bluuebunny/crossref_metadata_2025_split huggingface dataset:
P22.06.A DOES ADDING INFORMATION ON PATIENT GOALS VIA AN APP IMPROVE SHARED DECISION-MAKING IN NEUROSURGICAL CONSULTATIONS WITH BRAIN TUMOR PATIENTS?
Authors: Bras I J , Rutten G J , Sitskoorn M M , Hoogendoorn A P , Gehring K 
Published: October 2024

Abstract

BACKGROUND
In shared decision-making (SDM), the patient serves as the expert on their own life, while the health care professional (HCP) provides medical expertise. Recent models of SDM propose incorporating patient “goals” into the decision-making process (i.e. what patients find important activities or roles in everyday life), to better align treatment with patient preferences and everyday life priorities. This study aims to evaluate the effect of an intervention for tracking patient goals and symptoms (the Goings-On app). We will assess the number and nature of goals that brain tumor patients enter into the app, their experiences with using the app and the degree of SDM. We hypothesize that the use of the Going-on app leads to more goal-oriented discussions and will improve SDM.

MATERIAL AND METHODS
Data was collected for an observational and an intervention cohort of non-treated patients with a newly diagnosed presumed glioma or meningioma. The Goings-On app allows patients to enter their own goals (including personal photos), and symptoms, and log them daily. This information is made available to the neurosurgeon in the electronic patient file for use during the consultation. Consultations were audio-recorded and evaluated using the OPTION-MCC. This observer-based coding scheme is used to rate SDM behaviors of the HCP, patient and informal caregiver regarding: (1) goal talk: eliciting and identifying patient goals, (2) option talk: alternate options and information about options, (3) team talk: support deliberation/forming a partnership, (4) decision talk: eliciting preferences and integrating preferences and (5) evaluation talk. Following the consultation, questionnaires concerning Goings-On app usage were administered.

RESULTS
Patients in the intervention cohort (n=49) entered on average 4.7 ± 1.8 [range 1-9] goals into the Goings-On app, with the majority of goals belonging to the categories: Social/Role/Relationship (32%), Leisure/Pleasure (26%) and Everyday/Practical (22%). Of the patients who completed the questionnaires (n=44), 61% reported that their goals were discussed during the consultation, with 84% of them finding the experience pleasant and 85% considering it meaningful. Rating of SDM behaviors for the observational cohort (n=66) and the intervention cohort and analysis of between-group differences, from the audio-recordings is ongoing. Results will be expected end of July 2024.

CONCLUSION
In this study, patients reported various goals via the Goings-On app that were discussed in over half of the neurosurgical consultations, with predominantly positive patient experiences. Further investigations will show whether eliciting and depicting patient goals improves SDM for brain tumor patients during neurosurgical consultations.
P22.07.A END-OF-LIFE CHALLENGES IN NEURO-ONCOLOGICAL PATIENT CARE: A YOUNGNOA SURVEY
Authors: Lazaridis L , Pepper N , Agkatsev S , Bodensohn R , Berg R , Seliger C , Hau P , Platten M , Combs S , Mildenberger I , Müther M , Kebir S 
Published: October 2024

Abstract

BACKGROUND
Despite advanced treatments, malignant brain tumors inevitably relapse, almost always causing significant functional and neurological impairments in patients. Thus, palliative care is crucial in managing individuals with malignant brain tumors. It is essential for neuro-oncologists to be well-prepared and supported to openly communicate about and meet the palliative needs of these patients. With this survey, we sought to evaluate palliative care practices in Germany and their impact on the treatment of neuro-oncological patients.

MATERIAL AND METHODS
We conducted an anonymous, interdisciplinary survey targeting palliative care practices among neuro-oncologists in Germany, all members of the Neuro-oncology Working Group “Neuroonkologische Arbeitsgemeinschaft” (NOA) of the German Cancer Society (Deutsche Krebsgesellschaft, DKG). The questionnaire, designed in close coordination with board-certified palliative care specialists, was distributed to 450 physicians. It collected personal information and assessed respondents’ knowledge of and access to palliative care structures. The survey was conducted online from March 31 to April 30, 2023.

RESULTS
Ninety-two physicians (39 female, 52 male, 1 unspecified) participated and completed the survey (response rate: 20%). Of these, 81 (88%) reported feeling comfortable with end-of-life conversations, while 11 (12%) did not. No significant differences were observed between the two subgroups regarding their level of medical education (p=0.7140), workplace (p=0.4966), sex (p=0.9999), medical specialty (p=0.5478), or region of practice (p=0.9999). However, those comfortable with end-of-life discussions had significantly more palliative care training either during specialty training (p=0.0475) or through active participation in palliative care courses (p=0.0254). Further detailed analysis is in progress.

CONCLUSION
The survey indicates that while the majority of participants are comfortable with end-of-life discussions, a clear correlation exists between their comfort level and the extent of palliative care training received. This highlights the critical need for enhanced and targeted palliative care education within neuro-oncology training programs to better prepare physicians for the complex communication and care challenges in neuro-oncological palliation. Further analysis will continue to explore additional educational and systemic factors that could increase the quality of palliative care in neuro-oncology.
P23.01.A ANCIENT SCHWANNOMA MASKING DIAGNOSIS OF SECONDARY NORMAL PRESSURE HYDROCEPHALUS IN A 65-YEAR-OLD MALE PRESENTING WITH GAIT INSTABILITY: A SYSTEMATIC REVIEW AND ILLUSTRATIVE CASE
Authors: Torio J R , Rabe Y , Meceda E , Fandialan E 
Published: October 2024

Abstract

BACKGROUND
NPH can present as primary or secondary. Recent studies indicated that most symptoms can emerge early, while some showed delayed onset. These differences in patterns underscores the complexity of NPH relationship with its underlying causes and highlights the need for further research to elucidate the temporal dynamics of its development, aiding in early detection and appropriate management strategies.

MATERIAL AND METHODS
We report a case of a 65-year-old male diagnosed of sNPH, initially treated for a confounding left cerebellopontine angle schwannoma. A systematic search was conducted using MeSH keywords “Secondary Normal Pressure Hydrocephalus”, “Intracranial Tumors” and “Normal Pressure Hydrocephalus” on February 2024, across multiple databases. A total of 504 records were identified, wherein 110 articles were excluded and only four studies satisfied the inclusion criteria.

RESULTS
A total of 1312 cases were identified and diagnosis of NPH made through clinical history, PE and imaging studies. Of the etiologies identified in 2 studies, SAH accounted for 46.5%, post-traumatic 29%, and malignant pathology for 6.2% only. VPS insertion was the preferred treatment in all of the studies. In the study of Daou, 84.2% of patients with sNPH from SAH improved after shunt insertion, while 83% of patients with post-traumatic sNPH and 86.4% of patient with tumors, which is similar to the other studies.

CONCLUSION
Prompt identification of sNPH is crucial because its outcomes differ from iNPH. A comprehensive evaluation to determine the etiology of sNPH is indispensable in guiding appropriate management strategies to ensure optimal outcomes for affected individuals.
P23.02.A BPPV IS A SIGNIFICANT CAUSE OF DIZZINESS IN VESTIBULAR SCHWANNOMA TREATED WITH STEREOTACTIC RADIOSURGERY
Authors: Jethwa J , Williams L , Davenport S , Adonis A 
Published: October 2024

Abstract

BACKGROUND
Vestibular schwannoma (VS), a vestibulocochlear nerve tumour, causes disequilibrium (sensory disorientation) and imbalance. The Royal Marsden Hospital (RMH) treats VS with stereotactic radiosurgery (SRS). Those with vestibular symptoms are referred for vestibular rehabilitation, where co-existing Benign Paroxysmal Positional Vertigo (BPPV) has been found on numerous occasions. BPPV causes vertigo on head movements due to dislodged crystals in the vestibular apparatus. UK incidence is 0.04%, with causative factors being head injury, increased age, and inner-ear inflammation such as infection. Cardinal signs are history of vertigo on head movements, and vertigo and nystagmus on Dix-Hallpike testing. BPPV is treated by the Eply manoeuvre. No evidence exists of significant post-SRS BPPV in VS, but does in nasopharyngeal cancer receiving similar SRS to VS.

PURPOSE
To investigate incidence of post-SRS BPPV in VS.

METHODS
A case-note audit of VS referred for rehabilitation from 2017-2022, identifying subjective BPPV symptoms, vertigo and nystagmus on Dix-Hallpike testing, and BPPV treatment outcome.

RESULTS
24.6% (n=16) of VS patients referred to physiotherapy with dizziness had co-existing BPPV post-SRS. This was significant (p= &lt; 0.001) compared to UK incidence. Diagnosis was confirmed by resolution of vertigo following treatment in all cases. However, disequilibrium associated with VS remained in all. In 68.7%, nystagmus was significantly absent (p=0.002) on BPPV testing compared to post-SRS nasopharyngeal cancer population. There was no significant difference in age between those with and without BPPV. The time from SRS to BPPV was 2-43 weeks (mean=12).

DISCUSSION
This is the first study finding significant incidence of BPPV in VS post-SRS. Remaining disequilibrium following successful BPPV treatment confirmed dual causes of dizziness. The causative factor is likely inflammation caused by SRS as there was no age difference, no head injury or inner-ear infection, and all cases occurred post-SRS. As BPPV occurred over a wide time following SRS, degradation of crystals may be attributable to acute inflammation and/or delayed inflammation from radiation necrosis. Lack of nystagmus in BPPV with VS may cause misdiagnosis, affecting clinical management. A theory for absent nystagmus is: nystagmus is a result of vestibular imbalance. However, VS causes slowly progressing vestibular imbalance allowing the central nervous system time to compensate, resulting in lack of nystagmus.

CONCLUSION
BPPV should be considered a side-effect of SRS in VS. Nystagmus should not be a diagnostic essential to avoid misdiagnosis and ensure correct management. More robust research is necessary to substantiate findings.
P26.13.A TUMOR TREATING FIELDS (TTFIELDS) AT A FREQUENCY OF 100 KHZ AND 170 KHZ OPEN THE BLOOD-BRAIN BARRIER (BBB) IN A 3D IN VITRO BBB-MODEL
Authors: Lysinger A S , Salvador E , Vormwald L , Ernestus R , Löhr M , Hagemann C 
Published: October 2024

Abstract

BACKGROUND
The highly restrictive properties of the blood-brain barrier (BBB) pose a critical hurdle in combatting brain cancer. Tumor Treating Fields (TTFields) are a non-invasive treatment modality comprised of alternating electric fields of intermediate frequency (100-500 kHz) and low intensity (1-3 V/cm) that are CE-approved for WHO grade 4 glioma, and FDA-approved for the treatment of glioblastoma. At 100 kHz, TTFields loosen the BBB by reversibly delocalizing various tight junction and associated proteins in vascular brain endothelial cells, allowing drug delivery to peripheral regions of the brain. We investigated the effects of TTFields at 100 kHz and 170 kHz on a 3D human cell-based BBB in vitro model with the goal of improving on the outcomes already demonstrated at 100 kHz.

MATERIAL AND METHODS
The in vitro BBB model combines human brain microvascular endothelial cells (HBMVEC) grown on glass coverslips and immortalized pericytes in transwell inserts, or vice versa, two crucial cell types responsible for BBB integrity. Cells were treated with TTFields at either 100 kHz or 170 kHz for 72 h, whereas untreated cells served as controls. Change in BBB permeability was assessed by fluorescein permeation assays with dextran molecular weights of 4 kDa, 40 kDa and 70 kDa immediately before and after 72 h of TTFields administration. Effects on a molecular level were investigated by immunofluorescence staining of junctional proteins ZO-1, PECAM-1 and Claudin-5 in HBMVEC after 72 h of treatment with either frequency and their expression was monitored by Western-blotting.

RESULTS
Permeability assay of various fluorescein molecules demonstrated consistent increase in HBMVEC permeability among all treated groups compared to untreated cells for molecular weights of 4 kDa and 40 kDa with a significant increase from 100 kHz to 170 kHz, as well as significant increase in permeability for 70 kDa after treatment at 170 kHz. Staining of junctional proteins ZO-1, PECAM-1 and Claudin-5 revealed delocalization from the cell membrane to the cytoplasm in all treated samples, while Western-blot proved that their expression did not change in relation to untreated controls.

CONCLUSION
TTFields with a frequency of 170 kHz showed consistent or improved effects on BBB permeabilization over 100 kHz by rearranging tight junction proteins in HBMVEC in vitro, without impairing tight junction protein expression.
P27.05.B DECODING GLIOBLASTOMA SURVIVAL: UNRAVELING THE PROGNOSTIC POTENTIAL OF OLFACTORY FUNCTION IN A PROSPECTIVE OBSERVATIONAL STUDY
Authors: Oster C , Matyar A , Hummel T , Hattingen E , Schmidt T , Jokisch M , Jokisch D , Ahmadipour Y , Sure U , Stuschke M , Tertel T , Giebel B , Kleinschnitz C , Scheffler B , Deuschl C , Kebir S , Glas M 
Published: October 2024

Abstract

BACKGROUND
Olfactory impairment is a common neurologic deficit among glioblastoma patients. We have previously shown that glioblastoma patients with reduced smell sensitivity had lower overall survival rates compared to those with normal olfactory function. A notable limitation in that study was the unequal distribution of prognostic factors between the two groups, and the absence of continuous olfactory assessments during treatment to investigate if therapy-associated neurotoxicity could be a contributing factor to diminished olfactory acuity. In this trial olfactory function will be evaluated in glioblastoma patients as a prognostic marker with regard to overall survival, neurocognition and quality of life.

METHODS
This prospective, multicenter study is set to recruit 64 glioblastoma patients alongside 64 healthy controls. Stratification of participants is based on prognostically relevant variables such as resection status, MGMT promoter methylation status, radiographic involvement of olfactory brain areas, olfactory function, age, and Karnofsky performance status scale. We utilize Sniffin´ Sticks to evaluate olfactory function through identification and threshold tests, and this assessment is carried out longitudinally throughout the therapy starting from tumor diagnosis. Infiltration of the olfactory nerves or olfactory brain are scrutinized using a high-resolution coronal T2-weighted sequence which is added to a dedicated brain tumor protocol. MRI images are independently reviewed by two board-certified radiologists from distinct institutions, who are blinded to the patients’ olfactory function status. Furthermore, quality of life data, neuropsychological testing, and psychosomatic screening are performed at specific intervals throughout the study. Also, we examine next-generation sequencing results to investigate potential genetic associations with hyposmia in glioblastoma patients.

RESULTS
The first participant was enrolled in May 2023. Currently, 16 patients and three controls are already enrolled (April 2024). Plans are underway to open a second study site in 2024, with the aim to complete recruitment by December 2025. Follow-up assessments will continue until December 2027. We anticipate that the final results of the study will be available in 2028.

CONCLUSIONS
In the process, this study is the first prospective study which investigates the olfactory function systematically as prognostic factor in glioblastoma patients.
P27.07.A EFFICACY AND SAFETY OF STUPP REGIMEN WITH OR WITHOUT ANLOTINIB FOR NEWLY DIAGNOSED GLIOBLASTOMA: A MULTICENTER, DOUBLE-BLIND, RANDOMIZED PHASE II TRIAL
Authors: Chen Y , Liu G , Sun P , Li M , Yang X , Pan L , Wang L , Hua Y , Zhao M , Liu Y , Ran J , Cai H , Lu X , Jiang H , Li X , Zheng W , Liu Z , Lin S , Deng M , Yang Q , Guo C , Li J , Chen Z 
Published: October 2024

Abstract

BACKGROUND
The STUPP regimen, which consists of postoperative radiotherapy with concurrent temozolomide (TMZ) followed by up to six cycles of adjuvant TMZ chemotherapy, is the established standard treatment for newly diagnosed glioblastoma (GBM). However, its effectiveness is limited. Anlotinib, a multi-kinase inhibitor targeting tumor angiogenesis and cell proliferation, has demonstrated promising results in preclinical GBM models and phase I clinical trials. In order to assess the efficacy and safety of combining the STUPP regimen with anlotinib, we conducted a phase II trial aimed at evaluating their combined effects. (NCT 04959500).

MATERIAL AND METHODS
This study is a multicenter, double-blind, randomized, placebo-controlled trial with an expected 150 patients randomly assigned 1:1 ratio to receive TMZ-based radiochemotherapy with anlotinib or placebo. Eligibility criteria include histologically confirmed GBM, ECOG performance score ≤2, age ≥18 years, and lack of significant comorbidity. The primary endpoint is median progression-free survival (PFS), while secondary endpoints include 1-year overall survival rate, PFS at 6 months, overall response rate, duration of response, disease control rate, quality of life, and toxicity.

RESULTS
From July 2021 to April 28th, 2024, 153 patients were enrolled. The results in this abstract were all obtained without exposing the blind state. The median PFS was 10.22 months (95% CI, 9.43-11.93) in the overall patient population, while the predicted mPFS of placebo group was 7 months according to the results of STUPP and AVAGlio trials. The median OS was 18.69 months (95% CI, 15.90-26.71). The 1-year overall survival rate is 75.71% (95% CI, 64.82%-79.11%), and the 2-year overall survival rate is 42.04% (95% CI, 33.14%-50.67%). 26.8% of patients experienced at least one grade 3 or higher treatment-related adverse events (TRAEs). 11.1% of patients experienced serious treatment-related adverse events. The most frequent grade 3 or higher TRAEs were lymphocytopenia, thrombocytopenia, leukopenia, decreased neutrophil count.

CONCLUSION
The current research findings, conducted under the condition of data blinding, suggest that the combination of anlotinib with the STUPP regimen demonstrates promising therapeutic efficacy and favorable tolerability in the treatment of patients. These results indicate the potential of this treatment modality as a viable option in clinical practice.
P27.22.B SEMISITTING POSITION VS. STANDARD SUPINE POSITION IN REDUCING INTRACEREBRAL BLEEDINGS DURING STEREOTACTIC BRAIN BIOPSY
Authors: Bonosi L , Carone G , Porto E , Barbotti A , Galbiati T , Del Bene M , Di Meco F 
Published: October 2024

Abstract

BACKGROUND
Stereotactic brain biopsy (SBB) represents a minimally invasive procedure to acquire tissue samples for histological diagnosis. Despite SBB’s many benefits, there is a chance of hemorrhagic complications. The incidence of hemorrhagic complications following SBB is not well established, but studies suggest that it may be higher than previously thought. In semi-sitting position (30° elevation of the head), the intracranial pressure is lower than in supine position due to decreased venous congestion. In our hypothesis, intraoperative bleeding may be reduced by exploiting semi-sitting position, potentially leading to decreased surgical morbidity.

MATERIAL AND METHODS
We conducted a retrospective monocentric 2-arms cohort study at our institution (Istituto “C. Besta” in Milan, Italy). We reviewed all patients who underwent stereotactic brain biopsy from the 1st of March 2023 to the 1st of April 2024. The primary endpoint is to demonstrate the improved safety of the semi-sitting position, as assessed by the absence of intracranial bleeding on postoperative CT scans compared to standard supine position.

RESULTS
Our analysis covered 78 patients, with 39 undergoing biopsy in the semi-sitting position and the remaining 39 in supine positions. Out of those in the semi-sitting position, 5 exhibited a hemorrhagic spot along the catheter’s edge or within the lesion as revealed by CT scans. This contrasts with the 14 instances found among patients not in the semi-sitting position, indicating a statistically significant difference (p-value: 0.028). However, no other significant correlations were observed in CT findings, such as bleeding, when compared to age (p-value: 0.352), biopsy site (p-value: 0.355), number of samples (p-value: 0.141), or histology (p-value: 0.251).

CONCLUSION
This study can potentially shed light on an innovative approach for patient positioning in stereotactic brain biopsy. The observed decrease in intraoperative bleeding may decrease procedure-related risks and surgical morbidity. As a result, patient safety and outcomes can be improved.
P27.24.A SYSTEMIC AND LOCAL THERAPIES BEFORE AND AFTER DIAGNOSIS OF LEPTOMENINGEAL DISEASE IN PATIENTS WITH BRAIN METASTASES: AN EXPLORATIVE, SINGLE-CENTER RETROSPECTIVE COHORT STUDY
Authors: Wasilewski D , Eitner C , Murad S , Shaked Z , Steinle J , Sargut A , Wetzel-Yalelis A , Roethe A , Jelgersma C , Mertens R , Truckenmüller P , Früh A , Rösler J , Wessels L , Kroneberg D , Kowski A , Radbruch H , Ehret F , Kaul D , Frost N , Onken J , Keller U , Sehouli J , Vajkoczy P , Keilholz U , Misch M 
Published: October 2024

Abstract

BACKGROUND
Leptomeningeal metastasis (LMD), the dissemination of cancer cells into leptomeninges and/or cerebrospinal fluid, is believed to increase in incidence due to improved survival of oncological patients. Real-world data on therapies before and after diagnosis of LMD in brain metastasis patients are still limited. We aimed to characterize local and systemic therapies before and after diagnosis of LMD in these patients.

MATERIAL AND METHODS
We included 120 patients (treated from 2012 to 2023) with underlying solid malignancy, presence of brain metastasis together with leptomeningeal spread, either confirmed by MRI, cerebrospinal fluid sampling, or both modalities. Data on demographics, radiological, and therapy-related characteristics were collected. Kaplan-Meier estimates and Cox model regression analysis were performed to identify factors associated with survival.

RESULTS
Breast cancer (35.8%), NSCLC (20.8%), melanomas (16.7%), and gastric cancer (5.7%) were among the most common entities. In 56% of cases, the diagnosis was made by MRI, in 5% by cerebrospinal fluid puncture (LP) alone, and in 39% by both MRI and LP. The median overall survival (OS) of the cohort was 2.77 months [95% CI: 2.27 - 4.20]. Patients who received systemic after diagnosis of LMD, either chemotherapy (n=26), targeted therapies (n=21) or checkpoint inhibitors (n=9) showed increase survival as compared to respective control patients. The only independent prognostic factors at diagnosis of LMD were presence of lung cancer (HR: 2.36 [95% CI: 1.28 - 4.4], p=0.006) and melanoma (HR: 2.30 [95% CI: 1.27 - 4.2], p=0.006). Local or systemic treatment modalities before LMD diagnosis were not associated with survival.

CONCLUSION
This study provides insights into the complex treatment modalities for LMD patients, both in terms of prior therapies and therapies after diagnosis of LMD. These results underscore the need for large prospective multi-center registries and interventional studies to further improve interdisciplinary and personalized therapy for these patients.