bluuebunny/crossref_metadata_2025_split huggingface dataset:
CLRM-07 RANO 2.0: PROPOSAL FOR AN UPDATE TO THE RESPONSE ASSESSMENT IN NEURO-ONCOLOGY (RANO) CRITERIA FOR HIGH- AND LOW-GRADE GLIOMAS IN ADULTS
Authors: Wen Patrick , Van Den Bent Martin , Youssef Gilbert , Cloughesy Timothy , Ellingson Benjamin , Weller Michael , Galanis Evanthia , Barboriak Danial , DeGroot John , Gilbert Mark , Huang Raymond , Lassman Andrew , Mehta Minesh , Molinaro Annette , Preusser Mattias , Rahman Rifaquat , Shankar Lalitha , Stupp Roger , Sul Joohee , Villanueva-Meyer Javier , Wick Wolfgang , Macdonald David , Reardon David , Vogelbaum Michael , Chang Susan 
Published: August 2023

Abstract
The Response Assessment in Neuro-Oncology (RANO) criteria for high-grade gliomas (RANO-HGG) and low-grade gliomas (RANO-LGG) were developed to improve the reliability of response assessment in glioma trials. Over time some limitations of these criteria were identified, and uncertainty emerged regarding integrating features of the modified RANO (mRANO) or the immunotherapy RANO (iRANO) criteria. Informed by data from a cohort of glioblastoma patients and other evaluations of RANO criteria that allowed evaluation of features of the different criteria, we propose updates to the RANO criteria (RANO 2.0). Based on the 2021 WHO classification of gliomas, we recommend a standard set of criteria for both high and low-grade gliomas, to be used for all trials regardless of the treatment modalities being evaluated. In the newly diagnosed setting, the post-radiotherapy MRI, rather than the post-surgical MRI, will be used as the baseline for future comparison. Since the incidence of pseudoprogression is high in the 12 weeks following radiotherapy, continuation of treatment and confirmation of progression during this period with a repeat MRI, or histopathologic evidence of unequivocal recurrent tumor, is required to define tumor progression. However, confirmation scans are not mandatory after this period nor for recurrent tumors. For treatments with a high likelihood of pseudoprogression, mandatory confirmation of progression with a repeat MRI is an option. The primary measurement remains the maximum cross-sectional area of tumor (2-dimensional) but volumetric measurements are an option. For IDH-wildtype glioblastoma, the non-enhancing disease will no longer be evaluated. In IDH-mutated tumors with a significant non-enhancing component, clinical trials may require evaluating both the enhancing and non-enhancing tumor components for response assessment.
LMAP-05 BEVACIZUMAB AND GAMMA KNIFE RADIOSURGERY IN THE TREATMENT OF FIRST-RECURRENCE GLIOBLASTOMA
Authors: Zhang Jeff , Okai Bernard , Iovoli Austin , Goulenko Victor , Lim Jaims , Hess Ryan , Prasad Dheerendra , Fenstermaker Robert 
Published: August 2023

Abstract
Glioblastoma is the most common central nervous system malignancy in adults and remains a uniformly fatal disease despite two decades of developments in surgical management, radiation treatment, chemotherapy, and immunotherapy. There is currently no established standard of care for patients with recurrent glioblastoma following failure of initial Stupp protocol management. In this retrospective cohort study, we set out to determine if the use of bevacizumab and/or Gamma Knife radiosurgery in patients with recurrent disease could have an effect on prolonging progression-free survival (PFS) or overall survival (OS). Patients in the combined treatment group demonstrated longer post-recurrence mean PFS (9.1 ± 6.0 months) and OS (13.5 ± 8.6 months) compared to glioblastoma patients previously reported in the literature, and showed improvements in total OS (p=0.021), total PFS (p=0.057), post-recurrence PFS (p=0.034), and post-recurrence OS (p=0.017) compared to patients who received standalone bevacizumab or Gamma Knife treatment. This study demonstrates that the combined use of an antiangiogenic agent with stereotactic radiosurgery can have significant effects on improving patient survival in recurrent glioblastoma.
LMAP-08 MULTI-INSTITUTIONAL CLINICAL OUTCOMES FOLLOWING STEREOTACTIC RADIOSURGERY FOR BRAIN METASTASES FROM GYNECOLOGIC MALIGNANCIES
Authors: Huang Christina , Leng Jim , Qazi Jamiluddin , Carpenter David , Chino Junzo , Ayala-Peacock Diandra , Stephens Sarah , Natarajan Brahma , Arshad Muzamil , Schultz Olivia , Moravan Michael , Reitman Zachary , Kirkpatrick John , Floyd Scott , Chmura Steven , Hong Julian , Salama Joseph , Mullikin Trey 
Published: August 2023

Abstract
Brain metastases (BM) are rare in patients with gynecologic (GYN) malignancies. We identified and analyzed all patients who completed a course of stereotactic radiosurgery (SRS) between 1/2015 and 12/2020 across two institutions. Demographic and clinical parameters were collected. Intracranial progression (ICP) was defined as any concern on post-SRS imaging for recurrence determined by multidisciplinary consensus. Clinical parameter distributions were compared across GYN and non-GYN patients utilizing chi-squared tests and t-tests. Overall survival (OS) and freedom from intracranial progression (FFICP) were estimated via the Kaplan Meier method. From a cohort of 1383 patients who completed SRS for BMs, 2.4% (n=33) had a BM from a GYN malignancy. Subsites included endometrial (n=19), ovarian (n=11), vulvar (n=2), cervical (n=1). There was no difference in age between GYN and non-GYN patients (mean 67.1 years vs. 63.0 years, p=0.06). GYN patients with BMs compared to non-GYN patients were more likely to have resection of BMs (48.5% vs. 25.6%, p=0.003), larger planned target volumes of all BMs (mean 23.6cc vs mean 15.2cc, p=0.02), and pre-SRS chemotherapy (72.7% vs. 49.6%, p=0.009). GYN patients were less likely to have whole brain radiation therapy prior to SRS (0 vs. 10.5%, p=0.049). GYN patients had worse OS compared to non-GYN patients (median 6.6 months (95% CI 3.3-12.4) vs. 10.0 months (95% CI 9.1-11.2), (HR 1.62 (95% CI 1.11-2.36), p=0.011)). Median FFICP for GYN patients was 9.5 months (95% CI 4.0-not reached) and for non-GYN patients was 8.7 months (95% CI 7.7-9.5). There was no difference in FFICP for GYN patients compared to non-GYN patients (HR 0.84 (95% CI 0.5-1.5), p=0.55). When comparing patients with BMs from endometrial cancer versus ovarian cancer, there was no difference in OS (p=0.13) or FFICP (p=0.58). These data may help guide treatment decisions and post-therapy surveillance in patients with BMs of GYN origin.
LMAP-10 RE-IRRADIATION FOR RECURRENT ADULT DIFFUSE GLIOMA
Authors: Zhou Jiangfen , Lai Mingyao , Cai Linbo 
Published: August 2023

Abstract

OBJECTIVE
To investigate the efficacy of re-irradiation and prognosticators for recurrent adult diffuse glioma diagnosed per 2022 WHO diagnostic criteria for central nervous system tumors.

METHODS
Patients older than 18 years with recurrent diffuse glioma confirmed by functional imaging or secondary surgical histopathology in Guangdong Sanjiu Brain Hospital from January 1, 2016, to December 31, 2022, were retrospectively analyzed. All patients were re-diagnosed per the 2022 WHO classification of central nervous system gliomas. All patients received re-radiotherapy after tumor recurrence, including conventional fractionation, hypofractionation, and stereotactic radiosurgery.

RESULTS
A total of 61 patients were included in this analysis, male to female ratio was 34:27, median age of 45 (ranging from 18-64) years. There were 35 cases of grade IV glioblastoma, 5 cases of grade IV astrocytoma, 3 cases of grade III astrocytoma, 13 cases of grade II astrocytoma, 3 cases of grade III oligodendroglioma, and 2 cases of grade II oligodendroglioma. Twenty-four patients (39.3%) underwent re-operative surgery after recurrence. Forty-one patients (67.2%) received concurrent re-irradiation and chemotherapy, and 26 (42.6%) received concurrent bevacizumab. The median interval from the first to the second radiotherapy was 19 months. The median overall survival (OS) of 61 patients was 47 months, and the median OS following re-irradiation was 13 months. Univariate analysis showed that WHO grading (p = 0.007), IDH status (p = 0.026), reoperation after recurrence (p = 0.019), re-irradiation with or without concurrent chemotherapy (p = 0.026), maintenance chemotherapy (p = 0.038), and antiangiogenic therapy (p = 0.011) were the significant prognosticators.

CONCLUSIONS
Re-radiotherapy is feasible and safe for recurrent adult diffuse glioma. Re-irradiation subsequent to the re-operative surgery after recurrence combined with other therapies are favorable prognosticators. Patients with IDH mutation could benefit more from re-irradiation after recurrence.
LMAP-20 EVIDENCE-BASED MULTIVARIATE NORMAL TISSUE COMPLICATION PROBABILITY (NTCP) STUDY OF DOMAIN-SPECIFIC COGNITIVE DECLINE AFTER PARTIAL BRAIN RT
Authors: Hopper Austin , Connor Michael , Salans Mia , Unnikrishnan Soumya , Huynh-Le Minh-Phuong , Tibbs Michelle , Qian Alex , Reyes Anny , Stasenko Alena , McDonald Carrie , Moiseenko Vitali , Hattangadi-Gluth Jona 
Published: August 2023

Abstract
Beyond the hippocampus, there are no evidence-based dose constraints for eloquent structures which subserve memory and attention/processing speed. We performed a multivariate normal tissue complication probability analysis of post-RT neurocognitive decline, examining dosimetric predictors of eloquent brain regions in a prospective longitudinal clinical trial. 78 patients with primary brain tumors receiving fractionated RT completed a comprehensive neurocognitive evaluation and high-resolution volumetric and diffusion MRI at baseline and 6 months post-RT. Image processing using validated automated segmentation parcellated individual white matter (WM) tracts, cortical regions, and hippocampi. Neurocognitive test performance was scored using reliable change indices adjusted for practice effects: negative scores indicate decline. Univariate logistic regression and multivariate model building were performed. On univariate analysis mean and max dose to multiple regions of the corpus callosum (CC) correlated with attention/processing speed decline including Dmax to anterior CC (p=0.011) and central CC (p=0.010), and Dmax/Dmean to mid-anterior CC (p=0.006 and 0.010). Dmean to left fornix was associated with memory decline (p=0.023), as were increasing age and chemotherapy. On multivariate analysis for attention, automated bootstrapped logistic regression showed the most frequently selected variable was Dmean to mid-anterior CC. Performance at nested cross-validation by AUC was 0.80 (0.75-0.84); LASSO model performance by AUC was 0.76 (0.72-0.81) with Dmean to the mid-anterior CC being the most frequent variable. The top five most important variables in Random Forest were Dmean to mid-anterior CC, all WM, combined CC and Dmax to CC and posterior CC. Model performance by AUC was 0.66 (0.60-0.71). We present the first, to our knowledge, multivariate NTCP model for decline in attention/processing speed, and dosimetric predictors of memory decline beyond the hippocampus. Dose to several eloquent ROIs significantly correlated with post-RT impairment. These data can guide future cognitive-sparing strategies for brain RT.
LMAP-22 STEREOTACTIC RADIOSURGERY FOR PATIENTS WITH BRAIN METASTASES FROM GASTROESOPHAGEAL PRIMARY CANCERS
Authors: Taori Suchet , Wei Zhishuo , Deng Hansen , Lunsford L Dade , Niranjan Ajay 
Published: August 2023

Abstract

BACKGROUND
Patients with brain metastases from gastroesophageal primary cancers have poor prognoses, and current management remains unclear. The authors present the largest single-institution experience of utilizing stereotactic radiosurgery (SRS) to treat patients with brain metastases from primary gastroesophageal cancers.

METHODS
A retrospective review of 71 patients (64 male, 90.14%) treated with Gamma Knife SRS from 2000 to 2022 for gastroesophageal primary cancers was conducted. Overall, 243 brain metastases were treated, and the median number of metastases per patient was 2 (range:1-21). The primary sites were esophagus (59 patients, 83.10%), gastric (7 patients, 9.86%), and gastroesophageal junction (5 patients, 7.04%). The median age at SRS was 66 years (range: 26-85), and the median KPS was 80 (range: 50-100). The median cumulative tumor volume was 6.7 cc (range: 0.27-104.76), and the median margin dose was 18 Gy (range: 11-20).

RESULTS
The median overall survival after SRS was 7 months (range: 1-64). At the last follow-up, 54 (76.06%) patients were deceased, and 8 (14.81%) patients died due to intracranial metastases. Four patients (5.63%) experienced local tumor progression at a median time of 8 months (range: 2-13) after SRS. On univariate analysis, &gt; 2 brain metastases at SRS presentation (p=0.02, HR: 10.76, 95% CI: 1.48-78.40) was found to be the only significant predictor of local tumor progression. Ten patients (14.08%) experienced new tumor development at a median time of 4 months (range: 0-14) after SRS. On multivariate analysis, both the absence of concurrent systemic therapy (p=0.01, HR: 6.58, 95% CI: 1.55-27.0) and ≤ 2 tumors at SRS presentation (p&lt;0.01, HR: 1.21, CI: 1.08-1.36) were found to be significant predictors of distant tumor control. The incidence of transient adverse radiation effects was 8.45%.

CONCLUSIONS
SRS can safely and effectively be used to treat primary gastroesophageal cancer brain metastases while allowing patients to focus on primary disease management.
NEIM-07 HARNESSING END-TO-END CLOUD-BASED WORKFLOWS AND MULTI-MODAL DATA ANALYTICS IN PEDIATRIC BRAIN TUMOR IMAGING AT THE CHILDREN’S BRAIN TUMOR NETWORK (CBTN)
Authors: Nabavizadeh Ali , Familiar Ariana , Kazerooni Anahita Fathi , Viswanathan Karthik , Kim Meen Chul , Lubneuski Alex , Heath Allison P , Vossough Arastoo , Storm Philip B , Resnick Adam C 
Published: August 2023

Abstract
Neuroimaging is an essential component of the standard of care in pediatric brain tumor patients. Developing efficient and agile workflows for image processing and integration of imaging with other data types to perform predictive analytics is an increasing need. At CBTN, we developed user-friendly workflows to support the entire imaging data lifecycle and to bridge access to multi-modal datasets with scalable analytics, to empower researchers to make breakthrough discoveries that will advance patient care. An automated deep learning-based brain extraction and tumor subregion segmentation model based on a multi-institutional dataset was developed that can reliably segment the treatment-naïve MRI scans of children across a variety of brain tumor histologies. This model was subsequently integrated into an end-to-end imaging pipeline for collecting, managing and analyzing clinically acquired radiology exams of the CBTN consortium with processing of 19,975 exams (1,443 subjects) to date. Critically, the constituent software tools enable the preparation of images for downstream AI analytics, from acquisition to feature extraction. A public website was also created to allow users to search and explore the dataset based on sequence labels, and clinical and imaging attributes. In addition, we established a scalable workflow and processes for de-identification, ingestion, quality control, and management of digital pathology slides for CBTN (over 8,000 slides to date). Finally, we evaluated the feasibility of interoperability between imaging (Flywheel) and molecular (CAVATICA) platforms deployed in cloud ecosystems which can allow streamlined, user-friendly workflows to ingest and harmonize files, perform cohort selection, prepare data using standard processing packages and cloud resources, and conduct analysis on extracted multi-modal feature sets. The described workflow lays the foundation for the broad use of imaging studies and access to multi-modal datasets and analytics, with the goal of empowering researchers to make breakthroughs in patient care.
NEIM-12 PRE- AND POST-TREATMENT RADIOLOGIC FEATURES AND VOLUMETRIC CHANGES LINKED TO TREATMENT RESPONSE OF BRAIN METASTASES AFTER LASER INTERSTITIAL THERMAL THERAPY (LITT)
Authors: Sanvito Francesco , Telesca Donatello , Cho Nicholas S , Sayari Jessica T , Nagaraj Raksha , Raymond Catalina , Rana Shivam , Patel Kunal , Mozaffari Khashayar , Uterberger Ansley A , Khanlou Negar , Magaki Shino , Pouratian Nader , Everson Richard G , Yang Isaac , Kim Won , Ellingson Benjamin M 
Published: August 2023

Abstract

OBJECTIVE
To identify pre-treatment imaging features of brain metastases (BM) associated with lesion-specific progression free survival (PFS-L) after laser interstitial thermal therapy (LITT) and to report longitudinal volumetric changes following the treatment.

METHODS
Forty-seven BM treated with LITT were retrospectively examined. BM were followed until clinical progression, radiologic progression according to the modified RANO criteria, or censoring. The association between imaging features and PFS-L was assessed with survival analyses. Post-LITT volume shrinkage over time was fit to an exponential decay model.

RESULTS
Thirteen BM progressed after LITT (median time to progression 3.9 months), seventeen met radiologic criteria for response after LITT (median time to response 12.1 months), and seventeen were stable at time of censoring. Median follow-up duration for censored BM was 18.5 months. The probability of PFS-L at six months (PFS6) was 70.6% for the whole cohort. Pre-LITT enhancing volume &lt;2.5 cc (p=0.0004) and sphericity ≥0.705 (p=0.0026) predicted longer PFS-L (PFS6=86.8%), and BM meeting both cutoffs showed a cumulative benefit (p&lt;0.0001, PFS6=100%). Pre-LITT diffusion imaging did not predict PFS-L, while a subset of lesions (n=7) with highly perfused hotspots had worse PFS-L (p=0.0012). Immediate post-LITT volume was increased compared to pre-LITT (p&lt;0.0001, median increase 80.3%). The percentage of volume increase was not a predictor of PFS-L (p=0.56). In fifteen responding BM (88.2%), the post-LITT volumetric shrinkage over time was described by an exponential decay (R2 ranging 0.92-1.0), and the kinetics of shrinkage was heterogeneous (half-life ranging 0.3-5.4 months).

CONCLUSIONS
Pre-treatment small size and high sphericity are ideal baseline features for BM considered for LITT treatment and could aid patient selection. Modeling longitudinal volumetric changes of BM responding to LITT is a potential approach to identify BM at risk for progression which deviate from a typical shrinkage pattern.
NEIM-14 PET/MRI DETECTS A RAPID DECREASE IN CEREBRAL BLOOD FLOW IN GLIOBLASTOMA FOLLOWING BEVACIZUMAB INFUSION
Authors: Thaw-Poon Serena , Zaharchuk Greg , Spielman Daniel , Recht Lawrence , Corbin Zachary 
Published: August 2023

Abstract

BACKGROUND
The impacts of bevacizumab on the vasculature and metabolism of glioblastoma have been understudied. Previous work has shown that perfusion measurements of lesions decrease weeks after infusion. Metabolic consequences, either direct or as sequelae of vascular changes, have also been proposed. The timing of both processes in humans, however, is unclear. We aimed to study changes to the vasculature and metabolism of glioblastoma after the administration of bevacizumab.

METHODS
Patients (n = 8) diagnosed with recurrent glioblastoma requiring bevacizumab were enrolled. Baseline scans were acquired with a GE Healthcare SIGNA PET/MRI scanner. Following the first infusion of bevacizumab (7.5 mg/kg), repeat scans were obtained within two days and two weeks. All scans were co-registered and analyzed using 3D Slicer. Cerebral blood flow (CBF) and standard uptake value (SUV) measures were normalized by taking the ratio of the mean tumor and contralateral region values, and the ratios at different time points were compared using Wilcoxon signed-rank tests.

RESULTS
A statistically significant decrease in tumor CBF was detected within two days of infusion (0.88 ± 0.36 vs. 0.79 ± 0.29, p = 0.01), but no significant decrease in SUV was detected within the same timeframe (0.89 ± 0.36 vs. 0.88 ± 0.39, p = 0.26). No statistically significant drop was detected at two weeks in our sample.

CONCLUSIONS
Our results provide evidence that bevacizumab decreases glioblastoma blood flow within two days of the infusion. The measure of tumor metabolism also trended downward, though not significantly. Taken together, these data support a model by which bevacizumab rapidly affects VEGF-mediated vascular changes within the tumor, withpotential effects on tumor metabolism over a longer timeframe. These findings enrich our understanding of the impacts on glioblastoma of bevacizumab, which has a continued high clinical utility that is underscored by its ubiquity in the neuro-oncology clinic.
SDPS-05 ASSESSING SURVIVAL OUTCOMES AND COMPLICATION PROFILES FOLLOWING SURGICAL EXCISION OF SKULL BASE CHORDOMA: A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Brown Nolan , Kuo Cathleen , Gendreau Julian 
Published: August 2023

Abstract
Despite their precarious behavioral classification (histopathologically benign (low-grade), behaviorally malignant), great strides have been taken to improve prognostication and treatment paradigms for patients with skull base chordoma. However, due to the rarity of this tumor, prior investigations remain limited to small retrospective series. Accordingly, we performed a systematic review and meta-analysis in order to profile surgical and survival outcomes for skull base chordoma. Fixed and random-effect meta-analyses were performed for categorial variables including number of males, GTR, STR, 5-year OS, 10-year OS, 5-year PFS, and 10-year PFS. Following the systematic search and screen, 47 studies published between 1993-2020 reporting data for 2204 patients remained eligible for analysis. Sex distribution was comparable between males and females, with a slight predominance of male-identifying patients (0.5625 [0.5418;0.3909]). Average age at diagnosis was 42.4 ± 12.5 years, while average age of treatment initiation was 43.0 ± 10.6 years. Overall, there was a substantial degree of heterogeneity across the 47 studies (I^2=56.3% [44.0%; 65.9%]). With respect to operative margins, the rate of GTR was 0.3323 [0.2824; 0.3909], I^2 = 91.9% [90.2%; 93.4%], while the rate of STR was significantly higher at 0.5167 [0.4596; 0.5808], I^2 = 93.1% [91.6%; 94.4%]. Interestingly, 5-year OS rate was 0.7113 [0.6685; 0.7568], I^2 = 91.9% [90.0%; 93.5%]. Furthermore, 10-year OS rate was 0.4957 [0.4230; 0.5809], I^2 = 92.3% [89.2%; 94.4%], which was comparable to both 5-year PFS rate of 0.5054 [0.4394; 0.5813], I^2 = 84.2% [77.6%; 88.8%] and 10-yr PFS rate of 0.4949 [0.4075; 0.6010], I^2 = 14.9% [0.0%; 87.0%]. There were 55 reported deaths for a perioperative mortality rate of 2.5%. The most common complication was CSF leak(5.4%). Overall, these results indicate good 5-year outcomes; however, 10-year prognosis for skull base chordoma remains poor due to its radiotherapeutic resistance and high recurrence rate.