and will provide data on tumor control and long-term RN rates.