bluuebunny/crossref_metadata_2025_split huggingface dataset:
P14.20 Anxiety level in a prospective cohort of newly diagnosed glioblastoma patients: preliminary results from the IMAGE study
Authors: Maillet D , Narme P , Menard V , Larrieu M , Sahel K , Belin C , Carpentier A 
Published: September 2019

Abstract

BACKGROUND
Quality of life (QoL) is an important area of clinical neuro-oncology, especially in glioblastoma patients. Although previous studies showed an association between QoL and anxiety, few studies have focused on the anxiety level throughout the disease progression (Bunevicius et al., 2017; Kilbride et al., 2007). Underestimating anxiety may have several consequences: a low treatment compliance, exacerbation of somatic symptoms or side effects of treatment, difficulties with understanding medical information and lower cooperation with the medical staff (Spencer, 2010). In the present study, we aimed assessing the current state of anxiety in a prospective cohort of patients treated for glioblastoma. We also investigated potential correlations with other clinical and psychological variables to better understand determinants of anxiety in this population.

MATERIAL AND METHODS
At the beginning of their cycle of temozolomide cure and after radio-chemotherapy, 30 patients with glioblastoma were included. Inclusion criteria were: Karnofsky index (IK) ≥ 70% and absence of cognitive disorder that could interfere with the completion of questionnaires. The characteristics of patients were as follows: mean age of 56.6 years ± 12.5 (70% were more than 50 years old); 20% were women; 50% had a university degree and IK of 87% ± 5. Anxiety level was assessed using the State-Trait Anxiety Inventory. This scale consists of 40 items on a self-report basis measuring how patients feel right now (“state”) and how they generally feel (“trait”). We also assessed (i) QoL using the Cancer Quality of Life Questionnaire 30 and the Brain Cancer Module-20; (ii) the presence of depressive symptoms using the Hospital Anxiety and Depression Scale; (iii) the self-esteem using the Rosenberg self-esteem scale and (iv) memory complains using the Prospective and Retrospective Memory Questionnaire.

RESULTS
The preliminary results showed that - at baseline - 21% of our sample reported high levels of anxiety. Correlation analyses showed that state anxiety was correlated with trait anxiety (rho=0.799, p< .001), QoL (rho=0.678, p< .001), level of self-esteem (rho=-0.514, p=0.004) and memory complains (rho=0.618, p< .001). Any correlation was found with age, education level, lesional lateralization or depressive symptoms. Women had higher state anxiety scores than men (t(27)=-2.4, p=0.02).

CONCLUSION
These preliminary results suggest that higher current state of anxiety is associated with lower QoL and lower self-esteem, regardless the presence of depressive symptoms, age, education level or lesional lateralization. Anxiety level at the follow-up (4 and 6 months after the baseline) and determinants of its progression will also be presented and might help health professionals to understand patients’ experience and better meet their needs.
P14.34 Priority of comet tail sign in the planning of stereotactic irradiation for the treatment of brain metastases
Authors: Mitsuya K 
Published: September 2019

Abstract

BACKGROUND
A highly enhanced cap attached to the surface of metastatic tumours in the brain parenchyma is occasionally encountered on magnetic resonance (MR) images. This atypical cap termed “comet tail sign (CTS)” is attributed to leakage of contrast medium from the tumour body into the oedema surrounding it and is containing no neoplastic tissue (Mitsuya, et al. 2016. J Neurooncol). The purpose of this study was to demonstrate our clinical results of excluding CTS in the planning of stereotactic irradiation (STI) for brain metastases to avoid radiation necrosis.

METHODS
We selected 16 consecutive cases of newly diagnosed brain metastases with CTS treated with STI between May 2007 and January 2019. Patients underwent STI with target fields including CTS until December 2014 (Group A, n=4), while STI with fields excluding CTS from January 2015 (Group B, n=12). CTS was carefully diagnosed using contrasted T1-weighted images and T2-weighted images by radiation oncologists and neurosurgeons. Treatment outcome and toxicity were compared among two groups.

RESULTS
Primary cancers were lung in 13 and colon in 3 patients. Ten (63%) were male, and the median age was 68 years (range, 47 to 78). The median follow-up time was 13.5 months from STI. There was no significant difference of the mean tumour volume between two groups (4.28ml vs. 4.68ml). Disease control rates were 25% in Group A and 92% in Group B. Symptomatic radiation necrosis was observed in two (50%) patients of Group A but none (0%) of Group B.

CONCLUSION
CTS could be excluded from STI target planning to increase local control and to decrease radiation toxicity. Prospective study is needed to clarify optimal STI planning for patients with brain metastasis accompanied CTS in the future.
P14.40 Incidence and risk factors identification for lung cancer brain metastasis
Authors: Fariña H , Rodríguez-Salazar M , Rodríguez-Yanes M , Plata-Bello J 
Published: September 2019

Abstract

BACKGROUND
Lung Cancer (LC) is the most frequent malignant neoplasm around the world and it is one of the most frequent brain metastasis origins. The aim of the present work is to measure the incidence of brain metastasis in new-diagnosed LC patients and to identify the risk factors associated with its development.

MATERIAL AND METHODS
A retrospective observational study has been performed. Patients with new diagnosis of LC between January 2015 and December 2016 in our Center were included. Demographic, clinical and molecular variables were studied. Statistical analysis included a uni- and multivariate COX regression, survival analysis (log-rank test) and non-parametric two-independent sample tests.

RESULTS
Three-hundred and thirty-nine patients were diagnosed with LC in our Center between 2015 and 2016 (99 female; mean age: 66.1 years, SD=10.89). The incidence of brain metastasis was 16.25 cases each year since the initial diagnosis (19.2% of all patients). The risk of brain metastasis was increased in the first year after the diagnosis of LC (83.07% of cases). Patients with metastasis were younger than non-metastatic patients (64.0 vs. 66.6 years of age; p=.041). Small-cell lung carcinoma was the most frequent histological subtype associated with the development of metastasis (HR=2.267; p=.011), followed by the adenocarcinoma (HR=1.131; p=.624) and epidermoid (HR=.546; p=.067). No molecular factor (EGFR, ALK or p63 expression) was identified as risk factor. The overall survival of brain-metastatic patients was significantly lower than non-metastatic patients (167.0 vs. 273.0 days; p=.0002).

CONCLUSION
Brain metastasis are diagnosed in almost 20% of LC patients with, at least, three-years follow-up. Small-cell carcinoma subtype and younger patients were associated with a higher risk of brain metastasis, which is associated with a bad prognosis.
P14.46 SUBEPENDYMAL GIANT CELLS ASTROCYTOMA (SEGA) IN TUBEROUS SCLEROSIS COMPLEX (TSC): A SERIES OF 31 PATIENTS
Authors: Giordano F , Moscheo C , Lenge M , Mari F , Grandoni M , Buccoliero A , Sardi I , Genitori L , Guidi M 
Published: September 2019

Abstract

Background
Subependymal Giant Cells Astrocytomas (SEGAs) are characteristic of Tuberous Sclerosis Complex (TSC). They are usually benign tumors but may rapidly grow and cause hydrocephalus and raised intracranial pressure. Surgery is mandatory for large and symptomatic SEGAs

METHODS
31 patients harboring SEGAs in TSC were admitted for surgery. The main indications for surgery were tumor size and location, tumoral growth and cystization/hemorrhage, and hydrocephalus. In presence of symptomatic hydrocephalus firts surgery aimed to reduce intracranial pressure

RESULTS
Forty-four surgeries were performed in 31 patients achieving Gross Total and Subtotal Removal in 36 and 8 patients respectively. Recurrences occurred in 11 patients; nine of them were reoperated while two were administered therapy with m-TOR pathway inhibitors. Surgical morbidity and mortality accounted for 22.7% and 2.3% respectively; hydrocephalus was the main complication. After an average follow-up of 5 years, 90% of patients had no evidence of the disease and most (93,3%) had a good clinical status after surgery; 12 out of 30 patients (40%) had a VP-shunt for hydrocephalus

Conclusions
GTR is feasible and represents the treatment of choice of SEGAs in TSC. Therapy with m-TOR pathway inhibitors is to be considered in selected patients and especially in recurrences of SEGAs
P14.53 Deconstructing pathologically increased MEG network clustering in glioma patients
Authors: Kulik S D , Derks J , Numan T , Hillebrand A , de Witt Hamer P C , Klein M , Geurts J J G , Reijneveld J C , Stam C J , Schoonheim M M , Douw L 
Published: September 2019

Abstract

Introduction
Functional brain networks in glioma patients are characterized by higher global clustering than healthy controls, indicating stronger connectivity in triads of brain regions when averaging across the entire brain. However, this could be due to either primary increased local clustering of (peri)tumor regions or higher local clustering throughout the entire brain.

METHODS
Magnetoencephalography recordings of 71 glioma patients and 53 HCs were analyzed by calculating functional connectivity with the phase lag index between source-localized time series of 78 cortical regions of the automated anatomical labelling atlas. Per participant, we calculated (1) global average clustering, (2) local clustering of tumor and non-tumor regions, and (3) Euclidean distance between tumor centroids and of all other region centroids.

RESULTS
Glioma patients had higher global average clustering (p=0.002) than HCs. This increase was indeed global: there was no difference between tumor and non-tumor regions (p=0.154) and no association between distance and local clustering (p=0.759). When splitting patients into high (top 25%, n=18) and normal global clustering (other 75%, n=53) to more specifically pick up on the determinants of pathological global average clustering, again no localized or distance-dependent effects were found. High clustering patients were younger than patients with normal global clustering (p=0.027). Posthoc analysis into tumor localization preference for particular network regions in the entire patient cohort revealed greater tumor occurrence in regions with high clustering in HC (p<0.001), while patients with high global clustering showed tumors localized in regions with lower clustering in HC (p=0.032).

CONCLUSION
The functional brain network of a subset of (relatively young) glioma patients is disturbed on a global level, suggesting that treatment thereof might benefit patients. Moreover, our exploratory analyses suggest that gliomas occur more often in normally highly clustered regions, but that tumors occurring in less clustered regions are associated with more extensive global network alterations. These findings may speculatively indicate that patients with and without such pathologically altered global clustering represent distinct phenotypes (both in terms of age and tumor localization) and may also need to be treated as such.
P14.58 Extending adjuvant temozolomide longer than six cycles doesn’t add any benefit to glioblastoma patients according to the randomized GEINO-014 TRIAL
Authors: Balana C , Sepulveda J , Pineda E , Vaz M , Mesia C , Fuster J , Girones R , Muñoz-Langa J , Navarro M , Alonso M , Gil Gil M , Herrero A , Estival A , Gallego O , Peralta S , Olier C , Pérez-Segura P , Covela M , Martinez García M , Domenech M , Carrato C , Sanz C , Velarde J , Berrocal A , Luque R , De las Peñas R , Del Barco S 
Published: September 2019

Abstract

BACKGROUND
Standard treatment of glioblastoma (GBM) is focal radiation with concomitant and adjuvant temozolomide (TMZ) for 6 cycles. The GEINO-14-01 trial (NCT02209948) investigated the role of extending adjuvant TMZ to 12 cycles in a randomized multicenter study.

MATERIAL AND METHODS
Between Aug/2014 and Nov/2018, 166 patients (p) were screened and 159 randomized to extend (80p) or not (79p) TMZ treatment to 12 cycles after proving stable disease in the MRI performed before inclusion. The trial was stratified by MGMT status and presence or absence of residual disease (defined as a residual enhancement larger than 1cm on the MRI). The primary endpoint was differences in 6monthsPFS, secondary endpoints were differences in PFS, OS, toxicity, between arms and per stratification factors.

RESULTS
Median age was 60.4 (range 29–83), 97p (61%) were methylated and 83 p (52.2%) were reported with residual disease. Median (m) PFS was 7.9 months (95%CI: 6.1–9.8) and mOS: 20.9 (95%CI: 17.6–24.1). A methylated status was a factor of better PFS (HR=0.29, 95% CI 0.46–0.95; p=0.029) and better OS (HR= 0.43: 95% CI 0.28–0.66; p=0.000) as well as the absence of residual disease (PFS: HR = 0.84: 95% CI =0.71–1.01; p=0.068; OS: HR=0.77, 95%CI 0.63–0.96; p=0.019). We didn’t find any difference in PFS (HR=1.02, 95%CI 0.85–1.21; p=0.82), or OS (HR=0.90; 0.73–1.11; p=0.34) on extending treatment with temozolomide longer than 6 cycles.

CONCLUSION
There is no benefit of continuing TMZ treatment for more than 6 cycles in the adjuvant treatment of glioblastoma. Final data will be presented at the congress. Supported by a Grant of the ISCIII: PI13/01751
P14.60 FET PET response upon radiochemotherapy followed by Tumor Treating Fields (TTFields) in a patient with progressive high-grade glioma
Authors: Keßler A F , Weiland J , Linsenmann T , Ernestus R , Hagemann C , Löhr M 
Published: September 2019

Abstract

BACKGROUND
The addition of Tumor Treating Fields (TTFields) to the first-line therapy in glioblastoma (GBM) demonstrated significantly improved progression free survival, overall survival and longterm survival rates in the EF-14 phase 3 trial. However, responder analysis of patients with recurrent GBM (rGBM) treated with TTFields monotherapy (in the EF-11 trial) revealed delayed response monitored by MRI analysis. More recent data suggests that O-(2-18F-fluoroethyl)-L-tyrosine (FET) PET may add valuable information for monitoring therapy response of glioblastoma patients treated with TTFields. Here, we report on FET PET response in a patient with progressive anaplastic astrocytoma WHO grade III (AA) treated with TTFields in combination with temozolomide (TMZ) chemotherapy.

METHODS
We present a 38-year old patient with an initial diagnosis of a diffuse astrocytoma WHO grade II in 2011, and malignisation to an AA on progression. The treatment regimen included initially radio-chemotherapy (RCT) with TMZ. On further progression of the AA in 2017, TTFields were added to another 6 cycles of TMZ. Several FET PET scans for differentiation of tumor progression from treatment-related changes were performed over time. The definitive diagnosis (tumor progression and grading) was confirmed by histopathology after stereotactic biopsy (SB).

RESULTS
In 2012, the patient was first diagnosed with a low grade astrocytoma WHO grade II of the right frontal, temporal and parietal lobe including infiltration of thalamus and corpus was confirmed by SB, followed by irradiation. On progression in 2015, a FET PET Scan showed FET avidity in all tumor affected regions of the brain. SB confirmed an AA, while FET PET scans showed only a mild response in the temporoparietal region after 6 cycles of TMZ. In 2017, the next progression without further malignisation was confirmed by SB and treated RCT with 41.4 Gy and TMZ chemotherapy, followed by application of TTFields with an average usage rate of 85.7 % over 6 months. Thus, the TTFields adherence was well above the independent prognostic threshold of 75 %. No additional adverse events due to the combined therapy of TTFields and TMZ were observed. Due to a new contrast enhancing lesion in the right frontal lobe (10x7mm), another FET PET scan was performed 1.5 years later. In this scan, obtained after combined TTFields and RCT therapy a strong response regarding FET avidity was observed.

CONCLUSION
In summary, FET PET is able to add important additional information for evaluation of treatment response in high grade glioma patients, in particular for TTFields treated patients, while adding TTFields to radiochemotherapy might even enhance treatment response of high grade glioma. Further studies might elucidate the role of FET PET imaging for therapy monitoring in high grade glioma patients treated with TTFields.
P14.76 Characteristics of anaplastic oligodendrogliomas short-term survivors: a POLA network study
Authors: Garnier L , Dehais C , Curtit E , Tabouret E , Ramirez C , Vauleon E , Bourg V , Boone M , Figarella-Branger D , Ducray F 
Published: September 2019

Abstract

BACKGROUND
Although patients with 1p/19q codeleted anaplastic oligodendrogliomas (AO) usually have a prolonged survival, some patients have a poorer outcome. The aim of the present study was to analyze their characteristics.

MATERIAL AND METHODS
The characteristics of AO patients with a survival < 5 years included in the POLA network were analyzed and compared to those of AO patients with a survival > 5 years.

RESULTS
In January 2019, among the 519 patients AO patients included in the POLA network, 55 patients were short-term survivors and 146 patients had a survival > 5 years. Among the 55 AO short-term survivors, 44 patients (80%) died from tumor progression and 11 patients (20%) from another cause (suicide n=2, toxicity n=2, intercurrent disease n=6, other n=1). Compared to > 5 years survivors, short-term survivors were older (57 years vs 48 years, p<0.001) and less frequently presented with isolated seizures (9% vs 33%, p=0.0017). They presented with tumors that more frequently involved multiple lobes (66% vs 47%, p=0.03), had a higher rate of nuclear atypia (80% vs 48%, p<0.001), a higher proliferative index (Ki67, 26% vs 18%, p<0.001), a higher level of p53 expression (10.8% vs 3.9% p<0.001), and had a higher rate of chromosomal abnormalities (91% vs 71% p=0.008). Compared to > 5 years survivors, short-term survivors less frequently underwent a surgical resection (64% vs 89% p<0.001) and their initial treatment more frequently consisted in temozolomide chemotherapy alone (41% vs 20% p=0.008).

CONCLUSION
AO short-term survivors are associated with distinct clinical, radiological, histological and molecular characteristics at diagnosis.
P14.85 Brain metastasis from Hodgkin’s Lymphoma: case report and literature review
Authors: Bruno F , Pronello E , Bortolani S , Palmiero R , Melcarne A , Chiappella A , Mantovani C , Soffietti R , Rudà R 
Published: September 2019

Abstract

BACKGROUND
Central nervous system (CNS) metastases from Hodgkin’s Lymphoma (HL) are very rare, occurring in 0.02–0.5% of cases. They are usually associated to systemic relapse of the disease. Treatment options for HL brain metastases include surgery, radiotherapy, and systemic chemotherapy.

CASE REPORT
A 54 year-old woman presented with thoracic pain and dyspnea. Chest CT showed a thoracic bulky mass larger than 10 cm. Biopsy confirmed HL stage IIA, nodular sclerosing variant. No typical B symptoms, such as fever, night sweats or weight loss, were observed. The patient underwent chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD scheme), followed by 30Gy mediastinic radiotherapy (RT), which led to complete remission in September 2017. After 3 months, she presented with headache and rapidly progressing gait disorder. MRI showed a contrast-enhanced lesion in the right occipital lobe, with central necrosis and massive edema. Total-body CT scan and FDG-PET ruled out either the presence of new solid tumors or systemic relapses of HL. Gross total resection of the brain lesion was carried out, and HL histology was confirmed. CSF analysis from lumbar puncture was normal. Afterwards, the patient underwent 2 cycles of high dose cytarabine, but she rapidly progressed, and received salvage RT (30 Gy). Nevertheless, further systemic progression occurred: the patient developed headache, diplopia and dysphagia and, unfortunately, she died 6 months after the diagnosis of brain metastasis.

DISCUSSION
Thus far, only 45 cases of CNS HL have been reported from 2000 to 2018. Whole brain radiotherapy, with or without chemotherapy, was the most common treatment. In our patient, we chose surgical resection for the solitary brain metastasis followed by chemotherapy, delaying RT at recurrence. In the literature, median overall survival of patients diagnosed with brain metastases from HL is 18 months (1–273): 17 patients (38%) showed a progression (local / systemic: 12/17 - 71%), while 28 (62%) showed complete remission after a median follow-up of 20 months (6–273).

CONCLUSION
Intracranial localisation of Hodgkin’s Lymphoma is a rare entity but still has to be taken into account. Advanced brain imaging could be of help in case of uncertain radiological presentation. A multidisciplinary approach is needed as there is no consensus on the best treatment to choose: surgery, radiotherapy and chemotherapy should be considered on individual basis.
P14.92 Study of Glutaminergic and Glutamatergic Metabolism in 1H-MRS Monovoxel in the Most Aggressive Part of 62 Glioblastoma Before and After 18 months Treatment
Authors: Heintz A , Chombar J , Boussida S , Saidak Z , Lefranc M , Deleval N , Coutte A , Chauffert B , Boone M , Constans J 
Published: September 2019

Abstract

BACKGROUND
To study the relationships between glutaminergic metabolism (Glx/tCr), tumor proliferation (tCho/tCr) and other metabolic activities in patients with glioblastoma (GBM).

MATERIAL AND METHODS
Patients: 62 patients with glioblastoma, all having a STUPP Protocol (radiotherapy and concomitant chemotherapy), were selected and separated into 2 groups: Biopsies (30) and resections (32). In total, 269 NMR spectra (PRESS at GE 1.5T and 3T; multi-TEs TE=35ms and TE=144ms) were acquired. Processing: MRS data were processed with jMRUI software and quantitated using HLSVD and QUEST algorithms. Statistical analysis of longitudinal MRS data (every 3 months)

RESULTS
Glx/tCr and Lac/tCr ratios are correlated with the tumoral proliferation (tCho/tCr) before the beginning of treatment. This correlations decreases over time in biopsied and resected patients. In biopsied patients, the evolution of lactate (Lac/tCr) and Glx (Glx/tCr) ratios is similar along the follow-up with a progressive decrease in tumor proliferation (tCho/tCr). However, in resected patients, the evolution of lactate (Lac/tCr) and Glx (Glx/tCr) ratios is similar until 6 months and differ above: a progressive decrease of Lac/tCr and Glx/tCr until 18 months with a higher level of Glx/tCr.

CONCLUSION
Despite the difficulties to separate glutamine from glutamate (post-processing improvement is ongoing), spectroscopic measurements of Glx changes before clinical deterioration. The increase of Glx is longer (in time) than the Lactate increase after 6 months of treatment in the resected patients could be predictive of the observed increase of tumor proliferation at 12 months of treatment.The study of glutaminergic metabolism in the GBM could be used to evaluate the response to treatment. Being able to predict the increase of tumor proliferation in resected patients could allow a faster treatment adaptation.