bluuebunny/crossref_metadata_2025_split huggingface dataset:
NCMP-07. HEADACHE PRESENTATION AND MANAGEMENT IN VON HIPPEL-LINDAU (VHL)-ASSOCIATED HEMANGIOBLASTOMAS
Authors: Vohra Sanah , Malkhasyan Yelena , Chandla Anubhav , Gordon Michael , Shuch Brian , Graber Jerome , Yang Isaac 
Published: November 2023

Abstract

BACKGROUND
Hemangioblastomas are the most common brain tumors among patients with Von Hippel-Lindau (VHL) disease. Common characteristics of these benign tumors, such as tumor growth, peritumoral edema, and cystic expansion, may lead to neurologic morbidity and/or mortality. Thus, early diagnosis based on symptom presentation and appropriate treatment is paramount to VHL-associated hemangioblastoma management.

METHODS
We conducted a systematic review of PubMed, Scopus, Cochrane, Embase, and Web of Science databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified studies reporting pre-diagnostic symptoms and post-diagnostic treatments among patients with VHL-associated hemangioblastomas.

RESULTS
Data from 150 patients were analyzed. The average age at presentation was 35.3 years (range: 18-75) and 52.7% of patients were female. Headache was the most common presenting symptom (73.3%). Other presenting symptoms included balance or gait disturbances (42%), ataxia (41.3%), nausea (24.3%), emesis (24.3%), dysmetria (15.5%), swallowing difficulties (11.3%), and singultus (10.7%). Anatomically, 98.7% of tumors were in the posterior fossa, specifically 69% in the cerebellum and 30% in the brainstem. Approximately 62.8% of patients had tumor associated cysts. A majority of the patients (98.7%) underwent gross-total resection of the tumor and cyst drainage as needed. Other common treatments included radiotherapy, gamma-knife surgery, and ventriculoperitoneal shunt placement.

CONCLUSION
Patients with VHL-associated hemangioblastomas commonly presented with headaches, balance or gait difficulties, and ataxia. Tumors were generally found in the posterior fossa and were associated with cysts. Gross-total resection was the main treatment offered to patients with these tumors.
NCMP-12. PREVALENCE OF RADIONECROSIS IN RECURRENT GLIOBLASTOMA
Authors: Morin Nicolas , Cottin Sylvine Carrondo , Saikali Stephan , Michaud Karine , D’Astous Myreille 
Published: November 2023

Abstract

INTRODUCTION
Glioblastoma (GBM) standard treatment consists of maximum and safe surgical resection, followed by radiation therapy in combination with temozolomide. Some patients show radiological and/or clinical deterioration soon after radiotherapy treatment. Early MRI changes, in the first 3 months following radiation is considered pseudo-progression. After this initial period, changes are considered as tumor recurrence. However, cases of early radiological deterioration have been related to radionecrosis. When tumor progression is suspected on imaging, it may causes treatment withdrawal or change. Therefore, for a certain percentage of patients, effective treatment could be abandoned in the presence of radionecrosis.

METHODS
The aim of the study is to assess the prevalence of radionecrosis at the Hôpital de l'Enfant-Jésus. This is a retrospective, observational case-control study evaluating recurrent GBM patients who underwent a second resection surgery.

RESULTS
The charts of 110 GBM patients with second resection were retrospectively reviewed (men: 62%, mean age: 58.3 years). Among these patients, we observed 87 cases of GBM recurrence as compared to 23 cases of radionecrosis (21%). No statistically significant difference was observed between the two groups regarding demographics, survival, Karnofsky performance status, type of surgery and treatments received. However, in the radionecrosis group, decreases in time between the 2 surgeries (55.3 vs. 24.3 weeks, p = 0.006) and in the number of cycles of chemotherapy received (5.7 vs. 3.7 weeks, p = 0.004) were observed as compared to GBM group.

CONCLUSIONS
This study characterizes demographically the patients with second surgery for suspicion of GBM in order to better adapt the treatments. Clinical and radiological data could not differentiate radionecrosis from true tumor recurrence or progression. A prospective study will be carried out as a second step, in order to determine radiological or molecular factors that could predict the presence of radionecrosis.
NCMP-16. A CASE OF WIDESPREAD EXTRACRANIAL METASTASES FROM A GLIOSARCOMA
Authors: Mohamadpour Maliheh , Budhu Joshua 
Published: November 2023

Abstract
BACKGROUND: Glioblastoma (GBM) with sarcomatous features (gliosarcoma) accounts for 2-8% of all glioblastomas1,2, characterized by a biphasic histopathology pattern consisting of glial and sarcomatous components. While GBMs generally do not metastasize outside the central nervous system (CNS), GS has been associated with extracranial metastases in up to 11% of cases3. Case presentation: A 58-year-old right-handed woman with a GBM presented to our institution for a second opinion. She was initially diagnosed 18 months prior and had received radiotherapy with concurrent temozolomide. Her adjuvant temozolomide was discontinued due to rash, and she started on bevacizumab. Her tumor progressed and she sought additional treatment options. On her initial presentation, she was tachycardic with leukocytosis, prompting admission. A chest CT showed thoracic adenopathy, multiple bilateral pulmonary nodules, and a large left malignant pleural effusion. Bronchoscopy revealed spindle cell sarcomatoid neoplasm raising the possibility of metastasis from a CNS primary tumor. Additionally, the patient endorsed development of subacute radicular pain in her bilateral lower extremities as well as weakness. MRI of total spine revealed multilevel osseous and epidural lesions, infiltrating the paraspinal muscles and thickening of cauda roots with concern for leptomeningeal disease. A subsequent PET-CT showed increased FDG avidity in these lesions. Reevaluation of the initial CNS pathology confirmed the presence of mesenchymal/sarcomatous differentiation, consistent with a diagnosis of GS. As confirmed by autopsy, the patient eventually passed away due to widespread and metastatic disease. Discussion: While GBM rarely metastasizes outside the CNS, GBM with sarcomatous features are more likely to exhibit extracranial metastasis. Our patient had widespread involvement, including the lungs, heart, liver, omentum, and bone. Metastasis was thought most likely once EBUS of the lung returned with sarcomatous features. Clinicians should therefore maintain a high suspicion for metastases when dealing with patients diagnosed with GS.
NCMP-18. ENDOVASCULAR TREATMENT OF SYMPTOMATIC TUMORAL VENOUS SINUS STENOSIS: COMPARATIVE ANALYSIS OF CORONARY BALLOON-MOUNTED STENTS AND CONVENTIONAL TECHNIQUES
Authors: Chen Adrian , Begley Sabrina , White Timothy G 
Published: November 2023

Abstract
Meningiomas may lead to symptomatic papilledema due to elevated intracranial pressure (ICP) from venous sinus compression. While venous sinus stenting has proven effective for treating elevated intracranial pressure, evidence for its application in tumoral-induced stenosis and acquired intracranial hypertension is limited. This study presents an institutional series of symptomatic tumoral venous sinus stenosis cases and compares the technical considerations of endovascular treatment using a coronary balloon-mounted stent to conventional venous sinus stenting. Three patients with meningioma-induced, bilateral papilledema received treatment with venous sinus stenting between 2019-2022. Presentation, stenosis severity, venous manometry, ophthalmologic findings, procedural techniques, and post-operative outcomes were retrospectively analyzed. Three patients (mean age: 59 years, 2 out of 3 male) presented with worsening blurry vision, diplopia, and persistent headaches. Bilateral papilledema was observed (median optic nerve sheath distension=0.48mm). Pre-procedure measurements showed elevated ICP with opening pressures ranging from 37-38 cmH2O. Imaging revealed extra-axial parieto-occipital lesions with significant mass effect, and MR venograms confirmed severe stenosis of the superior sagittal sinus (SSS). Venous angiography (DSV) demonstrated median venous sinus pressures of 32-mmHg proximal to the stenosis with a 4-mmHg pressure gradient across the stenosis. During the procedure, balloon-mounted Onyx coronary stents or a self-expanding PrecisePro carotid stent were deployed successfully. Post-stenting, papilledema resolved completely in two patients, while one patient experienced partial symptom resolution. Proximal SSS pressures decreased by a mean of 46.8%, and trans-stenotic pressure gradients were reduced to ≤1 mmHg. Stent patency without complications was maintained throughout the 2 to 5-month follow-up in all patients. Adjacent meningiomas were subsequently monitored for observation or stereotactic radiosurgery. Small extra-axial lesions causing symptomatic venous sinus compression can be endovascularly treated using balloon-mounted cardiac stents. Non-surgical meningioma patients, symptomatic for intracranial hypertension and lesions proximal to venous sinuses, should be assessed with DSV for potential management with endovascular interventions.
NCMP-20. ASSESSING THE IMPACT OF DRIVER MUTATIONS AND ANTINEOPLASTIC TREATMENTS ON RISK FOR STROKE RECURRENCE IN PATIENTS WITH LUNG ADENOCARCINOMA
Authors: Lim Sanghee , Keser Zafer , Carabenciov Ivan , Sener Ugur 
Published: November 2023

Abstract

BACKGROUND
Hypercoagulability is a well-described paraneoplastic phenomenon associated with strokes in cancer patients, but whether driver mutations or antineoplastic treatments contribute in a significant way to recurrent stroke risk are not well understood.

METHODS
As part of a larger study focusing on lung cancer and stroke, we retrospectively identified 103 patients with tissue-confirmed adenocarcinoma and prior diagnosis of stroke treated at the Mayo Clinic between 2000-2022. We collected data regarding demographics, performance status, cerebrovascular risk factors, antithrombotic use, chemotherapy, radiation, and genetic testing data, which were assessed for impact on recurrent stroke risk.

RESULTS
71.8% of patients had recurrent strokes (74/103). No class of chemotherapeutics was significantly associated with increased risk for recurrent strokes, including immune checkpoint inhibitors and thrombogenic chemotherapeutics (Gemcitabine, Cisplatin, Carboplatin, anti-VEGF therapies). 78 patients had genetic testing data available. Driver mutations in KRAS, EGFR, MET, and BRAF were not associated with increased risk for recurrent stroke. There was a signal towards increased risk for stroke recurrence in patients with ALK mutations (OR 2.647, p=0.4056). There was a trend towards increased risk for stroke recurrence in patients with advanced staging (Stage III/IV) at diagnosis (OR 2.125, p=0.09). Stroke recurrence risk was higher in patients treated with single antiplatelet agents compared to anticoagulation or dual antiplatelet therapy (OR 3.385, p=0.0061) though risk of hemorrhagic complications was similar (OR 1.559, p=0.3376). Patients with recurrent stroke had longer overall survival compared to those without (Median OS 43.2 months vs 26.3 months, Mantel-Haenszel HR 0.5202, p=0.0367).

CONCLUSIONS
In patients with lung adenocarcinoma who experienced ischemic stroke, prolonged survival and single antiplatelet therapy compared to dual antiplatelet therapy or anticoagulation were associated with increased recurrent stroke risk. ALK mutations and higher stage at initial diagnosis trended towards higher risk for stroke recurrence. Larger retrospective analyses are under way to confirm these findings.
NCMP-28. CIRCADIAN REGULATION OF NEUROINFLAMMATION DRIVING CANCER THERAPY-RELATED COGNITIVE IMPAIRMENT
Authors: Mehl Lindsey , Gibson Erin 
Published: November 2023

Abstract
More than 18 million cancer survivors were estimated to live in the United States as of January 2022. While advances in cancer detection and treatment have substantially improved survivorship, as many as 65% of patients treated for non-central nervous system tumors may develop cancer therapy-related cognitive impairment (CRCI), a neurological disorder which includes deficits in memory, attention, multitasking, fine motor function, and information processing. Our previous work found that methotrexate (MTX) chemotherapy induces persistent neuroinflammation driving CRCI in a pediatric mouse model. We now demonstrate that the time of MTX administration, called MTX chronotherapy, induces differential microglial activation and oligodendroglial dysregulation. Furthermore, we show that MTX chronotherapy alters the amount of chemotherapy that crosses the blood-brain barrier (BBB). Current experiments are elucidating the effect of various chemotherapeutics and chronotherapy on microglial activation and crosstalk with other glia. This work will reveal crucial factors regulating CRCI-associated neuroinflammation and will define novel strategies to alleviate CRCI to prioritize quality of life for cancer survivors.
NCOG-01. BASELINE PATIENT-REPORTED OUTCOMES IN AN ONGOING PHASE III TRIAL OF PRE-OPERATIVE SRS VERSUS POST-OPERATIVE SRS FOR BRAIN METASTASES
Authors: Bradshaw Mariana , Wefel Jeffrey , Noll Kyle , Rao Ganesh , Ferguson Sherise , Tawbi Hussein , Huse Jason , Johnson Jason , Court Laurence , O'Brien Barbara , Lang Frederick , Ejezie Lynette , Sullaway Catherine , Thomas Ashley , Suki Dima , Nana Yeboa D 
Published: November 2023

Abstract
In ongoing phase III randomized trial (NCT03741673) evaluating risk of LMD in patients with brain metastasis, patients are stratified by tumor size, location, and histology, and randomized to pre- versus post-operative SRS. Exploratory endpoints include patient reported outcomes (PROs) assessing symptoms (MDASI-BT) and health status (EQ-5D-5L). Characteristics of patients (N=40) with pre-treatment baseline include: mean (SD): age 59.3(11.4) years; 2.6(2.2) mets; 15.2(10.3) cc brain met volume; median KPS: 90 (range: 70-100). On the MDASI-BT, 22.5%, 47.5%, 27.5%, 12.5%, and 80% reported no symptoms on the Cognitive, Neurologic, Affective, Constitutional, and Gastrointestinal Factors, respectively. The median factor score was &lt;1 on all factors. Neurologic (r=-.35, p=.03) and Constitutional Factors (r=-0.34, p=.03) correlated with KPS. There was no correlation between MDASI-BT Factors and number/volume of metastases. On the EQ-5D-5L, patients reported no problems with Mobility (45%), Self-Care (72.5%), Usual Activities (62.5%), Pain/Discomfort (55%), and Anxiety/Depression (52.5%). Nearly twenty-eight percent reported no problems in any domain. KPS correlated with Mobility (r=-.48, p&lt; 0.01), Self-Care (r=-.49, p&lt; 0.01), and Usual Activities (r=-.44, p&lt; 0.01). There was no association between EQ-5D-5L items and number/volume of metastases. Patients’ baseline rating of current health on a 0-100 scale (VAS) ranged from 30-100 (mean (SD)=72.25 (19.18)). VAS correlated most with Anxiety/Depression (r=-.40, p=.01). VAS also correlated significantly with MDASI-BT Affective Factor (r=-.541, p&lt; .001) but not with Cognitive or Neurologic Factors. There was no correlation between VAS and KPS or number/volume of metastases. As previously reported, objective measures of cognitive function are associated with disease characteristics. PROs were associated with performance status but not disease characteristics. Mood was more strongly associated with patients’ self-perception of overall health status than clinical or disease characteristics. At baseline, a high proportion of patients report no adverse symptoms, suggesting use of these outcomes is best suited to trials measuring worsening of symptoms.
NCOG-03. SURGICAL MANAGEMENT OF CRANIOSPINAL AXIS MALIGNANT PERIPHERAL NERVE SHEATH TUMORS: A SINGLE-INSTITUTION EXPERIENCE AND LITERATURE REVIEW
Authors: Chowdhury A J , Vivanco-Suarez Juan , Belzer Alex , Teferi Nahom , Hitchon Patrick 
Published: November 2023

Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) are exceedingly rare and aggressive tumors with an overall incidence rate of 0.001%. The craniospinal axis is a rare location for primary MPNSTs with very few cases reported in the literature to date. Here-in, we present one of the larger series of single-institutional primary craniospinal MPNSTs, analyze patient outcomes, and extensively review the associated literature. All primary craniospinal axis MPNSTs managed at our institution between January 2005 to May 2023 were retrospectively reviewed. Patient demographics, tumor characteristics and radiographic features, treatment, and clinical outcomes were collected and analyzed. Descriptive statistics and multivariate logistic regression were performed. A total of 8 patients satisfied inclusion criteria (4 male and 4 female patients). Median age at presentation was 40 years (range 34-80 years). Most of these tumors were localized to the spine (6, 75%) and 3 patients (37%) had neurofibromatosis type 1(NF-1). Most common presenting symptoms were paresthesia/numbness in 50% of cases, and vision changes in 13%. Median tumor size was 3 cm (range 1-20), and most tumors were oval-shaped (4, 50%), with well-defined borders (6, 75%). One spinal tumor (11%) had an intramedullary extension. Most tumors were high grade (6, 75%), and gross-total resection was achieved in 5 (63%) patients with subtotal resection performed in the remaining 3 (37%). Radiotherapy and chemotherapy after surgery were performed in 6 (75%) and 4 (50%) cases, respectively. Local recurrence was evidenced in 5 (63%) cases and distant metastatic disease in 2 (25%) cases. The median progression-free survival time was 26.0 months, and 5 (63%) patients died due to recurrent disease. Early diagnosis and initiation of treatment is key as these tumors are highly aggressive with increased local invasion and distant metastatic rates. Maximal safe gross total resection with negative margins with adjuvant radiation therapy is associated with improved survival.
NCOG-10. LONG-TERM SURVIVAL ANALYSIS OF PLEOMORPHIC XANTHOASTROCYTOMA: INSIGHTS INTO PROGNOSTIC FACTORS AND TREATMENT STRATEGIES
Authors: Lee Chaejin , Byeon Yukyeng , Kim Gung-Ju , Jeon Juhee , Kim Young-Hoon , Hong Chang-Ki , Kim Jeong Hoon , Song Sang Woo 
Published: November 2023

Abstract

PURPOSE
Pleomorphic xanthoastrocytoma (PXA) is rare, accounting for less than 1% of astrocytomas. Despite its pleomorphic histologic features, PXA generally carries a favorable prognosis. Limited research exists regarding the clinical course and treatment outcomes of PXA. This study aimed to identify prognostic factors and evaluate treatment strategies in PXA.

METHODS
We retrospectively analyzed PXA patients who underwent surgical resection at our institution from 2000 to 2021. Demographic data, radiologic characteristics, and treatment outcomes were collected. Tumors were classified as grade 2 or grade 3 based on the 2021 World Health Organization criteria.

RESULTS
Among the included patients, 40 were diagnosed with grade 2 PXA, while 9 had grade 3 PXA. Five-year progression-free survival (PFS) rates were 75.8% for grade 2 and 37.0% for grade 3 (p = 0.003). Multivariate Cox regression analysis revealed that both grade (p = 0.044) and tumor infiltration (p = 0.008) significantly influenced PFS. Factors such as hydrocephalus (p = 0.005) and tumor infiltration (p = 0.017) were found to affect overall survival (OS). Subgroup analysis in grade 2 PXA showed significantly better OS and PFS when gross total resection (GTR) was performed during the initial surgery, as opposed to subtotal resection (STR). Adjuvant radiation therapy did not significantly alter the prognosis of grade 2 PXA.

CONCLUSIONS
Tumor infiltration was associated with improved PFS and OS in grade 2 and 3 PXA cases. GTR had a significant positive impact on PFS in the overall group, and both PFS and OS in grade 2 PXA. Adjuvant radiation therapy did not significantly alter the prognosis of grade 2 PXA.
NCOG-14. EFFECT OF CHOLINE ALPHOSCERATE ON THE SURVIVAL OF GLIOBLASTOMA PATIENTS
Authors: Kim Yeong Jin 
Published: November 2023

Abstract
Cognitive impairment often occurs in glioblastoma (GBM) patients due to the tumor itself and treatment side effects. Choline alphoscerate (L-alpha-glycerylphosphorylcholine, GPC) is frequently used to compensate for cognitive impairment in GBM patients. This study was conducted to determine whether GPC affects the overall survival (OS) and progression-free survival (PFS) of GBM patients. From 2011 to 2020, 187 isocitrate dehydrongenase (IDH)-wild-type GBM patients were analyzed. The patients were classified based on whether GPC was continuously used for at least 3 or 12 months (mos) after GBM diagnosis. Although GPC usage (≥3 mos) did not make significant differences in survival extension, median OS in the long-term GPC group (≥12 mos) was longer with statistical significance, compared to the control group (&lt; 12mos)(38.3 vs 24.0 mos, p=0.004). In addition to younger age, supratentorial location, complete resection, and MGMT promoter methylation, long-term use of GPC (≥12 mos) was significantly associated with longer OS in multivariate analysis (p = 0.019, hazard ratio [HR] 0.532, 95% confidence interval [CI] 0.314–0.900). Despite the limitations of this study, long-term GPC use was possibly associated with prolonged survival in GBM patients. Multi-center prospective randomized studies with a large number of patients are needed to validate these findings.
NCOG-16. VALIDATION OF EFFICACY OF CCRT FOLLOWED BY TEMOZOLOMIDE FOR NEWLY DIAGNOSED GBMS: 15-YEAR EXPERIENCE OF A SINGLE INSTITUTION
Authors: Ko Ka Hyen , Kang Ho , Hwang Kihwan , Choe Byung Se , Choe Gheeyoung , Kim Yu Jung , Kim Chag-Yong 
Published: November 2023

Abstract

PURPOSE
The authors have analyzed the long-term follow-up results of chemotherapy with temozolomide (TMZ) during and after radiotherapy in patients with newly diagnosed glioblastoma (GBM). This study self-validates the effect of a treatment protocol that has been applied at a single institute for more than 18 years.

MATERIALS AND METHODS
Total 229 patients of newly diagnosed GBM patients who were treated with TMZ during and after radiotherapy from 2004 to 2018 in the authors’ institute were enrolled and analyzed in this retrospective study. Primary outcome was overall survival (OS), and progression-free survival (PFS) was the second outcomes. Long term survivors (LTS) were also reviewed retrospectively. 2021 World Health organization (WHO) classification has been used for this study.

RESULTS
The median follow-up period was 16.4 months (range, 1.3-171.1). Younger age (&lt; 70 years old), higher KPS score (≥80 and ≥60), gross total resection (GTR), completion of the Stupp protocol, and salvage treatment in patients with the progressive disease showed significantly longer OS times than the other subgroups. Subgroup analysis has been gone through comparing LTS to non-LTS. non-GTR (42% vs. 67.6%, p &lt; 0.001), preop KPS ( &gt;60, 100% vs. 91.1%, p = 0.026) ( &gt;80, 94% vs. 81%, p = 0.027), MGMT promoter methylation (42% vs. 26.3%, p = 0.034) were statistically significant factors that differentiate LTS from non-LTS. In our study, salvage treatment was significantly associated with increased survival in patients with PD. More specifically, if standard treatment was aborted, salvage treatment improved overall survival

CONCLUSION
Concurrent chemoradiotherapy using TMZ might be still effective for newly diagnosed GBM. Completing the Stupp protocol in patients with newly diagnosed GBM and salvage treatment in patients with the progressive disease might help achieve better survival.