bluuebunny/crossref_metadata_2025_split huggingface dataset:
THREE FRACTION STEREOTACTIC RADIOTHERAPY (SRT) FOR VESTIBULAR SCHWANOMMA: THE WESSEX EXPERIENCE
Authors: Main Sean , Ching Jeng , Kaylan Jasdeep , Shanmugasundaram Ramkumar , Sinclair Georges , Clarke Enrico 
Published: September 2023

Abstract

AIMS
Retrospective review of SRT for vestibular schwannoma. University Hospital Southampton treat tumour vol umes max 2.5cm in diameter without brainstem compression with 21Gy/3#. This reviews the experience of local control and toxicity profile in our centre and the impact of limiting dmax.

METHOD
Retrospective analysis of patients treated for radiologically diagnosed vestibular schwannoma from 2019 to present. Patient notes, audiograms, imaging and radiotherapy planning system were reviewed for data collection. No patients were removed from analysis due to missing data.

RESULTS
36 patients have been treated with three fraction SRT. Median age 68 (47-83). PTV volume from 1.03cm3 to 5.52cm3 (median 2.37cm3). All patients have radiologically stable disease to date, with 14 patients (38.9%) having objective tumour response on imaging. 9 patients had serviceable hearing at baseline and 1 remained serviceable at follow up. 7 (19.4%) patients experienced treatment-related toxicity. 6 patients reported facial nerve toxicity in which 4 (66.7%) this was self-limiting with full recovery. 2 patients had persistent facial nerve symptoms (House-Brackmann score 2, and 3 respectively). Those with dmax &lt;26Gy (n=15) experienced this less with only 1 patient experiencing facial nerve toxicity (House-Brackmann score 2).

CONCLUSIONS
Three fraction SRT provides excellent local control with high levels of objective radiological response in tumours up to 4cm3, however, long term follow-up is required. This treatment has acceptable toxicity with most symptoms resolving spontaneously. Permanent facial nerve toxicity was seen in 2 (5.6%) of patients. By limiting dmax to &lt;26Gy the rate of facial nerve toxicity is reduced significantly.
CIRCULATING PROGNOSTIC BIOMARKERS IN MENINGIOMA: S100A4 AND FIBULIN-2
Authors: Kingdon Sarah , Sofela Agbolahan , Adams Claire , Hanemann Oliver 
Published: September 2023

Abstract

AIMS
We aim to identify circulating prognostic biomarkers that accurately identify high risk meningioma whilst reducing the burden of invasive diagnostics. In our proteomic analysis, S100A4 and Fibulin-2 are significantly over expressed in grade 2 tumours compared to grade 1. They are both calcium-binding proteins with S100A4 involved in mesenchymal transition while Fibulin-2 helps scaffold the extracellular matrix. Elevated levels correlate with aggressive phenotypes in multiple cancers.

METHOD
Anonymised pre-operative meningioma blood samples were obtained from ‘The Plymouth Brain Tumour Biobank’ and ‘UK Brain Archive Information Network (BRAIN-UK)’. In total, 155 samples were analysed via Enzyme-Linked Immunosorbent Assay (ELISA) for serum S100A4 and plasma Fibulin-2. The Area Under the Receiver Operating Characteristic (ROC) curve (AUC) was used to examine the specificity and sensitivity of both markers.

RESULTS
Circulating levels of S100A4 were significantly (*p&lt;0.05) higher in grade 2 meningiomas (mean 276.7 pg/mL (+/- 49.9 pg/mL) compared to grade 1 (mean 153.10 pg/mL +/- 20.68 pg/mL).
Serum S100A4 & plasma Fibulin-2 cut-off values of 344.8 pg/mL & 2500 pg/mL respectively have a 95% specificity for identifying patients with grade 2 tumours over grade 1.
To improve the diagnostic accuracy of grade 1 vs grade 2 samples, we combined S100A4 and Fibulin-2 concentrations to achieve an improved AUC of 0.682, *p&lt;0.05.

CONCLUSIONS
Serum S100A4 is significantly higher in grade 2 compared to grade 1 meningiomas (95% sensitivity; cut off 344.8 pg/mL). Combining S100A4 and the previously published Fibulin-2 improves the accuracy of predicting grade 2 meningiomas.
RADIOLOGICAL SURVEILLANCE AFTER RESECTION OF LOW GRADE DYSEMBRYOPLASTIC NEUROEPITHELIAL TUMOUR AND GANGLIOGLIOMA: HOW OFTEN AND FOR HOW LONG?
Authors: Marples Theodore , Wang Difei , Saumtally Tasneem , Kalyal Nida , Bodi Istvan , Hasegawa Harutomo , Selway Richard 
Published: September 2023

Abstract

AIMS
Prolonged follow-up with imaging has costs both financial and psychological. We sought to review clinical and radiological follow-up for operated dysembryoplastic neuroepithelial tumour (DNET) and ganglioglioma in our unit.

METHOD
Retrospective review of patients diagnosed with WHO grade 1 DNET or ganglioglioma identified from our histopathology database over the last 20 years.

RESULTS
44 patients were identified (DNET n=23, ganglioglioma n=21). Mean age at first surgery was 27.2 and 22.3 respectively. The median length of follow-up was 3.45 (0.84-13.9) years for DNET, and 5.03 (0.4-12.6) years for ganglioglioma. The majority of the patients had epilepsy (39/44, 88.6%) prior to surgery. Patients with DNET had 0.58 postoperative scans per year, whilst those with ganglioglioma had 1.17 scans per year. 11 (47.8%) DNET and 9 (42.9%) ganglioglioma patients had residual tumour after first surgery. None of the DNET patients had radiological change during follow-up. 9 (43%) patients with ganglioglioma had radiological change noted at least once during follow-up. 3 (13%) patients with DNET and 4 (19%) with ganglioglioma had further surgery for ongoing seizures due to residual tumour, but not for radiological progression.

CONCLUSIONS
Radiological change following tumour resection did not occur for DNET whereas it was more common for gangliogliomas. A reduction in postoperative imaging in our practice could be considered for operated low grade DNET and ganglioglioma, given that for all patients the indication for reoperation was seizures rather than tumour progression.
AUTOMATED VASARI FEATURE SET REPORTING FOR GLIOMAS IS EffCIENT AND EFFECTIVE
Authors: Lee Faith , Ruffle James , Mohinta Samia , Kopanitsa Valeria , Nachev Parashkev , Hyare Harpreet 
Published: September 2023

Abstract

AIMS
The quantitative evaluation of gliomas using the VASARI MRI feature sets aims to facilitate consistent radiological reporting of gliomas but rarely done in clinical practice due to user variability in addition to technical and time constraints. We questioned whether deep-learning driven systems for automated VASARI feature derivation might resolve these issues, with comparison to neuroradiologist ground truths.

METHOD
VASARI imaging features were derived for 125 gliomas, both manually and using the automated model. Tumour segmentation models were constructed using 1251 patients from RSNA-BRATS with nnU-Net, and a processing pipeline developed within Python. The following features were compared: tumour location (F1); side of lesion (F2); proportion enhancing (F5); proportion non-enhancing (nCET) (F6); multifocal (F9); proportion edema (F14); ependymal extension (F19) and deep white matter (WM) invasion (F21).

RESULTS
The out-of-sample Dice performance for the tumour segmentation model was 0.945. Automated VASARI feature sets could be derived at a rate of under 0.5 seconds per patient. There was high concordance between manual and automatic segmentation in determining side of lesion (F2, 91.2%), ependymal extension (F19, 86.4%), anatomical tumour location (F1, 77.6%), deep WM invasion (F21, 65.6%) and proportion of enhancing tumour (F5, 54.4%; r=0.377, p&lt;0.001). Automated segmentation overestimated proportions of edema (F14, 92.8%) and nCET (F6, 86.4%).

CONCLUSIONS
Automated VASARI feature set generation provides quick and accurate predictions however, proportions of oedema and non-contrast tumour were frequently over-estimated. Future empirical work will focus on optimization and further systematic evaluation of this automated pipeline for more accurate quantitative radiology reporting and corresponding clinical decision-making.
NON-ENHANCING/MINIMALLY ENHANCING GLIOMAS: CAN WE IDENTIFY LOW GRADE GLIOMAS?
Authors: Saady Yuta J , Mair Richard , Joannides Alexis , Santarius Thomas , Matys Tomasz , Price Stephen J 
Published: September 2023

Abstract

AIMS
Gliomas are traditionally separated into low-grade (LGG) and high-grade (HGG). As LGG are slower growing and with pressures on operating capacity, there is an argument that surgery for these patients can wait. Pre- operatively, contrast enhancement on imaging is usually taken as the method of differentiating grade, with the belief that the absence of enhancement indicates LGG. We therefore assessed patients with minimal/non- enhancing tumours and compared factors at diagnosis with final histological outcome.

METHOD
We identified a cohort of patients over a 19-month period with a first presentation to the neurosurgical oncology clinic with minimal/patchy/scattered foci of enhancement (ME) or no areas of contrast enhancement (NE) on imaging, collecting factors at diagnosis and histological outcome using electronic patient records.

RESULTS
Of 60 patients identified, 53.3% were HGG, 35.0% LGG and 11.7% non-glioma. In NE tumours HGG and LGG rates were equal (43.3%), whereas in ME tumours HGG comprised 63.3% versus 26.7% LGG. HGG patients were older on average than LGG (median age 53 years versus 33 years) and more prevalent in males (62.95%) compared to females (45.45%). HGG formed the majority of patients presenting with seizure only (60%), neurological deterioration only (50%) or ≥2 symptoms (57.6%), whereas LGG was higher in presentations with headache only (66.7%) or none of the symptoms (66.7%).

CONCLUSIONS
It is not possible to differentiate between ‘high-grade’ and ‘low-grade’ gliomas based on imaging findings alone. Age is clearly a differentiating factor, but symptoms do not appear to be. We are working to develop methods to better differentiate these tumours pre-operatively.
SURVIVAL OUTCOMES AFTER WHOLE BRAIN RADIOTHERAPY
Authors: Ho Andrew , Kazmi Farasat , Hendry Hannah , Gkogkou Pinelopi 
Published: September 2023

Abstract

AIMS
Cerebral metastases from extra-cranial primary cancer carries a poor prognosis. For patients in whom surgical resection or SRS are not suitable, local control rates are poor. There is considerable debate surrounding the value of whole brain radiotherapy in this patient cohort in terms of local control, survival and functional status. We aimed to measure survival in patients receiving whole brain radiotherapy at the Norfolk and Norwich University Hospital.

METHOD
All patients who completed a course of whole brain radiotherapy at our centre between April 2018 and December 2022 were retrospectively analysed. Patients who were receiving prophylactic cranial irradiation of small cell lung cancer were excluded. Baseline demographics, oncologist declared ECOG performance status at referral for treatment, radiotherapy dose and survival were recorded.

RESULTS
88 patients received WBRT during this period. The median follow-up interval was 85 days. 12 patients received 30 Gy in 10 fractions, 59 received 20 Gy in 5 fractions and 17 received 12 Gy in 2 fractions. The median overall survival following completion of radiotherapy was 85 days. At 6 weeks after radiotherapy, 23.9% of patients had died. Univariate analysis with Cox proportional hazards model did not demonstrate a significant hazard ratio for age (&lt;65 or ≥65), ECOG performance status or radiotherapy dose.

CONCLUSIONS
Survival following whole brain radiotherapy remains poor. In particular, almost a quarter of patients are not alive 6 weeks after treatment. This is particularly pertinent given the anticipated trajectory of acute toxicities from treatment.
ANTI-SEIZURE MEDICATION IN GLIOMA PATIENTS: GETTING IT RIGHT fiRST TIME
Authors: Brothwell Morag , Collins Jennifer , Dulley Louise 
Published: September 2023

Abstract

AIMS
Seizures affect between 60–90% patients with low grade glioma and between 40–60% patients with high grade glioma. There are no national guidelines for seizure management in glioma patients. This quality improvement project investigated the initiation of anti-seizure medication in glioma patients with new-onset seizures.

METHOD
A retrospective review was undertaken of new glioma patients’ electronic notes (2020-2022) seen in Oncology clinic at Colchester hospital.

RESULTS
Thirty-seven patients (twenty-five glioblastoma IDH-wt, two grade 3 astrocytoma IDH-mutant, one grade 2 astrocytoma IDH-mutant, three oligodendroglioma IDH-mutant, six radiological diagnoses of glioma) were included. Following neurosurgical discharge, twenty-three did not need anti-seizure medication, three had long standing anti-seizure medication which was not changed, one patient was advised to stop phenytoin medication after surgery, four patients were on levetiracetam 500mg twice daily and six patients were on levetiracetam 250mg twice daily, with no dose escalation plan in place. Three of these six patients were subsequently hospitalised with seizures, one of which interrupted chemoradiation. None of the four patients on 500mg BD were hospitalised with seizures.

CONCLUSIONS
This project highlights the need for local anti-seizure guidelines for new glioma patients, which should include consideration of personalised drug choice, dependent on seizure type and demographics. Patients should be escalated to the therapeutic levetiracetam dose to decrease the risk of morbidity from seizures. This supports the need for national guidelines on anti-seizure medication with neurology collaboration.
SHOULD CALCIUM SUPPLEMENTS BE PRESCRIBED PROPHYLACTICALLY FOR PATIENTS DIAGNOSED WITH A HIGH-GRADE GLIOMA (HGG) ON PROLONGED STEROID USE?
Authors: La Jessica , Hurwitz Victoria , Robinson Charlotte , Kostick Ellie , Suarez Aeron , Hedges Sarah , Harding Nicola , Fukuthi Renata , Brazil Lucy , Swampillai Angela , Al-Salihi Omar , Chia Kazumi , Manik Vishal , Bhangoo Ranjeev , Ashkan Keyoumars , Gullan Richard , Vergani Francesco , Lavrador Jose Pedro 
Published: September 2023

Abstract

AIMS
The case study review will evaluate whether patients on long term steroid would benefit from calcium supplements and if a protocol for a bone density scan should be in place in relation to how long patients have been on steroids for.
Duration of steroid use increases patients’ risk to steroid related toxicity when taken more than 3 weeks. These can include endocrine, skeletal and psychiatric side effects amongst many others. It is therefore important to assess how we can improve patients’ quality of life (QOL) with limited prognosis.

METHOD
In a single centre, patients diagnosed with a HGG will be reviewed if they were diagnosed with osteoporosis or spinal fractures between 2020- 2022, subsequent from prolonged steroid use.

RESULTS
All 7 patients identified had presented with severe lower back pain. 4 patients initially had bone density scans which prompted an MRI due to low minerals for patient age and osteoporosis, whilst the remaining 3 patients only had an MRI scan. All 7 patients had spinal fractures. The average dexamethasone use was 9 months unable to wean to stop.

CONCLUSIONS
Patients diagnosed with a HGG tumour sadly continue to have poor prognosis. For patients who have had limited debulking or biopsy only, this leaves them prone to require ongoing steroid use to help with side effects to improve QOL.
Though the figures are small, we can see patients who struggled to wean to stop dexamethasone since their intracranial surgery have had their QOL impacted due to steroid toxicities with no previous related comorbidities.
THE ROLE OF A GENOMICS CLINICAL NURSE SPECIALIST IN HELPING TO BUILD A PATHWAY FOR WHOLE GENOME SEQUENCING TO BE OFFERED TO NEURO-ONCOLOGY PATIENTS
Authors: Suarez Aeron , Hurwitz Victoria , La Jessica , Robinson Charlotte , Kostick Ellie , Hedges Sarah , Harding Nicola , Fukuthi Renata , Dias Ana , Alhaq Anwar , Clark Barnaby , Al-Sarraj Safa , Laxton Ross , Eggleton Kelly , Bhangoo Ranjeev , Ashkan Keyoumars , Gullan Richard , Vergani Francesco , Lavrador Jose Pedro , Bleil Cristina , Zebian Bassel , Brazil Lucy , Al-Salihi Omar , Swampillai Angela , Chia Kazumi , Manik Vishal 
Published: September 2023

Abstract

AIMS
Whole genome sequencing is currently being offered to paediatric, teenage and young adult neuro-oncology patients and this was being managed by a genomics practitioner who works cross-site. We found that some patients are being discharged from the hospital without 1 component of the test or the consent. Our aim is to create a solid pathway in which fresh tissue, blood sample and record of discussion are taken at a certain stage in their hospital admission.

METHOD
A poster was created to remind the theatre team that a fresh tumour tissue and EDTA blood sample are the required samples to proceed with whole genome sequencing. Consent training is being provided to all clinical nurse specialists who look after CNS tumours in order to secure the record of discussion at any point in their hospital appointment. After several shadowing and doing the consenting process with supervision, they are expected to be able to be independent in doing this.

RESULTS
The clinical nurse specialist team have consented 24 out of 37 paediatric, teenage and young adult neuro- oncology patients that were operated since July 2022. Almost all of them have had their bloods taken intra- operatively with some taken whilst still an in-patient.

CONCLUSIONS
Whole genome sequencing will soon be offered to all neuro-oncology patients and the entire team will need to be equipped in securing the record of discussion in order for this test to proceed and this will be led by the clinical nurse specialist team.
WHAT ROLE CAN A PERSONAL TRAINER PLAY IN IMPROVING QUALITY OF LIFE THROUGHOUT ONCOLOGY TREATMENT FOR PEOPLE WITH A BRAIN TUMOUR
Authors: Kostick Ellie , Hurwitz Victoria , La Jessica , Robinson Charlotte , Suarez Aeron , Hedges Sarah , Fukuthi Renata , Harding Nicola , Brazil Lucy , Swampillai Angela , Chia Kazumi , Manik Vishal , Africa Olivia , Clark Rebecca , Al-Salihi Omar 
Published: September 2023

Abstract

AIMS
Review of a single person case study to establish if a personal trainer (PT) could help build a personalised pro- gramme for people with brain tumours going through oncology treatment. The aim being to help manage resilience both physically and psychologically through treatment and improve quality of life.

METHOD
A young person who has completed radiotherapy and chemotherapy after surgical debulking of a brain tumour was contacted. He worked as a PT before diagnosis and continued throughout treatment. He gradually increased his exercise tolerance and tailored exercises to different days of the treatment cycle to match his needs. He managed his fatigue and gradually built his exercise tolerance up back to baseline and continue with treatment.

RESULTS
This patient created a ‘patient guide’ with suggested exercises from his unique perspective as a person who has been through treatment and as a PT.

CONCLUSIONS
This guide has not yet been trialled with the rest of the patient population. The hope is that this will be used to guide further research in this field and may lead to the implementation of a permeant PT member of staff to the oncology service. In his words ‘this is just an example of my journey and how I stumbled my way through the diffculty of a cancer diagnosis and subsequent treatment. If you can take something away and apply it to your own situation then that’s brilliant’, ‘each day is a testament to how well you’re doing’
A CASE ILLUSTRATION AND LITERATURE REVIEW OF THYROID CANCER METASTASIS TO THE PITUITARY FOSSA
Authors: Veljanoski Damjan , Sofela Agbolahan , Abdel-Fattah Abdel-Rahman , Shivane Aditya , Muquit Samiul 
Published: September 2023

Abstract

AIMS
To understand the clinico-radiological and histopathological features, treatment strategies and outcomes of patients with thyroid cancer metastasis to the pituitary fossa.

METHOD
A 71-year-old man presented with a few months’ history of headaches, blurred vision, diplopia and right sided ptosis.
MRI head revealed a 2.5cm pituitary fossa lesion distorting the optic chiasm with right sided cavernous sinus invasion. It also showed frontal, temporal and parieto-occipital lesions.
CT thorax, abdomen and pelvis found a retrosternal thyroid goitre.
An open biopsy of the occipital lobe lesion revealed a metastatic papillary adenocarcinoma from the thyroid gland. An ultrasound-guided fine needle aspiration of the goitre and abnormal level IV lymph nodes revealed Thy5. The patient subsequently underwent an endoscopic transsphenoidal resection of the pituitary tumour which was confirmed to be a carcinoma.
A date and language unrestricted literature search was performed across the MEDLINE, Embase (via Ovid) and Scopus databases using keywords relating metastasis, the pituitary & thyroid glands, and the brain. Citations reporting patients with thyroid metastasis to the pituitary fossa were included. A predetermined proforma was used to extract and store data from the included citations.

RESULTS
After de-duplication, 2,833 citations were screened for eligibility and 42 citations met the inclusion criteria.

CONCLUSIONS
We present a rare case illustration and literature review of patients with thyroid cancer metastasis to the pituitary fossa.
GLIOBLASTOMA: THE NEGLECTED CANCER IN THE TREATMENT REVOLUTION
Authors: Panks Christopher , Clemmow Richard 
Published: September 2023

Abstract

AIMS
A paper written from the perspective of people living with glioblastoma and their carers:
• Surveys the current treatment landscape in the UK
• Questions why standard of care has not significantly changed in two decades
• Argues for implementation of universal whole genome sequencing (WGS) for patients in line with a2018 government commitment that all patients in England with rare diseases should be offered WGS from2019
• Estimates how much WGS has been done

METHOD
OurBrainBank’s researcher gathered information from:
• Freedom of information requests
• Questions to health trusts and individual hospitals
• Interviews with patients and carers
• Interviews with clinicians, health administrators and researchers
• A literature review

RESULTS
The paper estimates that up to the end of 2022 fewer than 1% of glioblastoma patients in England diagnosed since January 2019, (the date originally suggested for implementation of the government commitment), have had WGS of their tumours. This figure rises to only 1.3% of GBM patients diagnosed since April 2021, the date when the WGS policy began to be rolled out.

CONCLUSIONS
The government’s 2018 commitment to the implementation of WGS as applied to glioblastoma patients in England has failed by almost 2 orders of magnitude.
The paper calls for this to be addressed through:
• Universal frozen tissue storage
• Universal genomic sequencing for all GBM patients where tissue is available
• Specific, reliable GBM information on NHS and other offcial websites
• Increased funding for translational research