bluuebunny/crossref_metadata_2025_split huggingface dataset:
PATH-13. LEARNED RESIZING WITH EFFICIENT TRAINING (LRET) FACILITATES IMPROVED PERFORMANCE OF LARGE-SCALE BRAIN TUMOR HISTOLOGY IMAGE CLASSIFICATION MODELS
Authors: Orr Brent A , Alom Zahangir , Tran Quyhn T 
Published: June 2024

Abstract

BACKGROUND
Histologic examination is vital in oncology research and diagnostics. The adoption of digital scanning of whole slide images (WSI) has created an opportunity to leverage deep learning-based image classification methods to enhance diagnosis and risk stratification. However, technical limitations prevent training and deployment of accurate comprehensive multiclass deep convolutional neural networks (DCNN) models for histopathology image classification. The input dimensions of DCNN architectures are small compared to the typical pathologist field of view, degrading performance by excluding important architectural features. Furthermore, data requirements for comprehensive models are sufficiently large to overwhelm the system memory during training.

METHODS
A method termed Learned Resizing with Efficient Training (LRET) was developed to address the main limitations of traditional histopathology classification model training. The LRET method couples efficient training techniques with image resizing to facilitate seamless integration of larger histology image patches into state-of-the-art classification models while preserving important structural information. The LRET method was coupled with two distinct resizing techniques to train three diverse histology image datasets using five different DCNN architectures. Performance metrics were compared on cross validation and hold out test sets.

RESULTS
LRET-trained models were flexible to multiple input patch dimensions and DCNN models. We demonstrated performance improvement across all datasets while significantly reducing the training time and resources over traditional methods. Using a large-scale, multiclass brain tumor classification dataset consisting of 74 distinct histopathologic classes, LRET-trained models outperformed existing methods by 15-28% in accuracy, yielding 94% accuracy for the best model.

CONCLUSION
The LRET method for DCNN training significantly enhances the performance of large-scale multiclass histopathology image classification. The implications of this work extend to broader applications within medical imaging and beyond, where efficient integration of high-resolution images into deep learning pipelines is paramount for driving advancements research and clinical practice.
LMIC-02. FREQUENCY OF NTRK FUSIONS IN PEDIATRIC LOW GRADE GLIOMAS. DATA FROM A SINGLE CENTER IN MONTERREY, MEXICO
Authors: Leal-Cavazos Carlos A , Arenas-Ruiz Jose A , Vidal-Gutierrez Oscar 
Published: June 2024

Abstract

BACKGROUND
Neurotrophic tyrosine receptor kinases (NTRK 1-3)fusions have been identified in a range of pediatric cancer. Among children with cancer NTRK fusions can be detected in less than 1% of cases. Low grade gliomas (LGG) are the most pediatric brain tumors and the frequency of NTRK fusions reported is between 0.4 -4.3%. NTRK2 fusions are the most commonly reported in pediatric brain tumors.

METHOD
We describe the characteristics of patients analysed. Due to limited access to Next Generation Sequencing (NGS) only patients with recurrent, progressive, metastatic or midline location LGG were tested during 2021-2022. Positivity to Pan-Trk immunohistochemistry was needed to proceed to confirmation with NGS. 10 patients with LGG were included. Median age of patients at baseline was 4.7 (range,1-12) years. 10/10 showed positivity to Pan-Trk stain and NTRK fusions were detected in 6/10 patients, 3/6 had NTRK1 fusions, 2/6 NTRK2 fusion and 1 with NTRK3 fusion.. All 4 patients without NTRK fusions are off therapy (more than 1 year survellaince) and 2/4 were treated with surgery only. All patients with NTRK fusions are still on treatment due to progressive disease, 4/6 patients have required 2 or more surgeries and 5/6 patients have needed 2 or more chemotherapy regimens.

CONCLUSION
This small cohort of patients represents a highly selected population with LGG and the frequency of NTRK fusions resulted significantly higher than expected (6 out of 10 patients tested). This finding could reflect a clinical or prognostic significance, it will be important to analyze a larger cohort of patients that share these same clinical characteristics to determine its real value as a prognostic marker in these heavily treated patients. There is well known molecular alterations that predict outcome in patients with LGG. NTRK targeted therapy already exists with proven efficacy although access may limits its use.
LMIC-04. BUILDING PEDIATRIC NEURO-ONCOLOGY CAPACITY IN LMICS THROUGH MULTIDISCIPLINARY EDUCATION AND COLLABORATION
Authors: Moreira Daniel , Andujar Allyson , Qaddoumi Ibrahim 
Published: June 2024

Abstract

BACKGROUND
The St. Jude Global Academy Neuro-Oncology Training Seminar (NOTS) is a course in pediatric neuro-oncology (PNO) designed for physicians from low-income and middle-income countries. The curriculum was systematically designed and includes 9 weeks of online learning and a 5-day in-person workshop. The NOTS has been run 3 times: 2019, 2022, and 2023. We sought to evaluate the outcomes of these courses.

METHODS
After the initial course where institutions were invited, applying institutions were selected based on the size of the neuro-oncology program, multidisciplinary representation, and perceived impact of the course. Data on course participants have been prospectively collected. A survey evaluating course impact was completed by graduates.

RESULTS
For 2022, 51 institutions from 29 countries applied and 15 were selected. In 2023, 60 institutions from 31 countries applied and 18 were selected. Overall, 41 institutions from 29 countries have participated in NOTS. Furthermore, 191 individuals, including 68 pediatric oncologists, 37 neurosurgeons, 22 radiation oncologists, 19 radiologists, 18 pathologists, and 27 other specialists have participated. Survey responses (n=39) describe that 47% did not have multidisciplinary tumor boards (MDTB) before NOTS. 55% of those institutions now have MDTB, all claiming to be influenced by their participation in NOTS. 89% of participants claim that multidisciplinary communication improved after the course. The participants of NOTS have continued to be engaged beyond the course through the creation of the Global Alliance in Pediatric Neuro-Oncology (GAPNO). GAPNO workstreams have included monthly cases discussions, a multisite retrospective review of medulloblastoma outcomes collecting &gt;300 patients in 8 countries, and the design of a comprehensive tool to evaluate PNO services.

CONCLUSIONS
A multidisciplinary course focused on pediatric CNS tumors care for resource-limited settings can help expand international engagement in PNO. Furthermore, through multidisciplinary collaboration, the PNO community can be galvanized to expand activities in capacity building.
LMIC-07. OUTCOMES OF NEUROFIBROMATOSIS TYPE 1-ASSOCIATED OPTIC PATHWAY GLIOMAS AT A SINGLE TERTIARY PEDIATRIC ONCOLOGY CENTER IN EGYPT: BORG EL ARAB UNIVERSITY HOSPITAL (BAUH) EXPERIENCE
Authors: Omran Nuha , Bahaie Nourelhoda S , Fadel Shady 
Published: June 2024

Abstract

BACKGROUND
Neurofibromatosis type 1 (NF-1) is a multisystem disease inherited in an autosomal dominant fashion. About 15% of the pediatric cases have associated brain tumors, among which the optic pathway gliomas (OPG) remain the most common. Due to their location, OPG can cause visual impairment, and endocrinal dysfunction, hence requiring therapeutic interventions, more commonly in sporadic non-NF-1 cases.

METHODS
NF-1 children with associated OPG followed at a single tertiary pediatric oncology center since its establishment from 2018 to 2023 were retrospectively evaluated.

RESULTS
Forty patients were identified either as firstly diagnosed NF-1 cases in our center or referred to us for follow up. Twenty-three of them who had associated OPG (mean age at diagnosis 83.7 months) were included in our study. The commonest clinical presentation was the bilateral initial visual affection occurring in 13 patients. Six had hormonal imbalance and four presented with seizures. Biopsy was taken only in 30%, with histopathology being mainly pilocytic astrocytoma. In terms of treatment, 10 cases received only one line of chemotherapy, six patients were kept on follow up, and the rest received more than one line of therapy. Overall survival (OS) was 100% throughout the study period, and progression-free survival was 64.1% at 1.5 years, and 46.8% at 5 years. Visual assessment at the end of treatment was stable in 71%, better in 22%, and worse in 7% of cases. Same pattern was observed in MRI assessment post therapy showing 57% stable disease, 39% regression, and 4% progression.

CONCLUSIONS
Survival of children with OPG is different in every center of the world as decisions regarding their management being challenging. Therefore, NF-1 multidisciplinary clinics are important to be established, with a high emphasis on early detection and referral of patients, standardization of symptoms grading and indications to start treatment.
LMIC-08. NEUROSURGERY UTILIZATION RATE FOR PEDIATRIC LOW-GRADE GLIOMA: A SIMULATION-BASED ANALYSIS
Authors: Boop Scott , Bhakta Nickhill , Bolous Nancy S , Moreira Daniel 
Published: June 2024

Abstract

BACKGROUND
The outcomes of pediatric low-grade glioma (pLGG) are markedly influenced by accessibility to neurosurgical services. Even when clinically recommended, neurosurgical interventions might not be feasible when there is scarcity in qualified medical professionals and preparedness of medical facilities, which is the case in many low- and middle-income countries (LMICs). To aid cancer control planning efforts and guide policy makers and clinicians to prioritize allocation of resources, accurate neurosurgical utilization rate (NUR) estimations are crucial. This study developed a model to estimate the NUR, to facilitate the approximation of neurosurgery needs for pLGG.

METHODS
A decision tree model was developed to assess the NUR in HICs and LMICs. Patients were classified into five groups based on the anatomic site of the tumor. For each type of cancer, patients had three surgical options, gross total resection, subtotal resection, and biopsy. Anatomic distribution and likelihood to perform surgical resection were retrieved from the literature for both HICs and LMICs.

RESULTS
Findings showed discrepancy in the anatomic distribution of pLGG in HICs and LMICs. Proportion of patients with cerebral hemisphere, cerebellum, OPHG/diencephalon, brainstem, and spine tumors and their likelihood to undergo surgical intervention were 34% | 28%, 32% | 27%, 17% | 4%, 12% | 3% and 5% | 4% in HICs, and 26% | 22%, 39% | 32%, 26% | 5%, 6% | 2% and 3% | 2% in LMICs, respectively. Overall, NUR in pLGG patients was 66% in HICs and 63% in LMICs.

CONCLUSION
Despite the limited resources in LMICs, the overall proportion of patients recommended to undergo a surgical intervention is comparable to HICs. For this need to be met, long-term planning need to take place at the policymaking level. It is possible to estimate the NUR for all pediatric CNS tumors following the same approach to more comprehensively estimate the neurosurgical needs of this patient population globally.
LMIC-09. CRADLE TO CRAYON: THE IMPACT OF COLLABORATION ON PEDIATRIC CENTRAL NERVOUS SYSTEM TUMORS IN GHANA
Authors: Schandorf Ernestina N B , Quarcoopome Mary-Ann Dadzie , Gbadamosi Hafisatu , Renner Lorna A , Bouffet Eric , Bankah Patrick E 
Published: June 2024

Abstract

BACKGROUND
A multidisciplinary team (MDT) approach is essential for quality care, especially in paediatric oncology. In developing countries like Ghana, paediatric neuro-oncology is a relatively young subspecialty and requires a multidisciplinary team approach. The St Jude Global Academy Neuro-Oncology Training Seminar in 2022 saw a significant milestone in this MDT journey. Four MDT members benefited from the training, with a profound impact. This study aims to study the effect of neuro-oncology training on the number of CNS cases reviewed at MDT meetings.

METHODS
A retrospective review of case announcements made on the Pediatric Oncology MDT WhatsApp group page were collated spanning the period August 1, 2022, to July 31, 2023. Tumour distribution of cases discussed at MDT was compared 4 months pre- and 4- and 8-months post-St Jude Global Academy Neuro-Oncology Training Seminar (NOTS) completion in November 2022. A T-test was used to calculate for statistical significance of the difference in the number of cases discussed over the period.

RESULTS
A total of 208 cases were discussed after 52 MDT Zoom meetings. The number of cases discussed at MDT increased from 40 recorded in the first four months (August -November 2022) to 89 cases in the last four months (April- July 2023). There was a significant increase in the number of CNS cases discussed by 3.9% (p=0.012) at 4 months and 6.6% (p=0.023) at 8 months after NOTS. The complexity of CNS tumours discussed also increased.

CONCLUSIONS
The St Jude Global NOTS positively influenced the number of CNS cases discussed at MDT. Multidisciplinary team discussions allow for collations of ideas from all specialists with a patient-centred approach which is particularly invaluable to the care of neuro-oncology patients. Further studies on the effect on time of plan implementation, and client satisfaction will be beneficial to evaluate the effectiveness of our MDTs.
LMIC-14. MAPPING THE REFERRAL PATH - HURDLES IN PEDIATRIC BRAIN TUMOR DIAGNOSIS: A PERSPECTIVE FROM TERTIARY CANCER CARE CENTRE IN A LOW MIDDLE-INCOME COUNTRY
Authors: K Vasudeva Bhat , V Archana M , Vellu Umesh , Bharadwaj Vishnu , V Vinay M , T Harish Varma , Rahiman Emine A , M Swathi P , Qaddoumi Ibrahim , Salman Zeena , Dhall Girish , Menon Girish 
Published: June 2024

Abstract

BACKGROUND
Delayed referral remains leads to worse outcomes for children with cancer in low- and middle-income countries (LMIC), especially for patients with brain tumors. Delay in treatment could be due to the ignorance from the families to seek health care advice or lack of awareness of primary care physician.

METHODS
A retrospective study was conducted to delineate the referral path of children with brain tumors who presented to our institution. Patients &lt;18 years with brain tumors registered from June 2022-December 2023 were included. Patients with relapsed disease, second opinion, or partially treated in an outside institute prior to referral were excluded. Data were captured using a proforma after obtaining permission from Institutional ethics committee.

RESULTS
Thirty-one children were enrolled with a median age of 5 years (range: 0-17) with M: F ratio of 1.58:1. The most common diagnosis in this cohort was medulloblastoma in 13(42%) followed by high grade glioma in 7(22%) and low-grade glioma in 4 patients (13%). Twenty-four (77%) belonged to low socio-economic strata defined by Modified Kuppuswamy classification, of which 22 (71%) were hailing from rural area with median distance from cancer center being 121 miles (range: 4.34 -242). Median of 3 (range: 1-6) consultations were sought prior to being referred to us and about 11 (35%) had visited alternative system of medicine before consulting us. Mean delay from symptom onset to diagnosis was 52 days (range: 2-530) with healthcare seeking delay of 5.4 days (Range: 0-30) and health system delay of 46 days (range: 1-500). The factors influencing delay included rural background (p=0.04) and lower socioeconomic strata (p=0.03).

CONCLUSIONS
Health system delay was a major cause of delayed referral in our study. By improving awareness of the primary care physicians about symptomatology of pediatric brain tumors, the referral pathway can be expedited thereby improving the outcomes of these children.
LMIC-17. DIAGNOSTIC DELAY IN CHILDREN WITH CNS TUMORS IN A TERTIARY HOSPITAL IN MEXICO
Authors: de la Peña-Hernández Beth Sainz , Arreguín-González Farina , Valdéz-Orduño Ricardo , Almazán-García Blanca , Sandoval-de Jesús San Juanita , Baños-Rodríguez Eduardo , López-Azcárraga Alejandra , García-Ramos Jeannie , Sebastian-Barajas Ruben , Ochoa-Madrigal Georgina , Moreira Daniel , Benito-Reséndiz Alma 
Published: June 2024

Abstract

BACKGROUND
Delays in diagnosis of central nervous system (CNS) tumors have been associated with increased morbidity and mortality. We aimed to describe the time intervals for diagnosis and explore factors related to diagnostic delays in a tertiary public hospital in a middle-income country.

METHODS
A retrospective study was carried out, collecting data from patients diagnosed with brain tumors between 2000 and 2021 at the National Medical Center “20 de Noviembre” in Mexico City. The data were analyzed using descriptive statistics.

RESULTS
Data were collected from 163 patients with a median age of 8 years (range 0-18 years). 81 (49.7%) patients were diagnosed with gliomas, 47 (28.8%) with embryonal tumors, 20 (12.3%) with ependymomas, 10 (6.1%) with germ cell tumors of the central nervous system, 3 (1.8%) with choroid plexus carcinoma, and 2 (1.2%) with other diagnoses. The median time of symptom start and first visit with a physician was 20 days (rage 1 to 180 days). The median time in which the patients arrived at the tertiary hospital after the first visit to a physician was 184 days (range 1 to 2520). The population served by the institution, included the 32 states, with 153 patients (93.9%) coming from an urban location, with easy access to medical services. 145 (89%) of the 163 patients had parents with a medium socio-economic level (urban housing, all basic services, at least one of the parents with higher education.) Of the patients studied, 75 (46%) died, 18 (11%) abandoned treatment, 65 (39.9%) survived and 5 (3.1%) were lost to follow-up.

CONCLUSION
An important delay was found in the start of treatment from the moment patients begin symptoms. The identified delays warrant local and national strategies that allow prompt referrals.
LMIC-18. RESOURCES FOR THE PRACTICE OF PEDIATRIC NEURO-ONCOLOGYIN MEXICO: A CROSS-SECTIONAL EVALUATION
Authors: Arce-Cabrera Daniela , Escamilla-Asiain Gabriela , Nájera-Castillo Melisa , Campo Regina Navarro-Martín del , Ortiz-Azpilcueta Mariana , Pantoja-Guillén Francisco , González Farina Arreguín , Zapata-Sosa Imelda , Lugo-Juárez Jocelyn , Santillán-Cortés Daniel , La Madrid Andrés Morales- , Moreira Daniel , Benito-Reséndiz Alma 
Published: June 2024

Abstract

BACKGROUND
The evaluation of existing resources and services is key to identify gaps and prioritize interventions to expand care capacity for children with central nervous system (CNS) tumors. We sought to evaluate the resources for pediatrc neuro-oncology (PNO) in Mexico.

METHODS
A cross-sectional online survey with 35 items was designed to assess PNO resources and services. The survey was distributed to the members of the Mexican Association of Pediatric Oncology and Hematology (AMOHP).

RESULTS
Overall, responses from 33 institutions were obtained. Responding institutions covered 9 healths systems in Mexico, including private and public institutions. Most of the participating centers have at least 2 pediatric oncologists, so in up to 42% of cases, the approach to children with brain tumors is initiated by a pediatric oncologist. Only half of the responding centers have complete chemotherapy treatments. Only 18% of the centers had access to targeted therapy. The majority (88%) of institutions had a blood bank, but 4 of the participating centers did not have a PICU. All centers have a pathologist but only perform basic immunohistochemistry techniques and have an average diagnostic timeframe of 2 weeks. Surgical treatment is usually available 8 to 14 days after the patient is admitted in 45% of centers. Some centers have radiotherapy available at the facility, others must be sent to other hospitals, but most (42%) can start radiotherapy within the first week after treatment is requested. Infectious processes are a common cause of death in children with brain tumors and only the centers have a half-integrated palliative care team.

CONCLUSIONS
This is the first situational overview of the resources available in Mexico, showing disparities in resource capacity and lack of a specific and efficient diagnosis that allow early initiation of treatmen. These data will allow for the prioritization of interventions.
LMIC-20. REAL-WORLD EXPERIENCE IN DEALING WITH CHILDREN WITH SUSPECTED CENTRAL NERVOUS SYSTEM (CNS) TUMORS AT THE CHILDREN’S HOSPITAL LAHORE (UCHS), PAKISTAN
Authors: Ain Rahat Ul , Rehman Laeeq Ur , Qaiser Rabia Aqeel , Hussain Mahwish , Goraya Amber , Zaman Samina , Ahmad Alia , Riaz Shazia , Faizan Mahwish , Salman Zeena , Qaddoumi Ibrahim , Mushtaq Naureen , Bouffet Eric 
Published: June 2024

Abstract

BACKGROUND
CNS tumors are the leading cause of cancer-related deaths in children in HICs, but data from LMICs are scarce. The objectives of this study were to document the trajectory of children with CNS tumors at a tertiary-care hospital in Pakistan.

METHODS
This prospective, analytic, cohort study recorded all new cases of suspected CNS tumors (birth to 16 years) presented from 2023/01/01 to 2023/12/31 at UCHS, Lahore.

RESULTS
A total of 145 cases were included. Median age at presentation was 7.0 years (1.5 months–15 years); male-to-female ratio was 1.4:1. Median time to presentation was 2 months (0.1 – 96 months); delay of &gt;6 months was observed in 30.5% cases due to delayed presentation to medical facility (74%) and healthcare delay (26%). Headaches and vomiting (56%), focal neurological deficit (23%), and seizures (15%) were the most common presenting complaints. Consanguinity (46%), and family history of cancers (19%) were frequent; café au lait macules were observed in 9.7%. 50% tumors were infratentorial, 46% supratentorial and 4% spinal. Tumor excision was done in 45%, VP-shunts in 42%, and upfront chemotherapy in 2%. Only 60% had a final diagnosis. Tissue diagnosis in 39% cases showed Medulloblastoma (18 patients, 32%), Pilocytic Astrocytoma (27%), and High-grade glioma (16%) as the commonest diagnoses, while 21% had a radiological diagnosis based on CT/MRI features: DIPG/DMG (12%), Craniopharyngioma (7.6%), and Optic Pathway Glioma (1.4%). Of 18 medulloblastoma patients, only 7 received postoperative radiotherapy. Seventy (48%) patients expired (including 38 before surgery), 27% are on follow-up and 25% are LAMA/LTFU/defaulted treatment. One-year survival was 36% with median survival of 4 months (0.07-96 months).

CONCLUSION
Less than half of the patients with CNS tumors undergo active treatment, a large proportion leave treatment/follow-up and have poor overall survival. Considerable cases with cancer predisposition syndromes were suspected.