bluuebunny/crossref_metadata_2025_split huggingface dataset:
ML-8 HIGH-DOSE CHEMOTHERAPY SUPPORTED BY AN AUTOLOGOUS STEM CELL TRANSPLANT IN RELAPSED PRIMARY CNS LYMPHOMA
Authors: Mishima Kazuhiko , Tkahashi Naoki , Shirahata Mitsuaki , Suzuki Tomonari , Mizuno Reina , Adachi Junichi , Ozawa Tastuya 
Published: December 2022

Abstract

Background
Many patients with primary CNS lymphoma (PCNSL) relapse despite complete response (CR) after initial therapy. Relapsed PCNSL (rPCNSL) has a poor prognosis, and no adequate standard of treatment has been established. Autologous stem cell transplant (ASCT)-assisted high-dose chemotherapy (HDC) for rPCNSL is a promising treatment option, as is thiotepa (TT), which has been used in malignant lymphoma as a treatment option for PCNSL. In March 2020, TT was approved in Japan as a pre-treatment for ASCT in malignant lymphoma. TBC, TT with busulfan and cyclophosphamide, and BCNU+TT are used in Europe and the US, but treatment-related mortality (TRM) has been reported in about 10% of patients. The regimen approved in Japan is Buslufan-TT(BuTT) therapy in combination with busulfan, which differs from TBC in dosage, and there is little information on efficacy and safety for rPCNSL. In our hospital, we have introduced BuTT therapy for rPCNSL in patients under 65 years of age. In this report, we describe our experience with this treatment. Subjects: Five patients with rPCNSL since May 2021, age &lt;66 years, PS 0-2, are included in this study.

Methods
After obtaining CR with (R)MPV therapy after relapse, peripheral blood stem cells were harvested after administration of G-CSF and plerixafor, pretreated with BuTT therapy (Bu: 3.2 mg/kg, Day-8, -7, -6, -5: TT: 5 mg/kg, Day-4, -3) and transplanted on Day 0.

Results
Adverse events of Grade 3 or higher were abdominal pain in 2 cases, diarrhea in 1 case, pharyngitis in 2 cases, sepsis in 1 case, and pleuritis in 1 case, but all recovered, and no TRM was observed. All five patients are currently alive without recurrence.

Conclusion
HDC/ASCT is expected to be a curative treatment for rPCNSL. Future issues include the establishment of an upper age limit for the indication.
ML-9 TREATMENT OUTCOMES OF TIRABRUTINIB FOR RELAPSED AND REFRACTORY PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA IN A SINGLE INSTITUTE
Authors: Ohka Fumiharu , Yamaguchi Junya , Motomura Kazuya , Takeuchi Kazuhito , Nagata Yuichi , Maeda Sachi , Nishikawa Tomohide , Kibe Yuji , Shimizu Hiroki , Saito Ryuta 
Published: December 2022

Abstract
Recent clinical studies improved prognosis of primary central nervous system lymphoma (PCNSL) using multiple treatment reagents combined with radiation therapy. However, for recurrent and refractory cases after treatment with regimen consisting of multiple reagents, potent effective treatment has not been established yet. Tirabrutinib, Bruton's tyrosine kinase inhibitor was introduced for treatment of recurrent and refractory PCNSL in Japan. However, case series study investigating the clinical outcome of PCNSL cases treated with tirabrutinib have not been reported yet excepting for phase I/II study of tirabrutinib. We treated nine recurrent and two refractory cases. In all of these cases, except for one case exhibiting severe skin rash in spite of cessation of administration of tirabrutinib, we obtained favorable overall response rate (CR or Cru=5 and PR=5) together with favorable progression free survival (median; 339 days). Five cases exhibited skin rash (CTCAE grade 3; n=2 and grade 2; n=3). Grade 3 or 2 skin rash were found on day 9 or 75 of tirabrutinib treatment, respectively. In one case, MYD88 mutations in ctDNA derived from blood plasma were turned to be negative after one week administration of tirabrutinib. Although adverse effects such as skin rash was frequently found, tirabrutinib is effective for recurrent or refractory PCNSL cases. Our data suggested that treatment response of tirabrutinib could be evaluated via evaluation of copy number analysis of MYD88 mutations in ctDNA of blood plasma.
MET-4 ANALYSIS OF METASTATIC BRAIN TUMORS DISCOVERED AT THE SAME TIME AS THE PRIMARY LESION
Authors: Yamamoto Yohei , Nawate Syohei , Nakamura Aya , Ishii Takuya , Tanaka Toshihide , Akasaki Yasuharu , Murayama Yuichi 
Published: December 2022

Abstract

Introduction
Among metastatic brain tumors, especially in cases where the primary tumor and metastatic brain tumor are found at the same time, it is necessary to consider the priority of treatment for intracranial lesions and the means to obtain a definitive diagnosis. In this study, we performed a statistical analysis on the factors affecting mean survival (mOS) in patients with concurrent primary and metastatic brain tumors.

Subjects and Methods
A total of 252 patients with metastatic brain tumors treated at our hospital since 2014 were divided into two groups: simul-meta (58 patients) and non-simul-meta (194 patients). Age, sex, primary tumor, number of tumors, presence or absence of metastasis to other organs, localization of intracranial lesions, presence or absence of carcinomatous meningitis, performance status (PS), details of therapeutic intervention (radiation therapy, chemotherapy, surgery). The background factors between the two groups were analyzed using the chi-square test. Factors affecting mOS were evaluated by univariate analysis with log-rank test and multivariate analysis with Cox proportional hazards test.

Results
In simul-meta and non-simul-meta, mOS was 328 and 295 days, respectively (p=0.864). As a background, lung cancer (76%: 59%; p = 0.02) and surgical intervention group (28%: 11%; p &lt;0.01) were numerous in simul-meta. Good prognostic factors in the simul-meta group extracted by multivariate analysis were surgical intervention and cases of chemotherapy. Chemotherapy cases were stratified into conventional chemotherapy and molecular-targeted drug use, and the prognosis of molecular-targeted cases was better than that of conventional chemotherapy (p=0.01).

Discussion
In patients with concurrent disease, it is important to complete treatment for intracranial lesions, including surgical treatment, and maintain a general condition that allows chemotherapy to be administered. In addition, considering the frequent occurrence of lung cancer, it is necessary to develop a treatment plan with molecular target therapy in mind.
MET-8 EFFECT OF VEGF-TARGETED THERAPY FOR SYMPTOMATIC/REFRACTORY BRAIN EDEMA CAUSED BY METASTATIC BRAIN TUMORS
Authors: Fumiyuki Yamasaj , Takayasu Takeshi , Yonezawa Ushio , Taguchi Akira , Onishi Shumpei , Novita Ikbar , Sugiyama Kazuhiko , Horie Nobutaka 
Published: December 2022

Abstract

Background
Molecular target therapy with EGFR and ALK inhibitors greatly improved the prognosis of lung cancer patients with driver mutation-positive metastatic brain tumors. Inhibitors of VEGF are also useful for treating brain edema induced by brain metastases. In this study, we examined the impact of VEGF inhibitors on symptomatic/refractory edema in metastatic brain tumors.

Materials and Methods
This retrospective study included the patients with metastatic brain tumors who received VEGF-targeted therapy for symptomatic/refractory brain edema. The primary cancer site, radiation therapy for metastatic brain tumors, corticosteroid administration, symptoms, Karnofsky performance status, and MR imagings before and after VEGF-targeted therapy were all gathered from the patient's medical records.

Results
19 patients with symptomatic/refractory cerebral edema [NSCLC(15), LCNEC(1), SCLC(1), breast cancer(2), colorectal cancer (2)] were treated with anti-VEGF medication. Nine patients were treated with bevacizumab as a monotherapy, and 12 patients were treated with bevacizumab or ramucirumab in combination as a multi-drug therapy. Prior brain irradiation was administered to 17 patients. Corticosteroids were used to treat brain edema in 8 patients. VEGF inhibitors were effective in all patients, improving symptoms by reducing brain edema.

Conclusion
We recommend VEGF inhibitor for symptomatic/refractory edema of metastatic brain tumors. This treatment may be successful independent of the primary cancer site.
MET-10 A SINGLE CENTER RETROSPECTIVE ANALYSIS OF AWAKE CRANIOTOMY FOR METASTATIC BRAIN TUMOR
Authors: Yanagisawa Shunsuke , Ohno Makoto , Takahashi Masamichi , Mukai Takayasu , Kawaguhci Yuki , Sakurai Takuro , Oki Mami , Matsuoka Aiko , Miyakita Yasuji , Narita Yoshitaka 
Published: December 2022

Abstract

Background/purpose
Recent advances in cancer treatment provide surgical indication chances of metastatic brain tumors, and awake craniotomy for them is increasing. However, a small number of hospitals can perform awake craniotomy by limitation of hospital capacity. Here we show a single center retrospective analysis of awake craniotomy for metastatic brain tumor.

Materials and Methods
we analyzed consecutive 35 cases from January 2016 to January 2022 in our hospital. Rehabilitation staff evaluated them before surgery and after within a week.

Result
Patients characteristic were as follows. Mean and median age 57.0 (16-81) and median 62 respectively. Left side tumor were 31(88.6%). Frontal lobe was 26(74.3%), temporal lobe 5(14.3%), parietal lobe 3(8.6%), occipital lobe 1. Origin of cancer was lung 17(48.6%), gastrointestinal lesion 5(14.3%), breast 4(11.4%), soft tissues 3(8.6%), radiation necrosis 4(11.4%), uterus and malignant melanoma 1 respectively. KPS was 100-90 18(51.4%), KPS 80 6(8.6%) and KPS70 11(31.4%). Gross total removal was 30, partial removal was 5. MMSE of before and after surgery was mean 27.1 and median 29. Trail Making Test (TMT) of 24 cases test showed improvement in 11 (45.8%) cases. Median OS was 18.8 months (95%CI: 11.2-526).

Discussion/conclusion
We selected most awake craniotomy on left frontal lobe and each evaluating scales showed no deterioration. Awake craniotomy for metastatic brain tumor is effective procedure for saving function.
MET-11 NEAR-INFRATED OPTICAL CONTRAST OF INDOCYANINE GREEN CAN LOCALIZE METASTATIC BRAIN TUMORS
Authors: Muto Jun , Mine Yutaka , Joko Masahiro , Oba Shigeo , Hirose Yuichi 
Published: December 2022

Abstract

Introduction
The utility of intraoperative real-time fluorescent navigation of indocyanine green (ICG) for cerebrospinal tumors has been demonstrated in gliomas, schwannomas, and meningiomas. We reported the usefulness of the existing Second window ICG (SWIG) for metastatic brain tumors, in which 5 mg/kg is administered 24 hours before the day before surgery. Subsequently, we developed a Delayed window ICG (DWIG) administered 1 hour before observation intraoperatively and report our experience.

Methods
The subjects were 28 patients from August 2019 to March 2022, with an average age of 67 years, diagnosed with metastatic brain tumors. Eighteen patients were in the SWIG group and 10 in the DWIG group. Iridium (Visionsense) and KINEVO (Carl Zeiss) were used for near-infrared irradiation and observation.

Results
Near-infrared light was irradiated during surgery, and in all cases, fluorescence from the tumor was confirmed. Fluorescence emission could be confirmed as far as 10 mm from the brain surface. The Signal Background Ratio (SBR) of tumor to brain parenchyma was 3.4 in SWIG and 4.2 in DWIG. There is no significant difference between them.(P=0.15) All patients had contrast areas on preoperative contrast MRI, and the ratio of contrast area to brain parenchyma (T1BR) was 2.5. After intraoperative resection, all resected patients showed no contrast lesions on immediate postoperative MRI. No perioperative complications due to I CG administration were noted.

Conclusions
Metastatic tumors may be difficult to distinguish from the normal brain visually due to the inaccuracy of the navigation system caused by intraoperative brainshift and blurring of the boundaries under an optical microscope. Intraoperative fluorescence angiography is useful in such cases because it allows tumor localization and removal in real time. DWIG is useful for metastatic brain tumors because it is simple and easy to use, with no significant difference compared to existing SWIG.
MET-14 OUTCOME OF METASTATIC CEREBELLAR TUMOR: A SINGLE-CENTER STUDY
Authors: Nakano Tomoyuki , Miyakita Yasuji , Ohno Makoto , Takahashi Masamichi , Yanagisawa Shunsuke , Omura Takaki , Tamura Yukie , Kikuchi Miyu , Hosoya Tomohiro , Narita Yoshitaka 
Published: December 2022

Abstract

Background
Brain metastases (BM) to the cerebellum account for approximately 20% of all of BM. From the results of JCOG0504 clinical trial, observation with salvage SRS (stereotactic radiosurgery) has been established as a standard therapy for a patient after complete resection of BM. However, we often experience early local recurrence after resection of cerebellar BM, therefore, we retrospectively analyzed them to consider the appropriate timing of SRS.

Methods
We extracted surgical cases with cerebellar BM from January 2015 to March 2022 and analyzed the patient characteristics, treatment content, postoperative intracranial progression-free survival (IC-PFS) and postoperative overall survival (OS).

Results
A total of 57 cases were enrolled (male: female = 43.9%: 56.1%) in this study. The median age was 61.9 years (51.9-68.2). The common primary lesions were NSCLC (31.6%), colorectal cancer (19.3%), and breast cancer (17.5%). The IC-PFS was 4.5 months (2.6-5.7) and the OS was 11.6 months (9.1-21.8), but the local recurrent rate within 3 months was 43.4%. The rate of patients with leptomeningeal metastases (LMM) at the first recurrence was 26.3%, significantly higher than 7.7% in JCOG0504 (p=0.000224). In the postoperative observation group (no SRS within a month), the OS was 25.3 months (11.6-NA), which was longer than the 15.6 months (11.4-20.8) of JCOG0504. RT was performed in 18 patients at the recurrence (SRS: 15, WBRT (whole-brain radiotherapy): 9). SRS was the only factor that prolonged the OS (25.2 vs. 6.1 months (p=0.0212)). Furthermore, in the patients who underwent radiotherapy within 1 month after surgery, postoperative SRS (10.2 vs. 3.1 months, p=0.00437), and postoperative SRS to the resection cavity (11.0 vs. 3.7mo, p=0.0012) significantly prolonged the OS.

Conclusion
Since cerebellar BM has high recurrence and frequent LMM, early SRS for a resected cavity after surgery might lead to more favorable outcomes in cerebellar BM patients.
MNG-2 AN ANAPLASTIC MENINGIOMA WITH THE DIFFERENTIATION INTO OSTEOSARCOMA TISSUE
Authors: Adachi Junichi , Komine Hiroyuki , Sasaki Atsushi 
Published: December 2022

Abstract
Eighty-two year old woman developed motor aphasia. A brain MRI revealed an (1) extramedullary tumor adhering to the dura mater which enhanced almost uniformly and (2) an intramedullary tumor in the left frontal lobe. She underwent surgery in which we removed both tumors. Pathological examination revealed that (1) was meningothelial meningioma, WHO grade 1, without malignant findings. (2) had a high cell density, many mitosis (about 15 in 10 high-power fields), and a high MIB-1 index, leading to atypical meningioma, WHO grade 2. In addition, osteosarcoma component was found in part of (2), MIB-1 was further elevated, and the same site was diagnosed as anaplastic meningioma, equivalent to WHO garde 3. As a result of genetic analysis,tumor (1) had hemi-deletion and tumor (2) had homozygous deletion of the CDKN2A/2B gene. A case of anaplastic meningioma with osteosarcoma tissue has not been reported in the past as far as we could find, and it seems to be an extremely rare case. In this case, it is presumed that the other allele was deleted in the CDKN2A/2B hemi-deficient cells with benign morphology, and the homozygous deletion cells transformed into malignant transformation.
MNG-3 STRATIFICATION OF TUMOR GROWTH BY RISK FACTORS AND PREDICTED TUMOR VOLUME CURVES FOR SUPRATENTORIAL MENINGIOMAS
Authors: Hirayama Ryuichi , Yamada Shuhei , Iwata Takamitsu , Utsugi Reina , Tachi Tetsuro , Kuroda Hideki , Kijima Noriyuki , Okita Yoshiko , Kagawa Naoki , Kishima Haruhiko 
Published: December 2022

Abstract

Background
The natural history of meningiomas is still unclear, and no guidelines have been established based on objective indices regarding the necessity and timing of therapeutic intervention.Objective: We attempted to provide statistics on the characteristics of tumor volume change, stratify tumor growth by risk factors, and generate a predictive tumor volume curve based on the statistics, with the aim of describing the natural history of meningiomas.

Methods
313 cases were included in the study, with the origin of meningioma being the circumflex and parasagittal sinus areas and the cerebral sickle region, and with multiple MRI scans performed at intervals of at least 3 months. Relative growth rate (RGR) and annual volume change (AVC) were calculated by measuring tumor volume, and the patients were classified into three groups according to the combination of gender, age, and MRI T2WI signal intensity, and compared.

Results
The median RGR and AVC of the entire cohort were 6.1% and 0.20 cm3/year, respectively, and there were significant differences between groups in gender (p=0.018) and MRI T2WI (p &lt; 0.001) for RGR and tumor location (p=0.025) and initial tumor volume (p &lt; 0.001)for AVC. The median RGR and AVC in the classification were 17.5% and 1.05 cm3/year for the very high growth group, 8.2% and 0.33 cm3/year for the high growth group, and 3.4% and 0.04 cm3/year for the low growth group, showing significant differences between the groups (p &lt; 0.001). The predicted tumor volume curve showed an average 2.24-fold or 5.24 cm3 increase in volume over 5 years in the very high-growth group, while little tumor volume change was observed in the low-growth group.

Conclusion
The combination of growth risk factors allowed stratification of tumor growth and provided a predictive tumor volume curve for each county. The results may assist in the treatment of meningiomas.
BT-5 LONG-TERM OUTCOME OF CLIVAL CHORDOMAS AT A SINGLE INSTITUTION
Authors: Shinojima Naoki , Uekawa Ken , Mukasa Akitake 
Published: December 2022

Abstract

Purpose
Chordoma is a rare malignant tumor, about 30% of which occurs in the clivus. The purpose of this study is to investigate the outcome after treatment of clival chordoma in our institute.

Methods
Nineteen patients {M/F=11/8, mean age: 50.4 (15-72) years} who were treated between 1987 and 2021 and followed for at least 6 months were retrospectively evaluated for survival and local control rate.

Results
The cumulative survival rate was 89.2% at 5 years, 82.3% at 10 years, and 54.9% at 25 years, and the median OS was 107 (6-359) months. 4 deaths: 2 tumor deaths (1 from poorly differentiated chordoma), 2 non-tumor deaths (1 from IC rupture after heavy ion radiotherapy). The cumulative local control rate was 47.3% at 5 years and 35.5% at 10 years, with a median progression-free survival (PFS) of 41 (0-278) months. There was no difference in OS (p=0.85) or PFS (p=0.90) between the two groups, with 6 cases of gross total resection, GTR (all transsphenoidal) and 13 cases of non-GTR (9 transsphenoidal, 4 transcranial) at first surgery. In the 4 patients without irradiation (1 GTR, 3 non-GTR), no disease progression (PD) was observed, and the mean OS was 170 (69-278) months. Of the 15 patients irradiated, 6 were irradiated before PD and 9 were irradiated after PD, and there was no difference in OS or PFS between the two groups, i.e., the timing of irradiation. One patient with refractory chordoma was found to have elevated TMB levels by cancer genome testing and is currently receiving pembrolizumab, which has resulted in significant tumor shrinkage.

Conclusion
The patients with clival chordoma have a varied course, which may be due to differences in molecular biology. Cancer genome testing may provide new treatment options, such as molecularly targeted drugs and immune checkpoint inhibitors, for refractory cases.
BT-6 CLINICO-RADIO-PATHOLOGICAL FEATURES OF 1ST RELAPSE OF GLIOBLASTOMA AFTER PHOTODYNAMIC THERAPY
Authors: Yoshioka Yamato , Akimoto Jiro , Fukami Shinjiro , Nagai Kenta , Saitou Yuuki , Kohno Michihiro 
Published: December 2022

Abstract

Introduction
We describe the clinicopathological picture of patients who underwent surgery at the time of initial recurrence after photodynamic therapy (PDT) for first-episode glioblastoma.

Subjects and Methods
We examined the clinicopathological picture of 12 patients who had undergone PDT in a sub-total or greater resected luminal wall at the time of initial surgery, and who were able to undergo repeat resection because a new contrast-enhancing lesion was detected during follow-up.

Results
The age at onset ranged from 43 to 80 years, with a male-to-female ratio of 9:3. PDT was applied to the wall of the resected lumen 4-13 times using a reflector as needed. Initial pathology showed IDH wild-type glioblastoma in all patients. Postoperatively, only the Stupp regimen was performed, but local recurrence on imaging was observed 9-24 months (median 11.5 months) postoperatively. Contrast-enhanced lesions were seen throughout or deeper into the luminal wall on imaging, but they were irregular and necrotic and were not well characterized by DWI/ADC due to strong perineural edema. Most of the patients had low density (around 15%) of tumor cells, but abundant T lymphocytes and foam cell infiltrate. 2 patients (9 and 20 months after the first surgery) showed no tumor cells, only necrosis, endothelial degeneration, and lymphocytic infiltrate, and were judged to have pseudoprogression. 1 patient (9 and 20 months after the first surgery) showed no tumor cells and was judged to have pseudoprogression. In one case (11.7 months after initial surgery), tumor-like dysplastic cells were found in less than 10% of the tissue.

Discussion/Conclusion
When the first recurrence of glioblastoma after PDT is diagnosed, the possibility of late pseudo-progression should be taken into account, and the pathological search using various modalities such as MRS, perfusion study, PET/SPECT, etc. should be performed. Short-term wait and scan are important.
CS-10 POLYMORPHOUS LOW-GRADE NEUROEPITHELIAL TUMOR OF THE YOUNG: OUR CASE AND REVIEW OF THE LITERATURE
Authors: Kakuta Kiyohide , Asano Kenichiro , Ueno Kouta , Watanabe Ryouta , Saito Atsushi , Kurose Akira 
Published: December 2022

Abstract
Polymorphous low-grade neuroepithelial tumor of the young (PLNTY) is a new tumor that was officially listed in the WHO 5th edition in 2021. It is clinically and pathologically oligodendroglioma-like, but can be distinguished by CD34 positivity. Although this case was initially thought to be an oligodendroglioma-like low grade glioma, it was clinically and pathologically considered to be a typical case, so we report it here.14 year old female. No special notes, including growth and development. The patient suddenly developed a generalized tonic convulsion and was taken to the emergency room. A CT scan revealed a lesion with strong calcification in her left temporal lobe, and she was referred to our department. She had no neurological findings and underwent total resection under awake surgery. She was difficult to diagnose with intraoperative frozen section. diagnosis.The pathological findings are medium-sized oval to oblong nuclei, diffuse proliferation of tumor cells with delicate cell projections, and oligodendroglioma-like areas with perinuclear halos. A very large number of fine calcifications are observed, but necrosis and microvascular hyperplasia are not observed. GFAP, olig2, and nestin were positive, and synaptophysin, Nf, Hu C/D, MAP2, and chromograninA were negative. MIB-1 was less than 5%. The sequence was IDH1/2, TERTwild, and the BRAF-V600E mutation was recognized. Tumor cells were CD34-positive, leading to a final diagnosis of PLNTY. PLNTY is a new concept of tumor and accumulation is still small. Although this case has typical clinical and pathological features, preoperative diagnosis was difficult because it is a rare tumor. Intraoperative diagnosis is also difficult, suggesting the difficulty of diagnosing this tumor. Based on past cases, we report preoperative diagnostic imaging, intraoperative findings, and histopathological findings, including literature considerations.