bluuebunny/crossref_metadata_2025_split huggingface dataset:
QLTI-04. USING VARIANT ALLELIC FRACTION OF DRIVER MUTATIONS IN ADULT-TYPE DIFFUSE GLIOMA TO IMPROVE MGMT PROMOTER METHYLATION TESTING
Authors: McCord Matthew , Galbraith Kristyn , Jamshidi Pouya , Lukas Rimas , Zhang Hui , Jennings Lawrence , Snuderl Matija , Horbinski Craig 
Published: November 2022

Abstract
Methylation of the O6-methylguanine-DNA methyltransferase (MGMT) promoter predicts favorable response to temozolomide in adult-type diffuse gliomas. Accurate MGMT results require adequate tumor cellularity. Too many admixed non-neoplastic cells (which are always MGMT unmethylated) may cause false-negative results. Currently, ~70% tumor cellularity, based on estimation by microscopy, is recommended for reliable testing. However, this is subjective, and few cases are actually excluded from testing, so there is a risk of false-negative MGMT results. Since adult-type diffuse gliomas usually have heterozygous driver mutations in nearly all tumor cells, including IDH1, IDH2, and/or TERT, we determined whether the variant allelic fraction (VAF) of these mutations could serve as a better quality control metric in MGMT assays. A discovery cohort consisted of 175 gliomas (112 IDH-wildtype, TERT-mutant GBMs, 34 IDH-mutant astrocytomas, and 29 oligodendrogliomas). A validation cohort consisted of 50 gliomas (32 GBMs, 11 IDH-mutant astrocytomas, 7 oligodendrogliomas); all cases had MGMT pyrosequencing and NGS data. Gliomas with average ≥ 10% methylation of 4 measured CpG sites on the MGMT promoter were considered positive, as per standard cutoffs. The discovery cohort showed positive correlation between VAF and MGMT methylation among all gliomas (slope=0.26, R2=0.034, P=0.014). The largest drop-off in MGMT methylation occurred with VAF &lt; 13% (average MGMT of 4.77% versus 18.65% for VAF ≥ 13%, P=0.037). Among GBMs, only 1/7 (14.0%) with TERT VAF &lt; 13% met the cutoff for MGMT promoter methylation, versus 39/105 (37.0%) with VAF ≥ 13%. Based on our previous study (PMID 33830235), approximately 36.5% of GBMs should be positive. The validation cohort showed a similar pattern, wherein gliomas with driver mutation VAF &lt; 13% had average MGMT of 5.75% versus 14.94% for VAF ≥ 13%. In summary, our results suggest that glioma samples with driver mutation VAF below 13% are at higher risk of false-negative MGMT promoter methylation.
QLTI-11. IMPROVING ACUTE STROKE RESPONSE AT A COMPREHENSIVE CANCER CENTER: A MULTIDISCIPLINARY HOSPITAL-BASED QUALITY IMPROVEMENT PROJECT
Authors: Quashie Wayne , Avila Edward , Barzola Melissa , Buchholz Tara , Majeed Jibran , Maria Nicole Santa , Schaff Lauren 
Published: November 2022

Abstract

BACKGROUND
Stroke is common in patients with malignancy, but cancer patients in treatment have contraindications to intravenous (IV) tissue plasminogen activator (tPA). Advancements in endovascular therapy (EVT) has expanded options for acute stroke management . Memorial Sloan Kettering (MSK) is a cancer center without a public emergency room. Acute stroke management occurs inpatient or in urgent care center (UCC). We determined a need for rapid identification and management for acute strokes in our patient population.

METHODS
We developed a multidisciplinary Acute Stroke Pathway relying on activation of our hospital’s rapid response team (RRT), neurology, radiology, nursing support, patient escort services, and pharmacy. We initiated hospital-wide education around stroke symptoms and the pathway. All stroke activations are reviewed by Neurology bi-weekly for real-time feedback. Metrics include the times of symptom identification (“door time” = UCC check in or symptom discovery for inpatients), evaluation, head computed tomography (CT), labs, and administration of IV tPA. Times are compared to our 2016 institutional baseline data and National Institute of Neurological Disorders and Stroke (NINDS) benchmarks.

RESULTS
Since implementation of the pathway (6/11/2018) through Q1 2022 (3/31/2022), there were 551 acute stroke activations, 13 IV tPA administrations, and 48 patients transferred to a comprehensive stroke center for consideration for EVT. Average 2021 door-to-evaluation time: 8 mins (baseline: 18 mins, NINDS: 10 mins), door-to-stroke team: 11 mins (baseline: unknown, NINDS: 15 mins), door-to-CT: 33 mins (Baseline: 95 mins, NINDS: 25min), door-to-CT interpretation: 34 mins (baseline: 251 mins, NINDS: 45 mins), door-to-labs: 50 mins (baseline: unknown, NINDS: 45 min), door-to-IV tPA: 62 mins (baseline: unknown, NINDS: 60min).

DISCUSSION
The patient population at MSK is distinct from most hospitals. Patients with cancer have a higher incidence of stroke but are unlikely candidates for intervention. Inter-professional collaboration resulted in early stroke care in oncology patients consistent with NINDS benchmarks.
QLTI-15. VENOUS SINUS THROMBOSIS AFTER BRAIN TUMOR RESECTION
Authors: Regis Patrick , Cavaliere Robert , Sauvageau Eric , Hanel Ricardo 
Published: November 2022

Abstract
Post-operative venous sinus thrombosis (POVST) is an uncommon complication from a craniotomy for brain tumor resection. There are few data in how to treat POVST, including the use of anticoagulation and follow-up. It has been found that POVST is more common in dural-based lesions especially located on or near a sinus, however treatment has not been standardized. We retrospectively reviewed our POVST cases between January 2018 to December 2020 for brain tumor resection, whether we chose to start anticoagulation or not, and the eventual outcome. We also performed a literature review on the topic to compare findings and management. We identified 14 cases of POVST; 8 of the cases were for extra-axial masses. Of the 14, 6 POVST had clot involving the superior sagittal sinus (SSS), with 3 being discharged with a direct oral anticoagulant (DOAC) and one being discharged on warfarin. With transverse sinus involvement, 6 cases were noted (with no SSS clot), with 2 started on a DOAC and 2 being started on ASA 81mg. In the sigmoid sinus there were 2 cases and did not receive anticoagulation. Of the 14 total cases, 1 was symptomatic (new-onset seizures) necessitating surgical recanalization and no other cases had symptoms attributed to the POVST. Two patients died from unrelated reasons prior to receiving any outpatient imaging, and all other patients had recanalization of their involved sinuses within 2-5 months. There were no complications in patients receiving anticoagulation. Our literature review didn't show a standardized method in POVST treatment. There is also disagreement in what anticoagulation should be used, and if it is necessary. Based on our retrospective analysis and literature review, if the clot is symptomatic, involves the SSS, or propagates, we recommend anticoagulation. Outside the SSS, it should be determined on a case-by-case basis, but anticoagulation may not be necessary.
QLTI-19. EVALUATION OF INTRA-OPERATIVE BRAIN TUMOUR DIAGNOSTIC SERVICES – A LARGE TERTIARY UK CENTRE EXPERIENCE
Authors: Digby Richard , Ramakrishnan Piravin , Moughal Saad , Chakrabarty Arundhati , Mathew Ryan 
Published: November 2022

Abstract

INTRODUCTION
Brain tumour intraoperative diagnosis (smear cytology, frozen section) is a commonly performed, routine diagnostic service. Currently, samples must be transported from the operating room (OR) to pathology, impacting turnaround time (TAT), carbon emissions (if cross-site), and motivation for repeat sampling. We performed a broad evaluation of current practice in a large, tertiary, UK brain tumour centre, to identify potential gains in real-time tissue diagnosis.

METHODS
All brain tumour samples (n=228) sent for intraoperative diagnosis in 2021 were analysed retrospectively. TAT was assessed by capturing different timepoints along the pathway. Concordance between diagnoses at the following stages was determined: preoperatively based on radiology, intraoperatively (frozen section or smear), provisional paraffin and final integrated. Additionally, we anonymously surveyed neurosurgeons’ opinions (n=18) on the current service.

RESULTS
The mean (±SD) specimen transportation time was 10.6±2.0 minutes, with an estimated total TAT of 30-60 minutes. Intraoperative diagnosis provided a slightly higher rate of concordance with provisional paraffin diagnosis than preoperative radiological diagnosis (89.5% vs 86.3%). Non-concordance was most commonly due to non-representative sampling (e.g., predominantly necrotic), with no repeat sample being sent/available intraoperatively. Prevailing neurosurgical opinion of the intraoperative diagnostic service was dissatisfaction or neutrality (50% and 39% of respondents), with a minority being positive (11%). Reasons for this included: intraoperative delay due to TAT (47%), perceived inaccuracy of results (41%), and perceived reduced out-of-hours availability (56%).

CONCLUSIONS
Current brain tumour intraoperative diagnostic practice relies on physical sample transportation and manual processing; the resultant long TAT causes surgeon dissatisfaction and dissuades repeat analysis in the case of non-representative sampling. Real-time tissue diagnostic technologies such as OR-sited probe-based confocal endomicroscopy, scanners and Raman spectroscopy should be considered to facilitate faster and repeated examination. The latter may have additional benefits in real-time expert pathology feedback, tumour margin-zone analysis and increased extent of resection.
QLTI-21. SAFETY OF THE UTILIZATION OF TELEMEDICINE FOR BRAIN TUMOR NEUROSURGERY FOLLOW-UP
Authors: Morell Alexis , Patel Nitesh , Higgins Dominique , Eatz Tiffany , Levy Adam , Eichberg Daniel , Shah Ashish , Kader Michael , Morell Alexis , Ivan Michael , Komotar Ricardo 
Published: November 2022

Abstract

BACKGROUND
There is a need to evaluate the outcomes of patients who underwent brain tumor surgery and were followed by telemedicine or in-person consults during the COVID-19 pandemic.

METHODS
We retrospectively included all patients who underwent surgery for brain tumor resection by a single neurosurgeon at our Institution from the beginning of the COVID-19 pandemic restrictions (March 2020) to August 2021. Outcomes were assessed by stratifying the patients using their preference for follow-up method (telemedicine or in-person).

RESULTS
Three-hundred and eighteen (318) brain tumor patients who were included. The follow-up method of choice was telemedicine in 185 patients (58.17%), and in-person consults in 133 patients. We found that patients followed by telemedicine lived significantly farther, with a median of 22.23 miles, compared to a median of 36.34 miles in the TM cohort (p = 0.0025). When comparing visits to the emergency department (ED) within 30 days after surgery, and we found no statistical difference between the TM and the IP group (7.3% vs 6.01%, p=0.72). Readmission rates, wound infections and 30-day mortality were similar in both cohorts. These findings were also consistent after matching cohorts using a propensity score. The percentage of telemedicine follow-up consults was higher in the first semester (73.17%) of the COVID-19 pandemic, compared to the second (46.21%) and third semesters (47.86%).

CONCLUSIONS
Telehealth follow-up alternatives may be safely offered to patients after brain tumor surgery, thereby reducing patient burden in those with longer distances to the hospital or special situations as the COVID-19 pandemic.
QOL-03. CLINICAL CHARACTERISTICS AND FACTORS ASSOCIATED WITH SEIZURES IN GLIOMA PATIENTS AT THE NATIONAL CANCER CENTER DHARMAIS HOSPITAL IN JAKARTA, INDONESIA
Authors: Suryawijaya Nathasia , Andriani Rini , Wilopo Siswanto Agus 
Published: November 2022

Abstract

BACKGROUND
Seizures are a common presentation of gliomas that substantially impact morbidity and quality of life. Little is known about the prevalence of seizures among glioma patients in Indonesia. Furthermore, there is no publication regarding clinical characteristics related to this prevalence.

OBJECTIVE
To measure the prevalence of seizures among glioma patients and its association with tumor grade (low or high), type, and location.

METHODS
This is a retrospective study based on the medical records of all patients diagnosed with glioma according to histopathology findings. There were 65 patients admitted to the National Cancer Center Dharmais Hospital, Jakarta between January 2019 and December 2020. The demographic characteristics and clinical data were extracted, including clinical and tumor characteristics. Using logistic regression, an odds ratio (OR) with 95% confidence intervals was used to investigate the association between factors related to seizures.

RESULTS
A total of 65 patients (39 males and 26 females) were included in the study. Most of the patients are ranging from 40 to 49 years old (39%). The prevalence of seizures is relatively high which is 42 out of 65 patients (64.6%). Headache (95%) is the most common complaint in patients. Our study shows that grading and location of tumor were significantly associated with seizure in glioma patients among clinical manifestations (headache, neurological deficits) and pathological classification (p=0.005 and p=0.022). Bivariate analysis using logistic regression showed that low-grade glioma had a 12.2-fold increase in the risk of developing seizures compared to high-grade gliomas with a 95% CI of 1.50 to 99.9 (P&lt; 0.05). Moreover, the temporal location of the tumor had a 5.6-fold increase in the risk of developing seizures compared to the parietal location with a 95% CI of 1.01 to 30.9.

CONCLUSIONS
Grading and location of the tumor were factors associated with seizures in glioma patients.
QOL-06. PREDICTING VENOUS THROMBOEMBOLISM IN PATIENTS WITH ADULT-TYPE DIFFUSE GLIOMAS
Authors: Burdett Kirsten B , Unruh Dusten , Drumm Michael , Lamano Jonathan , Schwartz Margaret , Chandler James , Javier Rodrigo , Steffens Alicia , Amidei Christina , Lipp Eric S , Peters Katherine B , Lai Albert , Eldred Blaine , McCortney Kathleen , Heimberger Amy , Scholtens Denise , Horbinski Craig 
Published: November 2022

Abstract
Venous thromboembolism (VTE) is a common paraneoplastic complication in patients with adult-type diffuse gliomas. VTE greatly diminishes quality-of-life, and can even be life-threatening. While effective VTE prediction models exist for other cancers, those models do not work for gliomas. Thus, there are no standard guidelines for thromboprophylaxis in glioma patients. To address this deficiency, arterial blood, tumor tissue, and comprehensive clinical-pathologic data (including next generation sequencing) were obtained from 258 newly diagnosed WHO grade 2-4 adult-type diffuse glioma patients at Northwestern Memorial Hospital. Forty-six out of 258 grade 2-4 glioma patients (17.8%) experienced a subsequent VTE. Intratumoral expression of two proteins that have been associated with VTE risk in other cancers, thromboplastin and podoplanin, was higher in IDH wild-type than IDH mutant gliomas. Tissue expression of both markers was associated with increased VTE risk, but in the circulation, only thromboplastin positively correlated with VTE. LASSO time-to-event analysis showed that older patient age, elevated body mass index, elevated WBC count, hypertension, a preoperative history of VTE, asthma, and higher WHO grade predicted increased postoperative VTE risk, whereas hypothyroidism, IDH mutation, and MGMT promoter methylation were negative risk factors. Together, these 10 variables generated a receiver operating characteristic curve for 3, 6, 9, and 12 months from original surgery resulting in estimated AUC value of 0.82 in the Northwestern discovery cohort, 0.72 in the UCLA validation cohort (N=68), and 0.68 in the Duke validation cohort (N=157). We created an online prediction tool based on this model, which estimates VTE risk up to 1 year from original surgery. To the best of our knowledge, this is the first externally validated VTE risk prediction tool designed specifically for adult-type diffuse glioma patients. This tool, based on readily obtainable information, provides treating physicians with more objective risk estimates on which to base thromboprophylaxis decision-making.
QOL-15. VALIDITY AND RELIABILITY EVALUATION OF PRO-CTCAETM FOR ADULT DIFFUSE GLIOMAS PATIENT IN CHINESE POPULATION. (VERONICA): A PRELIMINARY DELPHI STUDY
Authors: Luo Chen , Wu Shuai , Cai Linbo , Chen Juxiang , Chen Song , Fei Zhou , Kong Lin , Li Sanzhong , Ma Hui , Mou Yonggao , Qiu Xiaoguang , Shu Kai , Song Sida , Sun Chongran , Tang Zhiwei , Wu Zanyi , Xiong Zhang , Xu Geng , Xu Jiankun , You Yongping , Zhang Jianmin , Zhang Wei , Zhong Chunlong , Zou Yourui , Wu Zhenyu , Wu Jinsong 
Published: November 2022

Abstract

OBJECTIVES
Given the increasing importance of patient’s perspective in adverse events reporting, Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE™) has been proposed as new PRO measures in oncology; however, its implementation has not yet been evaluated in glioma patients, and standardized selection process of priority symptom terms has not been applied.

METHODS
A total of 16 experts (13 neurosurgeons, 2 radiotherapists, 1 psychiatrist) from 14 medical centers in China were invited to participate in a consensus-seeking 2-round online Delphi survey. Participants rated the level of their agreement with each symptom term likely to occur during adult diffuse gliomas treatment on a 5-point Likert scale. Terms not reaching consensus over the first round were modified in the second rounds. Consensus was defined as content validity index (CVI) &gt; 0.78，coefficient of variation (CV)&lt; 0.35 and average Likert score &gt; 3.00.

RESULTS
Experts reached a consensus on 21 PRO-CTCAE™ symptom terms in the first Delphi round, and 10 terms in the second round. Likert scale scoring among all experts showed significant consistency (Round 1: Kendall’s W= 0.415，p＜0.001; Round 2: Kendall’s W = 0.351，P＜0.001). The 31 terms (38.75%) screened out of all 78 terms covered neurological symptoms(n=7), psychiatric symptoms(n=6), dermatological symptoms(n=6), gastrointestinal symptoms(n=5) and other common postoperative systemic symptoms of glioma patients.

CONCLUSIONS
We identified a customized PRO-CTCAE™ questionnaire containing a core set of priority symptom terms for the adult diffuse glioma through a 2-round Delphi survey. Next, a prospective, multi-center, real-word study would be performed to assess the validity, reliability and responsiveness of the customized PRO-CTCAE™ for adult diffuse glioma patients in Chinese population (VERONICA).
QOL-21. REAL-WORLD QUALITY-OF-LIFE AND HEALTH UTILITIES FOR PATIENTS WITH CNS CANCERS ON THE XCELSIOR PLATFORM
Authors: Sabates Alanis , Wood Alayna , Lee Hope , Swain Andrew , Irizarry Sabrina , Hinton Chezney , Ginn Sarah , Cole Zac , Chavez Gordon , Tadic Kristina , Chuyka Don , Federowicz Bryan , Proescholdt Christina , Shapiro Mark 
Published: November 2022

Abstract

OBJECTIVE
xCures operates a direct-to-patient, real-world evidence platform according to the nationwide observational research protocol XCELSIOR (NCT03793088), which aggregates medical data in an FDA-compliant electronic database. There is a relative scarcity of published results on real-world Quality-of-Life (QoL) outcomes and resulting health state utilities for patients with Central Nervous System (CNS) cancers. We sought to use the xCures platform to help address this issue.

METHODS
XCELSIOR participants were invited weekly to complete the EuroQol 5-Dimension (EQ-5D-5L) QoL survey. A EuroQol-endorsed model was used to estimate health state utilities from patient surveys. Survey results, utility estimates, and clinical information were analyzed to understand the influence of common mutations in glioma on patient reported outcomes.

RESULTS
30 patients (21 glioblastoma, 4 oligodendroglioma, 2 diffuse midline glioma, 2 diffuse astrocytoma, 1 Schwannoma) completed at least one EQ-5D-5L survey over the course of 9 weeks. Health state utilities were positively correlated (p&lt; .03) with Karnofsky Performance Score (KPS). The average utility for EGFR-mutated patients (N=6) was .578 (SD=.334) while for EGFR-wildtype patients (N=7) it was .747 (SD=.227). The average utility for MGMT-methylated patients (N=13) was .816 (SD=.139) while for non-methylated patients (N=10) it was .583 (SD=.379). The average utility for IDH-mutated patients (N=9) was .789 (SD=.153) while for non-mutated patients (N=17) it was .685 (SD=.324). The average utility for patients with a 1p/19q co-deletion (N=4) was .837 (SD=.126) while for those without a co-deletion (N=8) it was .744 (SD=.244).

CONCLUSION
The xCures platform has enabled the study of real-world QoL outcomes for patients with CNS cancers. This is the first report studying the influence of genetic mutations on QoL collected through patient reported outcomes. Future research aims to perform similar studies with larger number of patients.
QOL-24. SILVER LININGS: THE EXPERIENCE OF POSTTRAUMTIC GROWTH IN NEURO-ONCOLOGY CAREGIVERS
Authors: Willis Kelcie , Lanoye Autumn , Kleva Christopher , Reid Morgan , Fox Amber , Sadicario Jaclyn , Brechbiel Julia , Loughan Ashlee 
Published: November 2022

Abstract

BACKGROUND
Posttraumatic Growth (PTG) refers to positive psychological changes resulting from a traumatic event. A brain cancer diagnosis may be experienced as traumatic—not only for patients, but also for their caregivers. While caregivers in neuro-oncology consistently report significant emotional distress throughout the disease trajectory, their experience of PTG is unknown.

METHODS
Cross-sectional data were obtained from patients (N = 101, Mage = 50 years, 59% female, 86% White, 47% high-grade) diagnosed with primary brain tumors and their caregivers (N = 62, Mage = 50 years, 79% female, 92% White, 58% spouses) during routine clinic visits or online following the precautions of COVID-19. Patients and caregivers completed the Post Traumatic Growth Inventory, where &gt; 46 and &gt; 3 represent the clinical cutoffs for high versus low PTG. We compared caregiver and patient PTG using descriptive statistics and independent samples t-test.

RESULTS
Caregivers’ total PTG score was in the low range (M = 44.58, SD = 20.95) and significantly lower than patients’ total PTG (M = 51.78, SD = 21.96, p = .04). All five of caregivers’ subscale scores were also considered to be in the low range. Nevertheless, 45% of caregivers demonstrated moderate-to-high total PTG (compared to 67% of patients), and 65% reported moderate-to-high PTG in at least one subscale (compared to 85% of patients). Similar to patients, caregivers reported the most growth in Appreciation for Life (M = 2.98, SD = 1.05) and the least growth in New Possibilities (M = 1.71, SD = 1.17).

CONCLUSIONS
Results mirror previous findings in neuro-oncology, where caregivers consistently demonstrate greater emotional distress than patients. The current study suggests caregivers may also experience fewer positive changes. Overall, caregivers would benefit from increased support to process traumatic experiences associated with the disease. Future research should continue to investigate predictors of PTG in this vulnerable sample.