bluuebunny/crossref_metadata_2025_split huggingface dataset:
SURG-01. DEVELOPMENT OF MURINE MODEL OF LASER INTERSTITIAL THERMOTHERAPY (LITT) FOR BRAIN TUMORS
Authors: Frain Matthew , Ebrahim Ghaidaa , Tomdio Macaulay , Mendez-Gomez Hector , Thomas Nagheme , Karachi Aida , Dastmalchi Farhad , Flores Catherine , Mitchell Duane , Bova Frank , Rahman Maryam 
Published: November 2022

Abstract
The objective of this study was to develop and test a murine system for delivery of laser interstitial thermotherapy (LITT). A system was built that allows for stereotactic placement of the laser into a mouse brain and real-time thermometry with a custom-made thermometer holder. Tissue heating curves for Laserglow Technologies 1064nm laser experiments testing tissue heating were performed by placing the laser in tissue and temperature monitoring via thermal probe. The laser was adapted for use with a stereotactic frame utilizing a system with a Hamilton syringe and a holder for consistent and precise placement of the thermal probe. The murine experiments were performed with C57BL/6 mice and samples were analyzed with H&E staining. First, ideal laser output was established using chicken breast. Laser dial setting of 4.38 successfully achieved slow tissue heating while a setting of 4.43 and 4.50 accomplished it rapidly, reaching a thermal ablative temperature of 43C in three and a half minutes. Next, a system for laser placement into the murine brain using the stereotactic frame was built revealing that the thermometer probe would require a separate system for consistent and precise measurements of heating. A thermometer probe holder was designed and fashioned via trigonometric calculations that allowed for thermal monitoring within 3mm spacing during laser ablation. Mice were anesthetized and treated with laser ablation at laser output of 4.38 and 4.43. H&E staining of the brain tissue demonstrated clear evidence of localized ablation identifiable by visible lesions on the H&E slides. The successful development of the stereotactic system for acquisition of tissue heating data coupled with evidence of successful live brain tissue ablation in a murine model via LITT proves that our protocol is ready for research of therapeutic combinatorial effects on live tumor bearing mice.
SURG-03. SURGICAL MANAGEMENT OF BRAIN METASTASIS FROM OVARIAN CANCER: A SYSTEMATIC REVIEW AND CASE SERIES
Authors: Costello Meredith , Bashti Malek , Merenzon Martin , Morell Alexis , Patel Nitesh , Higgins Dominique , Kader Michael , Shah Ashish , Eichberg Daniel , Luther Evan , Komotar Ricardo , Ivan Michael 
Published: November 2022

Abstract

INTRODUCTION
Ovarian cancer is a rare cause of brain metastasis requiring neurosurgical intervention. Management strategies vary and prognostic factors are not well known.

OBJECTIVE
We aim to systematically review the literature on management and outcomes of ovarian cancer brain metastasis and compare it with our experience.

METHODS
Systematic review was performed using PRISMA guidelines. Databases were sourced from inception to April 2022. Study selection was based on predetermined inclusion/exclusion criteria. A simultaneous retrospective analysis was performed on patients from our institution who underwent evaluation and treatment for metastatic intracranial lesions of ovarian origin.

RESULTS
Literature search generated 214 articles. Twelve were ultimately selected, representing 428 brain metastasis (BM) patients from ovarian cancer. Patients age from 27-80 years. The interval from cancer diagnosis to BM ranged from 0 – 226.2 months. Surgical resection (SR), stereotactic radiosurgery (SRS), and whole-brain radiotherapy were the most frequently used treatment modalities. Individual patients’ overall survival following BM diagnosis ranged from 0 – 173 months. For our institutional analysis, 9 patients were included with median age of 56 years. Median interval from diagnosis to BM was 51 months. Four patients were treated with SR and adjuvant SRS. Two patients had SR and SRS with additional extraventricular drain placement. Two patients had SR only, and one received only SRS. Median radiation dose received was 20 Gy. For those who experienced progression, median progression-free survival was 14 months. One patient exhibited no progression at the time of analysis. Three patients were alive at the time of analysis with two others lost to follow-up.

CONCLUSION
brain metastases following ovarian cancer are a rare outcome carrying a poor prognosis. Multimodal therapies, specifically SR and SRS, correlate with increased survival. Further study is needed to better guide optimal management, with particular attention to the benefits of resection with targeted adjuvant radiation.
SURG-04. CDK2NA/B, SMAD4, AND PIK3R1 MUTATIONS ARE ASSOCIATED WITH INCREASED RISK OF LOCAL RECURRENCE AFTER SURGICAL RESECTION OF BRAIN METASTASES
Authors: Morshed Ramin A , Cummins Daniel , Nguyen Minh , Young Jacob S , Theodospoulos Philip , Hervey-Jumper Shawn L , Aghi Manish , Daras Mariza 
Published: November 2022

Abstract

BACKGROUND
While resection of brain metastases (BMs) offers favorable local disease control, factors and genetic alterations associated with local recurrence are not well defined. This study examined patient, tumor, treatment, and genetic factors associated with local recurrence.

METHODS
A retrospective, single-center study was conducted with patients who underwent resection of a BM with available clinical outcome and genetic data available. Local recurrence was the primary outcome of the study. Next-generation sequencing of coding regions in over 500 cancer genes was performed to detect mutations. Cox proportional hazards analysis was performed to identify patient, tumor, treatment, and genetic factors associated with local recurrence.

RESULTS
We identified 91 patients who underwent surgical resection of a BM with available data, of which 80 (87.1%) underwent preoperative radiotherapy or received some form of adjuvant radiation to the resection cavity. Primary pathologies in the cohort included non-small cell lung cancer (24.2%), melanoma (24.2%), breast cancer (16.5%), gastrointestinal cancers (13.2%), gynecologic cancers (4.4%), renal cell carcinoma (4.4%), and other cancers (13.2%). Eleven patients (12.1%) developed postoperative recurrence at the surgical site with 6- and 12-month PFS of 91.2% and 84.2%. Multivariate Cox proportional hazard analysis identified cancer type (Gyn and RCC vs Others: OR 39.4, p=0.002), CDK2NA/B co-deletion (OR 37.52, p=0.0009), PIK3R1 mutation (OR 56.88, p=0.003), and SMAD4 mutation (OR 134.8, p=0.0007) to be associated with time to local recurrence. Overall survival and length of follow-up were not different based on mutational status of these genes, demonstrating that results were not due to survival bias.

CONCLUSIONS
Genetic alterations within BMs impact clinical outcomes after surgical resection. Further work is needed to determine if targeted therapies for BMs with these alterations can decrease rates of local recurrence.
SURG-05. SUPERVISED MACHINE LEARNING IDENTIFIES RISK FACTORS ASSOCIATED WITH LEPTOMENINGEAL DISEASE AFTER SURGICAL RESECTION OF BRAIN METASTASES
Authors: Morshed Ramin A , Saggi Satvir , Cummins Daniel , Young Jacob S , Viner Jennifer , Villanueva-Meyer Javier , Goldschmidt Ezequiel , Boreta Lauren , Braunstein Steve , Chang Edward , McDermott Michael , Berger Mitchel S , Theodospoulos Philip , Hervey-Jumper Shawn L , Aghi Manish , Daras Mariza 
Published: November 2022

Abstract

INTRODUCTION
Predictors of postoperative leptomeningeal disease (LMD) after resection of brain metastases (BMs) are not well defined.

OBJECTIVE
This study examined rates and predictors of LMD, including subtypes, in patients who underwent resection of a BM followed by postoperative radiation.Method: A retrospective, single-center study was conducted examining overall LMD, classical LMD (cLMD), and nodular LMD (nLMD) risk. Logistic regression and a Cox proportional hazards analyses were performed to identify risk factors associated with LMD. Random forest models were constructed to predict LMD and differentiate cLMD versus nLMD. Accuracy and the area under the receiver operating characteristic curve (AUROC) were calculated to evaluate the models.Result: Of the 217 patients in the cohort, 47 (21.7%) developed postoperative LMD with 19(8.8%) cLMD cases and 28(12.9%) nLMD cases . Six-, 12-, and 24-month LMD-free survival rates were 92.3%, 85.6%, and 71.4%, respectively. Patients with cLMD had worse survival outcomes from LMD diagnosis compared to nLMD (2.4 vs 6.9 mo, Log-rank p=0.02), and treatment of LMD was associated with improved survival for both cLMD and nLMD subtypes. Multivariate Cox hazard analysis identified cerebellar/insular/occipital location (HR 3.25, 95% CI 1.73-6.11, p=0.0003), absence of extracranial disease (HR 2.49, 95% CI 1.27-4.88, p=0.008), and ventricle contact (HR 2.82, 95% CI 1.5-5.3, p=0.001) to be associated with postoperative LMD. A predictive model using random forest analysis with an AUROC of 0.87 in a test cohort identified tumor location, systemic disease status, and tumor volume as the most important factors associated with LMD. Both regression analysis and random forest analysis identified postoperative systemic therapy exposure as the main factor differentiating cLMD from nLMD development.

CONCLUSION
Tumor location, absence of extracranial disease at the time of surgery, contact with a ventricle, and increased tumor volume are associated with LMD. Classical LMD is associated with worse prognosis compared to nLMD.
SURG-07. SURGICALLY TREATED BRAIN METASTASES FROM UTERINE ORIGIN: A CASE SERIES AND SYSTEMATIC REVIEW
Authors: Eatz Tiffany , Levy Adam , Bystrom Laure , Morell Alexis , Merenzon Martin , Higgins Dominique , Eichberg Daniel , Kader Michael , Guyot Manuela , Schlumbrecht Matthew , Patel Nitesh , Shah Ashish , Silva Michael , Komotar Ricardo , Ivan Michael 
Published: November 2022

Abstract

INTRODUCTION
Brain metastases from uterine origin have an incidence of 0.7-1.1%. Due to their rarity, there exists scarce literature entailing their neurosurgical treatment and outcomes.

OBJECTIVE
To report case management and outcomes of nine patients with brain metastases from uterine origin, as well as a systematic literature review findings focused on their neurosurgical treatment and outcomes.

METHODS
This study was divided into two parts: (1) a retrospective, single-center patient series assessing neurosurgical outcomes in patients with primary uterine cancer with brain metastases and (2) a systematic review of the literature between 1980 and 2021 assessing outcomes of patients with primary uterine cancer metastasized to the brain.

RESULTS
We report a case series at our single institution consisting of nine patients identified to have metastases to the brain from uterine origin that were treated with neurosurgical intervention. A total of 26 CNS lesions were identified among the 9 cases, with a mean number of lesions of 2.9 (1-7). The median age at the time of primary uterine cancer diagnosis was 49 years (26-80 years), with a median time from diagnosis to CNS metastasis of 19.5 months (3-54 months). The most common cerebral regions affected were the frontal lobe (42.3%) and the cerebellum (23%). Median progression free survival (PFS) and overall survival (OS) following intervention were 6.5 and 17.4 months, respectively. Stereotactic radiosurgery (SRS) alone resulted in the highest PFS and OS of 20.3 and 39 months, respectively. Sixteen studies were included in the systematic analysis. The mean OS was 13.3 months (3-41.1 months).

CONCLUSION
Brain metastases from uterine origin seem to most frequently result in multiple symptomatic lesions with additional concurrent metastasis to other organs. The most effective treatment modality appeared to be SRS alone. There is limited data on sole SRS treatment, so additional research regarding this modality is encouraged.
SURG-08. COMBINED LOCAL TREATMENT OF BRAIN METASTASES: SURGERY AND POSTOPERATIVE STEREOTACTIC RADIOTHERAPY
Authors: Fadrus Pavel , Vybihal Vaclav , Juran Vilem , Roskova Ivana , Sprlakova-Pukova Andrea , Koprivova Tereza , Kerkovsky Milos , Lakomy Radek , Kazda Tomas , Hynkova Ludmila , Belanova Renata , Vecera Marek , Hermanova Marketa , Jancalek Radim , Sana Jiri , Slaby Ondrej , Slampa Pavel , Smrcka Martin 
Published: November 2022

Abstract

INTRODUCTION
Modern comprehensive local treatment of BM provides the possibility of adequate local control while maintaining a satisfactory quality of life.

METHODS
Patients after metastasectomy and postoperative radiotherapy treated between 2007-2020 were evaluated. Local control was assessed separately at the site of the operated MM (localPFS) and separately in other parts of the brain (distalPFS).

RESULTS
A total of 118 patients were enrolled (70 with WBRT), 54% were women, the median age was 60 years, the median performance status Karnofsky 80%. The most common primary tumor was lung carcinoma (39/118, 33%). Targeted stereotactic radiotherapy was significantly more often indicated in operations performed after 2016 (p &lt; 0.001). In the period 2013-2019, gross total resection was achieved significantly more often (83 vs 64%; p = 0.061). The median follow-up is 49 months. The median overall survival (OS) is 9 months (6.2 - 12), the median localPFS 22 months (14 - unattainable), median distPFS 11 months (6.8 - 27 months), median extracranialPFS 11 months (5.9 - 15). Stratification of patients according to the prognostic index brainmetgpa.com led to significant separation of patients for OS (p = 0.00017). In a multivariate analysis, stereotactic radiotherapy was statistically significant positive prognostic factor for OS compared to WBRT (median OS 17 vs. 5.6 months, HR 0.59, p = 0.018) with no effect on localPFS.

CONCLUSION
Our results of comprehensive local treatment of BM are comparable with the results presented by important foreign studies from prestigious oncology centers. We described targeted stereotactic postoperative radiotherapy as an independent positive prognostic factor after brain metastasectomy. The study was supported by the programme project of the Ministry of Health of the Czech Republic with reg. no. NV18-03-00398, NV19-03-00501 and NV19-03-00559 and Supported by Ministry of Health, Czech Republic-conceptual development of research organization (FNBr, 65269705).
SURG-09. EFFICACY OF A BIWEEKLY 3-STAGE STEREOTACTIC RADIOSURGERY FOR LARGE BRAIN METASTASES: THE EFFECT OF EGFR TYROSINE-KINASE INHIBITOR ON TUMOR RESPONSE AND CLINICAL OUTCOMES
Authors: Kwon Ji-Eyon , Park Hyun Joo , Ji So Young , Han Jung Ho , Hong Yong-Kil , Kim Chae-Yong 
Published: November 2022

Abstract
Stereotactic radiosurgery(SRS) is one of primary treatment modalities for brain metastases(BM), however local control and radiation necrosis of large BM remain challenging. To overcome these limitations, biweekly 3-stage SRS for LBM was performed in this study. Total 53 patients were treated for 62 LBM. Female was 27(50.9%), and mean age was 63.7±11.8years. The mean KPS was 79.2±9.0 and GPA score was 1.9±0.7. Non-small cell lung cancer(NSCLC) was the most common primary cancer in 31 patients, others include 6 small cell lung cancer(SCLC), 9 gastro-intestinal tract cancer, 5 gynecological cancer, and etc. Epidermal growth factor receptor(EGFR) mutation was identified in 13 patients, and EGFR tyrosine-kinase inhibitor(TKI) was used in 10 patients during and after staged SRS. The mean tumor volume was 19.1cm3. The mean marginal dose of 11.7Gy was delivered to the 50% isodose line based on new treatment planning every two weeks. The mean tumor volume at the second and third stage was 14.8cm3 and 11.0cm3, respectively. The lesions from squamous cell carcinoma of NSCLC decreased most rapidly, and followed by gynecological cancer, SCLC and adenocarcinoma of NSCLC(volume ratio at 3rd stage was 0.39, 0.53, 0.56, and 0.64, respectively). The most significant factor related with tumor volume reduction at 3rd stage was usage of EGFR-TKI(p=0.016; LR analysis). The mean overall survival(OS) was 15.3months, and estimated OS were 62% and 46% at 6 and 12months. In the multivariate analysis, KPS(OR=0.918; 95% CI,0.871-0.968; p=0.002) and usage of EGFR-TKI(OR=0.216; 95% CI,0.059-0.790; p=0.021) were significantly associated with OS. The mean OS of the group of usage of EGFR-TKI was significantly longer than that of the others(20.7months, and 13.1months; p=0.029; log-rank test). The biweekly 3-stage SRS seems to be effective treatment for patients with LBM, especially in patients who were treated with EGFR-TKI during and/or after SRS, also cautiously considering the primary tumor origin.
SURG-12. SURGICAL INTERVENTION FOR PRIMARY B-CELL LYMPHOMA OF THE SPINE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF CLINICAL PRESENTATION, HISTOLOGICAL MARKERS, TREATMENTS, AND SURVIVAL OUTCOMES
Authors: Gendreau Julian , Patel Neal , Brown Nolan , Lee Seung Jin , Chan Andrew , Sahyouni Ronald 
Published: November 2022

Abstract
B-cell lymphoma is a potential cause of spinal cord compression that presents with nonspecific symptoms and inconsistent imaging findings. Surgical decompression is a mainstay for both diagnosis and management especially in patients with acute neurologic deficits; however, the long-term efficacy of intervention is still unclear. We perform a systematic review of the clinical symptoms, radiographic findings, and outcome after spinal decompression in B-cell lymphoma. The databases of Medline, PubMed, and the Cochrane Database of Systemic Reviews were queried for all articles reporting spinal B-cell lymphoma. Data on presenting symptoms, histological markers, treatment and survival outcomes were extracted. Bivariate and Multivariate Cox survival regression models and Kaplan-Meier curves were generated using R software survival package. In total, 57 studies were included with 72 patients diagnosed with spinal B-cell lymphoma. Mean age was 56.22 (IQR: 45.00-70.25) with 68% of patients being male and 4.2% of patients being immunocompromised. Back pain was the most common symptom (74%) with B symptoms and cauda equina symptoms present in only 6% and 29% respectively. Mean length of symptoms before presentation was 3.81 months (IQR: 0.45-3.25). The most common location was the thoracic spine (53%), with a majority of the lesions being hyperintense (28%) on T2 MRI. Surgical resection was performed in 83% of patients. Symptoms improved in 88% of patients after surgery and 80% of patients treated nonoperatively. OS at one- and five-years was 85% (95% CI: 0.749-0.953; n=72) and 66% (95% CI: 0.512-0.847; n=72), respectively. Age &gt; 70 was associated with poorer OS in bivariate (HR 4.07 [95% CI: 1.328-12.46], p &lt; 0.01; n=72) and multivariate analysis (HR 3.829 [95% CI: 1.158-12.662], p &lt; 0.03; n=72). Primary spinal B-cell lymphoma can have a variety of presentations. Both surgery and nonoperative management may have similar improvement in symptoms. Age &gt; 70 appears to confer poorer OS.
SURG-13. SYSTEMATIC REVIEW AND META-ANALYSIS OF IMPACT OF EXTENT OF RESECTION ON SURVIVAL ON GLIOBLASTOMA, IDH-WILDTYPE, WHO GRADE 4 (WHO 2021)
Authors: Jusue-Torres Ignacio , Lee Jonathan , Germanwala Anand , Burns Terry , Parney Ian 
Published: November 2022

Abstract

BACKGROUND
Glioblastoma diagnostic criteria have been redefined with the 5th edition of WHO classification of tumors of the central nervous system. Glioblastomas are defined as IDH wildtype diffuse astrocytic glioma tumors with one of the following features: microvascular proliferation, or necrosis, or TERT promoter mutation, or EGFR gene amplification, or +7/-10 chromosome copy number changes. The aim of this study is to establish the impact of extent of resection in overall survival (OS) and progression free survival (PFS) in glioblastoma, IDH-wildtype (WT), WHO grade 4 (WHO 2021).

METHODS
Systematic literature search was performed using the following databases: PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and ClinicalTrials.gov to identify studies comparing OS and PFS after gross total resection (GTR) vs subtotal resection (STR) or biopsy for glioblastoma IDH-WT. Prognostic hazard ratios (HR) for OS and PFS were analyzed using a random-effects model.

RESULTS
We identified 1439 publications. Nine studies met inclusion/exclusion criteria. 788 patients underwent GTR out of 1818. The meta-analysis showed a significant increase in OS and PFS duration when undergoing GTR for glioblastoma IDH-WT with a median OS of 20 months 95% CI (17-25) compared to 12 months 95% CI (9-15) for STR or biopsy and a median PFS of 11 months 95% CI (9-12) for GTR compared to 7 months 95% CI (5-7) for STR or biopsy respectively. GTR showed a 49% significant reduction of mortality risk HR=0.51 95%CI (0.42-0.59) and a 44% significant reduction of progression risk HR=0.56 95%CI (0.41-0.71) compared to STR or biopsy.

CONCLUSIONS
This systematic review indicates that GTR may be associated with improved OS and PFS compared to STR or biopsy for Glioblastoma, IDH-WT, WHO grade 4 (WHO 2021). However, this is limited by variable study design and significant clinical and methodological heterogeneity among studies.
SURG-14. LOWER-GRADE GLIOMA IN ELDERLY PATIENTS: TREATMENT AND OUTCOMES IN A MOLECULARLY CHARACTERIZED CONTEMPORARY COHORT
Authors: Jungk Christine , Gluszak Mara , Trong Philip Dao , von Deimling Andreas , Herold-Mende Christel , Andreas Unterberg 
Published: November 2022

Abstract
Lower-grade glioma (LGG) is rare among patients above the age of 60. Previous series reported poor outcomes, likely due to a high proportion of missed IDH wildtype astrocytomas which today would be diagnosed as glioblastoma, and thus proposed defensive treatment in elderly patients. We questioned these findings in our contemporary cohort of “true” LGGs, i.e. IDH mutant astrocytoma and oligodendroglioma WHO grade 2 and 3. Patients aged 60 years and older (“elderly”) treated for hemispheric LGG were retrospectively analyzed for demographic, tumor- and treatment-related factors and progression-free survival (PFS) and were compared to a cohort of patients younger than 60 years. Inclusion criteria, amongst others, were availability of molecular data and volumetric assessment of pre- and postoperative tumor burden. 212 patients were analyzed, among those 21 elderlies (9.9%). Elderly patients did not differ from younger ones regarding preoperative tumor volumes, eloquent location, presence of contrast enhancement and clinical presentation (seizures, focal deficits). In both groups (elderly vs. younger), most patients underwent tumor resection (81% vs. 90.6%; p=0.25) with comparable median residual tumor volumes (5.12 cm3 vs. 3.28 cm3; p=0.66). There was a trend towards more aggressive surgical approaches in younger patients, e.g., use of IOM and awake surgery. However, rates of functional deterioration (p=0.2) and revision surgery (p=0.98) were comparable. Oligodendroglioma, in relation to astrocytoma, was more common in the elderly (76.2% vs. 46.1%; p=0.011). Adjuvant radio- and/or chemotherapy was administered in 76.2% of elderly and 59.8% of younger patients (p=0.163). Median PFS was comparable (50 vs. 56 months; p=0.62), regardless of WHO grade (p=0.43) and tumor subtype (p=0.93). In conclusion, favorable surgical and survival outcomes were achieved in our series that were comparable to those of younger patients. Thus, intensified treatment including maximal safe resection should be advocated in elderly patients whenever feasible.