bluuebunny/crossref_metadata_2025_split huggingface dataset:
RADT-14 STEREOTACTIC RADIOSURGERY AND SACITUZUMAB-GOVITECAN FOR BREAST CANCER BRAIN METASTASES
Authors: Khatri Vaseem , Doniparthi Ajay , Nakashima Justyn , Zhao Dekuang , Mills Matthew , Oliver Daniel , Yu Hsiang-Hsuan , Soliman Hatem , Han Hyo , Ahmed Kamran 
Published: August 2024

Abstract

BACKGROUND
Sacituzumab-govitecan (SG) is an antibody drug conjugate (ADC) with activity against breast cancer brain metastases (BCBM). Efficacy and safety information of SG with stereotactic radiosurgery (SRS) is limited. Reports suggest SRS with ADCs may increase risk of symptomatic radiation necrosis (SRN).

METHODS
Patients treated with SG from 2020-2023 were reviewed. Patients had BCBM prior to SG and received SRS for active BM within 6 months of SG. Patients with prior leptomeningeal disease (LMD) were excluded. Kaplan-Meier method was used to estimate overall survival (OS), intracranial PFS (CNS-PFS), extracranial PFS (EC-PFS), local control (LC) and distant intracranial control (DIC). RESULTS: Between 2020-2023, 121 lesions were treated over 25 courses in 14 patients. Median follow up was 28.6 months. Median age was 60 (range 30-72). Five (36%) patients had neurologic symptoms, 7 (50%) were HR+. Eleven (9%) lesions received fractionated SRS (fSRS) and 110 (91%) single-fraction. Median dose for single fraction was 24 Gy (range 16-24), and for fSRS was 27 Gy (range 20-30) in median 5 fractions (range 3-5). Seventy-seven (63%) received SRS concurrent with SG. The median gross tumor volume (GTV) was 0.047 cc (range 0.007-17.4) and median planning target volume (PTV) was 0.14 cc (0.032-30). Six (5%) lesions were treated post-operatively. Median OS was 8.4 months (95% CI 4.2-not reached), with 12-month rate of 48%. Median CNS-PFS was 4.2 months (95% CI 1.9-6.3), with 12-month rate of 11%. Median EC-PFS was 4.4 months (95% CI 1.4-8.1), with 12-month rate of 17%. Twelve-month LC from SRS was 91%. Median DIC from SRS was 4.2 months (95% CI 2.1-7.5) with 12-month DIC rate of 12%. Two patients developed LMD. SRN occurred in 1 lesion, which received SRS prior to SG. CONCLUSIONS: SRS and SG demonstrated excellent local control and no increased risk of RN. Prospective investigation is warranted.
RMTD-07 LOST CHANCES: THE SYSTEMATIC EXCLUSION OF PATIENTS WITH BRAIN METASTASIS IN EARLY-PHASE ONCOLOGY TRIALS
Authors: Fernandes Italo , Carmona-Gonzalez Carlos A , Suthaaharan Shonekaa , Sandhu Serena Serena , Menjak Ines , Smoragiewicz Martin , Jerzak Katarzyna 
Published: August 2024

Abstract

RATIONALE
Historically, cancer trials have often excluded patients with brain metastases (BrM). This limits our understanding of CNS-specific drug efficacy. We aimed to determine the proportion of phase I clinical trials for patients with solid tumors that exclude patients with BrM.

METHODS
In March 2023, a systematic search of the clinicaltrials.gov website was performed. Results are described as frequencies and compared using the Pearson’s chi-square or Cochran-Armitage tests.

RESULTS
1,714 phase I trials were identified and 990 met inclusion criteria. Most trials spanned several tumor types (n=659, 66.6%) and were registered between 2000- 2023 (n=884, 89.3%). Trials were mainly conducted in Asia (n=95, 9.6%), Europe (n=112, 11.3%), and North America (n=619, 62.5%). Categories of investigational agents were: targeted therapy (n=496, 50.1%), cytotoxic chemotherapy (n=118, 11.9%), immunotherapy (n=73, 7.37%); the most common combinations included chemotherapy plus targeted therapy (n=265, 26.8%) and chemotherapy plus immunotherapy (n=14, 1.4%). Patients with BrM were included in 25.1% (n=248) trials, included under certain conditions in 53.6% (n= 521), and excluded in the remaining 22.3% (n=221) of trials. Recent trials (2015-2019) were less likely to exclude patients with BrM compared to trials conducted between 2000-2004 (18% vs 38%, p=0.003). Exclusion of patients with BrM was less common in trials focusing on melanoma (16%), breast (15%) and lung (14%) cancer. Trials involving the use of cytotoxic chemotherapy were significantly more likely to exclude patients with BrM (n=58, 49%) than those employing targeted therapy (n= 110, 22%) or immunotherapy (n=15, 21%) (p=0.016). Trial location and stage of disease were not associated with exclusion of patients with BrM.

CONCLUSION
Recent phase I trials, particularly those evaluating the use of targeted therapy and/or immunotherapy, have a low rate of exclusion of patients with BrM compared to previous cytotoxic trials. However, many opportunities to test drugs with potential CNS efficacy are still lost.
SPCM-03 TRENDS IN INTRAOPERATIVE NEUROMONITORING USAGE IN SURGERIES FOR PATIENTS WITH DIAGNOSED PRIMARY MALIGNANT SPINE TUMORS
Authors: Bishop Brandon , Woo Joshua , Rowe Dana , Luo Emily , Ndika Tobechukwu , Charles Antoinette , Arango Alissa , Yoo Seeley , Zachem Tanner , O’Callaghan Ellen , Owolo Edwin , Sperber Jacob , Crowell Kerri-Anne , Rivera Nicole , Nguyen Annee , Hockenberry Harrison , Reitz Kendall , Dalton Tara , Johnson Eli , Erickson Melissa , Goodwin C Rory 
Published: August 2024

Abstract

BACKGROUND
Given the complex nature of surgical resection and the potential for neural injury in spinal tumor surgery, the use of intraoperative neuromonitoring (IONM) could improve clinical outcomes and injury prevention in surgeries for patients diagnosed with primary malignant spine tumors (PMTs). While IONM has been growing in usage, especially during spinal procedures, its utility has been mixed due to undefined guidelines and potentially high costs. In this study, we examined trends in IONM use in surgeries for PMT patients, regional variations in IONM usage, and associations between IONM and clinical outcomes.

METHODS
A retrospective review was performed using the PearlDiver Patient Record Database to identify cases of PMTs that underwent surgery from 2011 to 2021. Rates of IONM usage were compared based on patient age, sex, family income, and region. Complications and 30-day readmissions were also assessed.

RESULTS
4,551 patients undergoing surgery for PMTs were identified, with 1,643 (36.1%) of these utilizing IONM. Significant regional variability was observed in IONM usage (Midwest: 32.6%; Northeast: 28.1%; South: 26.4%; West: 12.5%; p &lt; 0.001) and those using IONM were more likely to be in inpatient settings, compared to outpatient (p &lt; 0.001). Both younger age and mean family income were associated with IONM usage (p &lt; 0.001, p &lt; 0.01, respectively), although, clinically insignificant. 30-day readmission rates and complication rates were significantly higher for patients undergoing PMT surgery with IONM (both p &lt; 0.001).

CONCLUSIONS
This study demonstrates significant differences in IONM usage across geographic regions, sex, and operation settings among PMT patient surgeries. Differences in family income were observed to be significant but not clinically relevant. Notably, IONM was associated with higher 30-day post-operative readmission rates and complication rates. Given the increased adoption of IONM, these trends provide valuable insights in assessing its value and applicability across diverse settings.
SPCM-05 SPINAL EPITHELIOD SOLITARY FIBROUS TUMOR METASTATIC TO THE 4TH VENTRICLE
Authors: Wang Ryan , Pejhan Shervin , Ang Lee-Cyn , Megyesi Joseph 
Published: August 2024

Abstract
Twenty-four years prior to his current presentation, a 76 year old man underwent resection of a solitary fibrous tumor from the lower cervical spinal cord (C5-C7) (called hemangiopericytoma at that time). He had been treated with radiotherapy. His current symptoms included headache and gait ataxia. Neuroimaging revealed a 4th ventricular tumor with mild hydrocephalus. He underwent a suboccipital craniectomy and resection of the 4th ventricular tumor. Pathology showed a hypercellular tumor composed of epitheliod cells with eosinophilic cytoplasm and moderately pleomorphic enlarged oval nuclei containing finely dispersed chromatin and prominent eosinophilic nucleoli in some nuclei. The tumor cells were arranged in nests and sheets separated by thin walled branching to thick walled hyalinized vessels with frequent areas of hemorrhage. Tumor cells showed high mitotic activity (about 8 mitoses/mm squared). The majority of tumor cells were positive for CK7, synaptophysin, E-cadherin, and rarely for CK20 and D2-40. Tumor cells were negative for EMA, transthyretin, myogenin, desmin, progesterone receptor, NeuN, Olig-2, TTF-1, GATA3, PAX8, OCT3/4, SALL4, CD117, S100 and GFAP. Vasculature was highlighted by PAS, reticulin, CD31, ERG, and CD34. INI-1 was intact in the nuclei. Final diagnosis was epitheliod solitary fibrous tumor, at least CNS WHO grade 2. This was consistent with the pathology from 24 years prior. Solitary fibrous tumor is known for recurrence and metastasis a long time after initial diagnosis. However, this case highlights the delayed metastatic spread of a relatively rare subtype of solitary fibrous tumor (epitheliod) to rare location (intraventricular, specifically the 4th ventricle). The literature will be reviewed.
QSPC-03 PATIENT-REPORTED QUALITY OF LIFE AFTER UNDERGOING STEREOTACTIC RADIOSURGERY FOR BRAIN METASTASES: A PROSPECTIVE ASSESSMENT UTILIZING A U.S. NATIONAL REGISTRY
Authors: Pham BA Duy , Sheehan Darrah , Sheehan Kimball , MBBS Konstantinos Katsos , MD Camilo Fadul , MD Jason Sheehan 
Published: August 2024

Abstract
Patients with brain metastases (BMETS) frequently emphasize the impact on quality of life (QOL) over prolongation of life at the time of making treatment decisions. Thus, it is critical to evaluate patient-reported health utility scores after treatment of BMETS. Stereotactic surgery (SRS) is becoming the most frequent treatment modality. The objective of this study was to determine the changes in the EuroQol- 5 Dimension (EQ-5D) in patients with BMETS treated with SRS. The NPA SRS Registry is a multi-institutional collaboration prospectively collecting information from patients undergoing SRS since 2017. We queried the registry for the results of the baseline and follow-up EQ-5D questionnaire, with a utility index score given based on the patient’s responses for five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The cohort included 522 cases treated with SRS between 2017 and 2023; 264 (47.8%), 197 (35.7%), and 91 (16.5%) had 1, 2-4, and 5-14 metastases, respectively. The mean EQ-5D score at the time of SRS was 0.551 (SD=0.443). At the last follow-up after SRS, 107 (34.0%) patients indicated improvement from their EQ-5D baseline while 51 (16.2%) were stable. The score decreased in 113 patients (35.9%) while 44 (13.9%) showed mixed changes (i.e., domain sub-scores both increased and decreased). For mobility, usual activities, pain/discomfort, and anxiety/depression domains patients experienced similar rates of improvement (21.0%-22.5%). In the self-care domain, 32 (10.2%) patients reported improvement, 232 (73.7%) reported no change and 89 (28.3%) had worsening scores. Our study provided the first longitudinal prospective real-world data using the EQ-5D, a health utility tool, in patients with BMETS treated with SRS. In more than half of the cases, the patients reported improved or stable EQ-5D scores over time after treatment. Factors independent of treatment that may prompt worsening QOL following SRS are being identified and will be presented.
QSPC-04 BRAIN AND SPINE METASTASIS AWARENESS: AN INTERNATIONAL CAMPAIGN TO EDUCATE PATIENTS, PROVIDERS, AND POLITICIANS AND IMPROVE OUTCOMES
Authors: Van Swearingen Amanda , Roha Kiley , Harbers Carol , Painter Brice , Anders Carey , Fecci Peter 
Published: August 2024

Abstract
Almost any cancer can spread, or metastasize, to other locations in the body, including the brain, spine, or lining (leptomeninges) that all comprise the central nervous system (CNS). Each year, an estimated 480,000 new cases of CNS metastasis are diagnosed in the U.S., making them 5-10 times more common than primary brain tumors. The incidence is increasing as improved treatments for cancers result in longer patient survival, and many treatments do not protect the CNS. Despite the growing incidence and clinically unmet need, there is a lack of understanding among the general population and providers about the frequency and effective treatment options for patients with CNS metastases. To help raise awareness of the unique needs of these patients, and to improve their outcomes, the Duke Center for Brain and Spine Metastasis (DCBSM) has initiated a Brain and Spine Metastasis Awareness Initiative. This campaign seeks to educate the general public, patients, caregivers, providers, and politicians on several topics, including that brain and spine metastases can happen with almost any cancer, distinguishing between primary brain cancer and metastatic (secondary) brain tumors, the need for a different and multi-disciplinary treatment approach, and the availability of dedicated centers and clinical trials for these patients. Increasing awareness of brain and spine metastasis will improve the outcomes and quality of life for these patients, and will help these patients feel “seen.” The campaign will involve educational material developed by the DCBSM and shared digitally though social media and a website (brainspinemetastasis.org). It will also include the use of a new awareness ribbon, designed at Duke. In collaboration with Duke Government Relations and partnering international advocacy and research groups, we will push for U.S. Congressional actions towards designated funding on brain and spine metastasis, as well as proclaiming June National Brain and Spine Metastasis Awareness Month.
QSPC-10 DEVELOPMENT OF ISOLATED BRAIN METASTASES UNDERNEATH THE BLOCKED PORTION OF PROPHYLACTIC CRANIAL IRRADIATION FIELD IN A PATIENT WITH SMALL CELL LUNG CANCER, LEADING TO SIGNIFICANT MORBIDITY AND DEATH
Authors: Haldar Nilanjan , Ans Sharif Muhammad , Cappelli Louis , Werner-Wasik Maria 
Published: August 2024

Abstract

INTRODUCTION
The paradigm shift towards forgoing prophylactic cranial irradiation (PCI) in small cell lung carcinoma (SCC) management in favor of a surveillance approach raises concerns regarding metastases-induced patient morbidity. We present here a case exemplifying the morbidity associated with the development of brain metastases in a portion of the radiation field blocked due to concerns of increased toxicity due to re-irradiation.

CASE PRESENTATION
A 69-year-old male presented with a history of T1N0M0 laryngeal cancer treated with small field definitive radiation, followed by adjuvant post-prostatectomy radiation therapy to 68 Gy delivered in 34 fractions with androgen deprivation, and finally a history of pT1N2bM0 oropharyngeal cancer, treated with a comprehensive large-field radiation with concurrent chemotherapy. The oropharyngeal radiation field included a portion of the midbrain and cerebellum. Five years later, the patient developed limited stage SCC, for which he received definitive chemoradiation, followed by PCI. The previously irradiated mid-brain and cerebellum regions were blocked from the whole brain PCI fields due to &#x2028;concerns for toxicity. Two years post-PCI, the patient developed multiple symptomatic brain metastases, with a dominant lesion located in the mid-brain, responsible for his double-vision, as well as several lesions in the cerebellum causing complete ambulatory dysfunction. Stereotactic radiosurgery (SRS) was administered but the patient succumbed to his illness two weeks later from neurologic death.

DISCUSSION
This case underscores the benefit of PCI in preventing significant neurologic morbidity in patients with SCC. Forgoing PCI and adopting a surveillance approach may increase the risk of introducing increased metastases-induced morbidity in SCC patients.
QSPC-11 NEWLY DIAGNOSED BRAIN METASTASES: WHAT ARE THE CRITERIA FOR EMERGENCY ROOM EVALUATION AND HOSPITAL ADMISSION?
Authors: Soto Daniel , Wendel Sarah , Catalino Michael , Brady William , Gaughan Elizabeth , Sheehan Jason , Fadul Camilo 
Published: August 2024

Abstract

BACKGROUND
Approximately 40% of patients with newly diagnosed brain metastases (BMETs) present to the ED or are admitted to the hospital. The optimal diagnostic and therapeutic care for these patients has not been established.

OBJECTIVE
To map and identify the opportunities to provide value care for patients who come to the ED or are admitted to the hospital with newly diagnosed BMETs.

METHODS
Following quality improvement methodology, we defined the scope of the population to be studied, developed a flowchart, and identified decision points to measure the characteristics and outcomes of patients who come to the ED or are admitted with newly diagnosed BMETs at a tertiary academic center. We abstracted data between 2017 and 2019 including performance status (ECOG, KPS, U-RPA), synchronous/metachronous status, consulting and admitting specialties, diagnostic workup performed, BMETs characteristics on imaging, and acute interventions (surgery, WBRT, and/or GKRS).

RESULTS
We identified 138/339 (40.7%) patients who met eligibility criteria; 101/138 (73.2%) presented via ED; 37/138 (26.8%) were direct admissions. Of the 138 patients, 68 (49.3%) had synchronous BMETs with 66/68 (97.1%) having tissue sampled for pathology (peripheral tissue biopsy and/or BMET surgical resection). In 83/138 (60.1%), an intervention was performed during hospital admission. The median time (h:mm) spent in the ED was 7:16 (Range: 0:58 – 25:35). Of the 101 patients seen in the ED, 96 (95.0%) were admitted. All 12 patients with hydrocephalus received an acute intervention.

CONCLUSION
The lack of clear guidelines for ED evaluation and hospital admission for patients with newly diagnosed BMETs leads to higher admission rates and inpatient resource usage. Analysis of our results will identify interventions that may improve the value of the care provided to this complex patient population.
QSPC-12 CNS-ONLY DISEASE IS ASSOCIATED WITH LONGER SURVIVAL BUT HIGH CNS-RELATED MORTALITY IN PATIENTS WITH HER2+ BREAST CANCER
Authors: Ferraro Emanuela , Reiner Anne S , Nassif Rabih Bou , Tosi Umberto , Brown Samantha , Zeller Sabrina , Dang Chau T , Seidman Andrew D , Panageas Katherine , Moss Nelson 
Published: August 2024

Abstract

BACKGROUND
Due to poorer drugs efficacy in the CNS than extracranially, patients with metastatic HER2+ breast cancer and CNS-only disease are a growing population. Here, we aimed to report the overall survival (OS) and CNS-related death in HER2+ MBC patients with CNS metastasis by disease distribution.

METHODS
Patients with HER2+ MBC with CNS disease including BrM, leptomeningeal (LMD) and/or dural metastasis treated in our Institution between 8/2010 and 4/2022 were included. Extracranial metastasis (ECM) was evaluated at the time of CNS metastasis and at last follow-up/death. CNS-related death was defined as death from tumor-related brain injury, functional deficits/seizures, and/or complications of brain-directed therapies. OS was estimated using Kaplan-Meier methodology.

RESULTS
The cohort comprised 274 patients. At CNS metastasis diagnosis, 72/274 (26%) presented with CNS-only disease (63 without prior ECM diagnosis, and 9 with prior ECM in complete response), and 200/274 (73%) with concomitant ECM. Two patients had unknown ECM status at CNS disease diagnosis. Among patients with CNS-only disease, 34/72 (47%) never developed ECM progression by the time of their last follow-up/death. Patients with CNS-only disease had longer OS than patients with CNS+ECM: 3.48 years (95%CI: 2.10-5.14) versus 1.96 years (95%CI: 1.62-2.27), respectively (p=0.017).The cumulative incidence of CNS-related death at 3 years was 32.91% (27.2-38.7%), and did not differ between CNS+ECM versus CNS-only groups, p=0.14, despite higher use of neurosurgical resection in the latter group. Conversely, death due to other causes was more likely to occur in the CNS+ECM group than CNS-only, p=&lt;0.001. LMD and whole-brain radiotherapy were independently associated with CNS-related death [HR=1.88 (95%CI: 1.20-2.95), p=0.006; HR=1.69 (95%CI: 1.12-2.54), p=0.01].

CONCLUSIONS
With higher rates of local therapy, patients with CNS-only disease had longer survival but high rates of CNS-related death owing to the treatable but ultimately refractory disease nature. Novel therapies with CNS efficacy are urgently needed.
SRGD-04 FUNCTIONAL OUTCOMES FOLLOWING LASER ABLATION VERSUS RESECTION OF MOTOR CORTEX METASTASES
Authors: Jackson Joshua , Haskell-Mendoza Aden , Flusche Ann Marie , Woo Joshua , Gonzalez Ariel , Reason Ellery , Srinivasan Ethan , Lerner Emily , Edwards Ryan , Huie David , Calabrese Evan , Fecci Peter 
Published: August 2024

Abstract

BACKGROUND
Laser interstitial thermal therapy (LITT) has clinical utility in treating radiographically progressive brain metastases (BM) following stereotactic radiosurgery (SRS), while resection has been reserved for large, symptomatic lesions in the upfront setting. Resection-associated morbidity in eloquently-located metastases may hinder definitive management.

METHODS
Patients receiving resection or LITT for BM radiographically associated with the primary motor cortex (PMC) from 2015-2023 were retrospectively reviewed. Clinicodemographic and survival data were collected, with patient Karnofsky Performance Status (KPS) or modified Rankin Scale (mRS) scores assessed out to 1-year by independent raters.

RESULTS
Forty-one patients underwent resection and 30 underwent LITT to a PMC-associated lesion. Median age was 67 (range 38 – 80) vs 65 (44 – 80) for resection vs LITT; median pre-operative KPS (70 vs 80, P = 0.1) or mRS (2 vs 2, P = 0.66) did not differ between groups. Lung was the most common primary site (56.1% resections vs 56.7% LITTs). Resected lesions were of larger median diameter than LITT, 2.8 vs 1.9 cm, P = 0.0001. For resections, length of stay was longer, median 2 vs 1 day, P = 0.0002, and ICU use more frequent (75.6% versus 20.0%, P &lt; 0.0001). At 1-month post-op, 66.7% of resection patients and 51.7% of LITT patients had stable or improved symptoms from pre-op, P = 0.21, with parity at 3-months (65.7% vs 62.9%). Further, there was no significant decrement in KPS or mRS score out to a year for either intervention.

CONCLUSION
While LITT-induced edema may slightly increase the risk of post-operative neurologic deficits, this is a transient and clinically insignificant phenomenon. Reduced operative footprint in the context of LITT may allow for faster definitive management of BM. For carefully selected lesions, LITT adjacent to eloquent cortex is feasible.