bluuebunny/crossref_metadata_2025_split huggingface dataset:
NCOG-20. RADIATION-RELATED MORBIDITY OUTCOMES IN ATYPICAL MENINGIOMA PATIENTS: A RETROSPECTIVE COHORT STUDY
Authors: Rademacher Anneliese , Kagithala Dheeraj , Pawloski Jacob , Latack Katie , Fadel Hassan , Dallo Florence , Snyder James , Lee Ian , Robin Adam 
Published: November 2024

Abstract
Atypical meningiomas present with unique challenges in management and prognosis. Given their tendency to recur, adjuvant radiation therapy (ART) is frequently utilized, however there are few reports on radiation-related morbidity in this patient population. The study aims to investigate the radiation-related complications in atypical meningioma patients treated with or without ART. The primary outcomes were the incidence and severity of RT-related morbidity. All patients treated for atypical meningiomas at our institution between January 1, 2014 and January 1, 2024 were retrospectively analyzed. Patients were grouped into two cohorts, those who were initially treated with surgical resection only and those who also received adjuvant RT. Radiation morbidity grading was assigned for all patients that received radiation treatments during their clinical course based on established grading systems. Fisher’s Exact and Kruskal-Wallis tests were used to determine associations between the two groups. There were 76 patients who were initially treated with surgery only and 23 patients who had surgery and ART. Mean length of follow-up among all patients was 55.6 months. Significantly lower rates of RT-related morbidity in the surgery only group were observed compared to the surgery and RT cohort (15.8% vs. 60.9%, p &lt; 0.0001). Among patients in the surgery only cohort, 23 patients received RT at recurrence or progression. When comparing this subgroup to those who underwent ART, there was no significant difference in the severity of RT-related morbidity (p=0.2724). In this series, patients receiving ART experienced a higher incidence of radiation-related morbidity. When comparing only those who received RT, there was no difference in the incidence or severity of radiation-related morbidity between the two cohorts.
NCOG-25. STEREOTACTIC RADIOSURGERY VERSUS SURGICAL MICRODISSECTION FOR JUGULAR FORAMEN SCHWANNOMAS: A RETROSPECTIVE COMPARATIVE STUDY
Authors: Akhavan-Sigari Amirhossein , Park David J , Hori Yusuke S , Persad Amit R L , Emrich Sara C , Ustrzynski Louisa , Tayag Armine , Chang Steven D 
Published: November 2024

Abstract

INTRODUCTION
Jugular foramen schwannomas (JFS) are rare, benign tumors arising from lower cranial nerves. Given their delicate location, surgical microdissection carries a substantial risk of neurological morbidity. Stereotactic radiosurgery (SRS) presents an alternative, particularly for smaller or residual tumors.

OBJECTIVE
This study aims to compare the outcomes and symptomatic improvements between these two treatment modalities.

METHODS
We conducted a retrospective analysis of 32 patients with JFS who underwent SRS (13 cases [40.6%]) or surgical dissection (19 cases [59.4%]) as their primary management at Stanford Medical Center between 1998 and 2024. Outcomes included progression-free survival (PFS), post-management adverse events based on common terminology criteria for adverse events (CTCAE), symptom improvement, overall survival (OS), and the necessity for secondary interventions.

RESULTS
Significant differences were observed in baseline characteristics between the SRS and surgery groups, including mean age (62.52 vs. 46.87 years, p&lt;0.001), mean largest diameter (34.38 vs. 53.66 mm, p=0.02), and median total tumor volume (6.50 vs. 19.70 mm3, p=0.009). There were no significant differences in sex or lesion shape (dumbbell vs. non-dumbbell shaped). After adjusting for baseline characteristics, no significant differences were noted in PFS (85.71 vs. 77.77%), OS (92.3 vs 100%), symptom improvement (61.53 vs. 52.63%) or mean CTCAE grade (1.31 vs. 1.58) between the SRS and surgery groups. SRS patients had significantly lower odds of requiring secondary treatment procedures after their primary intervention as compared to those in the surgery group (OR=0.01, 95% CI: 0.0001-0.59, p=0.02).

CONCLUSION
Both SRS and surgery provide exceptional outcomes for JFS with no significant differences in PFS, OS, CTCAE grades, or symptom improvement between the two groups. However, SRS patients had lower odds of requiring secondary interventions for JFS. This is among the first studies comparing surgical microdissection and SRS for JFS. Future controlled prospective studies are necessary to derive more definitive conclusions.
NCOG-27. HIGHER LEVELS OF SERUM ICAM-1 AND IL-10 ARE ASSOCIATED WITH COGNITIVE DYSFUNCTION IN BOTH IDH-WILDTYPE AND IDH-MUTANT GLIOMA
Authors: Guedes Vivian A , Mendoza Tito , Slattery Kaitlynn , Kauss McKenzie C , Raval Dhaivat , Hsieh Emory , Wright Michelle L , Davis Tara S , Choi Ann , Reinhart Kimberly , Miller Hope , Vera Elizabeth , Penas-Prado Marta , Gilbert Mark R , Armstrong Terri S 
Published: November 2024

Abstract

BACKGROUND
Cognitive dysfunction is common among glioma patients, but the contribution of specific mechanisms to the development of cognitive symptoms is unclear. Circulating levels of proteins linked to neurodegeneration, inflammation, and vascular damage have been associated with cognitive symptoms in neurological diseases and aging, but their prognostic value in glioma is unknown. Here, we examined associations between cognitive symptoms and serum levels of protein biomarkers in glioma patients.

METHODS
Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA, scores ≤ 25 = cognitive dysfunction). Cytokines (interleukin-1β [IL-1β], IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, interferon-γ [IFN-γ], tumor necrosis factor-α [TNF-α]), and neurodegeneration (neurofilament light chain [NfL], tau, glial fibrillary acidic protein [GFAP]), and vascular damage markers (Serum amyloid A [SAA], C-reactive protein [CRP], vascular cell adhesion molecule 1 [VCAM-1], and intercellular adhesion molecule 1 [ICAM-1]) were measured using ultrasensitive assays (Meso Scale Discovery).

RESULTS
Patients (n=73) were predominantly male (58%), white (74%), with a median age of 44 (range=24,74). Cognitive dysfunction was found in 53% of the patients. Levels of NfL (p=0.035), IL-6 (p=0.006), IL-10 (p=0.007), TNF-α (p=0.035), IFN-γ (p=0.011), CRP (p=0.016), VCAM-1 (p=0.012), and ICAM-1 (p&lt;0.001) were higher in patients with cognitive dysfunction when compared to those with normal cognition. After adjusting for isocitrate dehydrogenase (IDH) tumor mutation status, age, tumor grade, and number of surgeries, higher levels of ICAM-1 and IL-10, but not other markers, remained associated with cognitive dysfunction. MoCA scores were negatively correlated with GFAP (r=-0.24, p=0.038), IFN-γ (r=-0.31, p=0.008), IL-6 (r=-0.29, p=0.014), IL-10 (r=-0.24, p=0.039), and ICAM-1 (r=-0.39, p&lt;0.001).

CONCLUSIONS
ICAM-1 and IL-10 levels were higher in patients with MOCA determined cognitive dysfunction, suggesting an association between cognitive symptoms and inflammation and vascular impairment in glioma patients. Future analyses in larger longitudinal cohorts are warranted to assess the predictive value of protein biomarkers.
NCOG-29. HIGHER HYPOTHALAMIC RADIATION DOSE AND FEMALE GENDER ARE RELATED TO HIGHER SELF-REPORTED FATIGUE
Authors: Neth Bryan , Alden Eva , Sener Ugur , Uhm Joon , D’Andre Stacy , Burns Terry , Amundson Adam , Routman David , Trifiletti Daniel , Vora Sujay , Mahajan Anita , Laack Nadia , Brown Paul , Breen William 
Published: November 2024

Abstract

BACKGROUND
Fatigue is among the most common symptoms managed by patients with cancer. Hypothalamic pituitary axis dysfunction has an established role in a subset of patients with fatigue. Our primary aim was to longitudinally assess the impact of hypothalamic radiation exposure to patient self-reported fatigue.

METHODS
We included a sample of patients who received radiation therapy treated at a single institution from 2014-2024. The PROMIS-10 questionnaire (“How would you rate your fatigue on average,” scale 1-5) was used in standard clinical practice, with measures from 6 time points over 2 years. We performed descriptive statistics. Linear mixed models were used to assess the impact of hypothalamic radiation dose on fatigue scores. Mixed models were controlled for gender, age, time, tumor category (CNS vs. non-CNS), and modality (photon vs. proton). Models were fit with random intercepts for each Patient ID.

RESULTS
1092 patients (43% female) with a median age of 54 years (range: 18-92) were included. Most patients were treated for CNS cancer (76%), with about 50% each photon and proton. Median hypothalamus radiation dose was 1306 cGy (range: 0.01-6138). Mean baseline fatigue (2.4) increased after treatment (2.7) remaining elevated at 3- and 6-months post-treatment (2.6, 2.5), returning near baseline at 1- and 2-years post-treatment (2.4, 2.3). Higher radiation dose (Estimate (SE): 0.014 (0.006), p=0.0266) and CNS cancer treatment (0.11 (0.051), p=0.0319) were significant predictors of higher fatigue in the mixed model. Male patients (-0.16 (0.042), p=0.0001) and time (-0.003 (0.0016), p=0.0398) were associated with lower fatigue. Age and treatment modality were not significant predictors of fatigue.

CONCLUSIONS
We found that higher hypothalamic radiation dose was related to more self-reported fatigue, which peaked by 6 months. This effect was seen more prominently in female patients and those treated for CNS disease. Treatment modality and age did not influence fatigue scores.
NCOG-37. SINGLE CENTER EXPERIENCE OF IDH INHIBITORS IN THE TREATMENT OF RECURRENT HIGH GRADE GLIOMAS
Authors: Garcia Catherine , Highsmith Kaitlin , Knight Stephanie , Puduvalli Vinay , Kamiya-Matsuoka Carlos 
Published: November 2024

Abstract

BACKGROUND
The antitumor effect of IDH inhibitors in high grade gliomas (HGG) is not well known, with conflicting views regarding the role of IDH status and the potential for resistance to DNA damage treatments. We present the outcomes of patients with HGG that were treated with IDH inhibitors at our institution.

METHODS
We performed a retrospective review of patients with IDH mutant gliomas treated with FDA approved IDH inhibitors (ivosidenib and enasidenib) in the past 5 years at our institution. One cycle of IDH inhibitor was defined as treatment for 28 days.

RESULTS
We identified 10 HGG patients (both oligodendrogliomas and astrocytomas). Median age at diagnosis was 31 years and 7 were male. Seven patients were diagnosed as WHO grade 3. Six patients were WHO grade 3 oligodendrogliomas, three WHO grade 4 astrocytomas, and one patient WHO grade 3 astrocytoma. Only one patient received enasidenib and the rest were treated with ivosidenib. Eight patients were started on IDH inhibitors after 3 recurrences. Median number of cycles was 5. One patient received 23 cycles, and one patient received 11 cycles. All patients underwent resection, 4 received chemotherapy (including temozolomide, bevacizumab, and CCNU), and 4 radiation prior to starting IDH inhibitors. One patient was treated with Tumor Treating Fields. Five patients progressed during the study follow up, and 3 patients died. Four patients are still on treatment. No serious adverse events. Median PFS after starting an IDH inhibitor was 6 months.

DISCUSSION
IDH inhibitors were well tolerated in IDH mutant HGG patients previously treated with DNA-damaging agents. It may have a role in the treatment of HGG with multiple recurrences with 3 patients showing stable disease for more than 18 months. More studies are needed to clarify the role of IDH inhibitors in patients with IDH mutant HGG.
NCOG-40. RARE ADVERSE EFFECT OF TEMOZOLOMIDE IN A 65-YEAR-OLD FEMALE WITH GLIOBLASTOMA MULTIFORME: A CASE REPORT
Authors: Jain Ujjwala , Desai Prashant 
Published: November 2024

Abstract

BACKGROUND
Temozolomide, an antineoplastic agent is primarily used to treat certain brain tumors, including glioblastoma multiforme (GBM). Common side effects include nausea, vomiting, constipation, loss of appetite, alopecia (hair loss), headache, fatigue, convulsions and rash. A rare (less than 1%) adverse effect includes aplastic anemia refractory to treatment. Herein we present a case of Temozolomide induced severe bone marrow suppression in a 65-year-old woman with GBM refractory to any treatment

CASE PRESENTATION
A 65-year-old female presented with dizziness and left-hand numbness. Imaging revealed a right hemisphere mass and she underwent partial resection with pathology showing GBM, IDH wildtype, with CDKN2A/B deletion. She was started on radiation therapy with concurrent temozolomide. After nearly 5 weeks of temozolomide/RT, she developed severe thrombocytopenia/neutropenia with onset of neutropenic fever and severe CMV infection, leading to her demise within a week.

DISCUSSION
Life threatening refractory cytopenias is a very rare side effect of Temozolomide with a high rate of morbidity/mortality. In the case of our patient, she initially had weekly CBC’s which were stable and hence was switched to a monthly schedule. The patient’s ANC and platelets showed a precipitous drop within a month and ended up with aplastic anemia. The development of this rare complication underscores the importance of increased awareness about this often-fatal adverse event and possibly more frequent monitoring to recognize it early, especially in these patients with an already limited life expectancy. A more tailored approach to monitoring blood work may be needed depending on patient factors.

CONCLUSIONS
Aplastic anemia refractory to treatment is a rare and life threating adverse effect of temozolomide. The frequency of checking blood work for patients on Temodar has not been definitively established with protocols ranging from once weekly to monthly. Given the potential for this fatal adverse event, it is important to develop better tools to help identify patients in whom more frequent monitoring may be necessary.
NCOG-41. COMPARATIVE ANALYSIS OF MORTALITY AND SHORT-TERM SIDE EFFECTS IN PATIENTS WITH GLIOBLASTOMA MULTIFORME TREATED WITH TEMOZOLOMIDE VERSUS TEMOZOLOMIDE PLUS BEVACIZUMAB CHEMOTHERAPY
Authors: Sallese Greta , Kandhadai Anuttham , Brindley Paul 
Published: November 2024

Abstract

INTRODUCTION
Glioblastoma multiforme (GBM) is a highly aggressive primary brain tumor in adults with limited treatment options and poor prognosis. Temozolomide (TMZ) chemotherapy is the standard treatment for GBM, but alternative therapies have shown limited success. Bevacizumab (BEV), a monoclonal antibody targeting vascular endothelial growth factor (VEGF), is used to restrict GBM growth and spread. This study evaluates the efficacy of combining TMZ with BEV compared to TMZ alone in managing GBM.

METHODS
A retrospective cohort study was conducted using TriNetX database data, focusing on patients diagnosed with GBM and receiving chemotherapy. Cohorts were defined by treatment: TMZ plus BEV versus TMZ alone. Propensity-score matching balanced baseline characteristics, including demographics and health conditions. Primary outcomes included mortality rates and short-term side effects within the first year of treatment, such as cognitive communication deficits, headache, dizziness, insomnia, and nausea/vomiting.

RESULTS
After matching, 922 patients were included in each cohort. There were no significant demographic differences post-matching. The mortality rate was higher in the TMZ plus BEV group compared to TMZ alone (51.30% vs. 36.98%, RR: 1.387, 95% CI: 1.249-1.541). However, TMZ plus BEV was associated with a lower incidence of cognitive communication deficits (1.95% vs. 4.34%, RR: 0.45, 95% CI: 0.26-0.779) and dizziness (7.27% vs. 10.52%, RR: 0.691, 95% CI: 0.513-0.93). No significant differences were found in headache, insomnia, or nausea/vomiting rates between the groups.

CONCLUSION
This study indicates that combining bevacizumab with temozolomide may increase mortality in GBM patients but reduce certain side effects such as cognitive deficits and dizziness. These findings emphasize the need to carefully consider the benefits and risks of different chemotherapy regimens for GBM and highlight the necessity for further research to optimize treatment strategies and improve patient outcomes.
NCOG-42. SPEECH-SPECIFIC ERRORS IN LEXICAL RETRIEVAL PREDICT GLIOMA MOLECULAR FEATURES
Authors: Kaur Jasleen , Persad Amit , Oten Sena , Hervey-Jumper Shawn 
Published: November 2024

Abstract
Recent work confirms that low and high-grade gliomas, remodel neural circuits which influence speech production. The extent to which speech kinetics and category of speech error during lexical retrieval may predict glioma molecular features remains unknown. Here, we extracted audiovisual speech production from 550 patients totaling over 26,400 individual stimuli to identify correlations with glioma molecular features including IDH, TERT, 1p19q co-deletion, and CDK2AB. Nonparametric statistics were used for analysis. IDH wild-type tumors were more likely to be temporoparietal, while IDH mutant tumors were more likely to be insular (p=0.02). Patients with IDH wild-type glioblastoma exhibited more errors (8.23 vs 3.79, p=0.02), with a higher occurrence of anomia (p=0.004), circumlocution (p=0.034) and general delay (p=0.04) when compared with IDH mutant WHO grade 4 astrocytoma. Binomial logistic regression identified lexical retrieval anomia, circumlocution, and initiation delays as an independent predictor of having an IDH wild-type tumor. Within the IDH mutant group, anomia (p=0.03) and articulation (p=0.014) errors were associated with malignant molecular features (after controlling for prognostic variables such as tumor volume). Binomial logistic regression identified articulation or anomia for picture naming as an independent risk predictor for WHO grade 2 gliomas with greater risk molecular features (based on Ki67 and CDK2AB). Distinct patterns of language errors were observed in patients with IDH wild-type and IDH mutant tumors. Further work is required to elucidate the functional and biological correlates of these findings.
NCOG-48. CT SCAN COMPOSITE SCORE CAN IDENTIFY GLIOBLASTOMA PATIENTS WITH WORSE OUTCOMES
Authors: Rahmani Farzaneh , Ippolito Joe 
Published: November 2024

Abstract

OBJECTIVE
Obesity is a risk factor for many cancer types including glioblastoma multiforme (GBM). We used CT body composition analyses to construct a sex-specific composite score that would optimally predict overall survival in GBM.

METHODS
Using a retrospective institutional cohort, we performed single slice (L3) and volumetric (L1-L5) automated body segmentation analyses on abdominal and pelvic computed tomography (CT) scans performed within 1 month of diagnosis of GBM. Multivariable Cox proportional hazards models were then used to identify variables that were independently associated with GBM overall survival. Lastly, a learning-tree algorithm was implemented to identify the relative importance of body composition metrics using a XGBoost-powered learning model. These weights were used to create sex-specific composite CT scan scores of protective and predisposing factor with relation to GBM survival. A log-rank pairwise t-test was used to compared GBM survival across patient groups stratified based on these CT composite scores.

RESULTS
Higher relative inter/intramuscular adipose tissue volume (HR(95%CI):1.9(1.01-3.06), p=0.02), visceral adipose tissue volume (HR(95%CI):2.1(1.04-4.1), p=0.04) and aortic calcification volume (HR(95%CI):2.6(1.2-5.5), p&lt;0.001) were associated with lower GBM overall survival, while higher subcutaneous adipose tissue volume (HR(95%CI):0.4(0.2-0.8), p=0.02), iliopsoas muscle volume (HR(95%CI):0.4(0.2-0.9), p&lt;0.001), and trabecular bone density (HR(95%CI):0.4(0.1-0.8), p=0.003) were predictive of higher GBM OS (p-value of all tests &lt;0.05). Using quartiles of the CT scan composite predisposing and protective scores, we were able to stratify male and female participants with significantly different outcomes with regards to GBM OS (Figure). Male and female participants with higher burden of predisposing factors had significantly lower chances of survival compared to those with lower cumulative burden of these factors (Figure, p-value Q4 vs. Q1 males&lt; 0.01 and 0.001 in females)

CONCLUSION
Using automated body segmentation analysis we optimized a CT scan composite score that was able to stratify GBM patients with worse overall survival.
NCOG-50. LONG TERM-SURVIVAL OF AN ELDERLY PATIENT WITH GIANT CELL CEREBELLUM GLIOBLASTOMA (GBM)
Authors: Ma Chunxiao , Choi Yoon Jae , Lomax Jerica , Ko Uvin , Fu Dan Beverly , Myung Joon , Kong Xiao-Tang 
Published: November 2024

Abstract

INTRODUCTION
Primary cerebellar glioblastoma (GBM) in adult is very rare and accounts for 1% of all GBM. Giant cell variant cerebellar GBM is even rarer. Because of the rarity, its molecular feature, the response to the standard treatment, and biological behavior of tumor progression are not well understood.

CASE REPORT
An 80 yo male presented with headache, nausea, vomiting and ataxia in 2019. Brain MRI was notable for a large enhancing cerebellar mass. Surgical resection was completed, and pathology was giant cell GBM. Molecular studies showed IDH-wildtype, CDKN2A/B copy number loss, positive TP53 G262V mutation as well as KIT and KDR amplification. The patient underwent standard 6-week concomitant temozolomide (TMZ) and radiation therapy. He only completed 3 cycles of low dose adjuvant temozolomide and two cycles of lomustine due to intolerance of both chemotherapy agents. After that the patient has been off treatment and received brain MRI surveillance over past 4 years. Two years later, his brain MRI showed new punctuate lesions in the radiation field. Suspecting the radiation necrosis; the patient underwent observation. Later, more nodular enhancing lesions developed at the outside region of the radiation field. Tumor progression was considered but the patient wished no biopsy or re-radiation. The new small nodular lesions on MRIs over past two years have behaved unusually with small fluctuations among mild progression, stabilization, or regression. His physical functions have been preserved with a Karnofsky Performance Status scale of 90% with normal cognition.

DISCUSSION
The patient, who is now 85 years old, has surpassed a 4.5-year survival mark, which is remarkable compared to the supratentorial and the cerebellar GBM with a few months’ survival mark in elderly patients. Our experience emphasizes the different behavior (good response) of a very rare giant cell cerebellar GBM to the standard treatment for newly diagnosed GBM.