bluuebunny/crossref_metadata_2025_split huggingface dataset:
NIMG-83. MULTIMODAL PET/MRI RADIOMICS AND CLINICAL PARAMETERS FOR OVERALL SURVIVAL PREDICTION IN PATIENTS WITH IDH WILDTYPE GLIOBLASTOMA
Authors: Gutsche Robin , Bauer Elena , Kocher Martin , Werner Jan-Michael , Fink Gereon , Shah Nadim , Langen Karl-Josef , Galldiks Norbert , Lohmann Philipp 
Published: November 2022

Abstract

BACKGROUND
Currently, most radiomics studies on survival prediction in brain tumor patients are based on MRI only. The goal of our study was to evaluate multimodal radiomics derived from amino acid PET/MRI and clinical parameters for survival prediction in patients with newly diagnosed IDH wildtype glioblastoma.

METHODS
Sixty-three patients with newly diagnosed IDH wildtype glioblastoma were evaluated retrospectively. At initial diagnosis, all patients underwent structural MRI and O-(2-[18F]fluoroethyl)-L-tyrosine (FET) PET. Tumor volumes were automatically segmented using a deep learning-based tool followed by visual inspection. Predefined and deep radiomics features were extracted from both imaging modalities. Feature repeatability analyses and feature selection were performed to avoid overfitting. Cox regression models for overall survival were built from clinical parameters such as age or the extent of resection, radiomics features, and combinations thereof, and finally validated using 5-fold cross-validation. Further evaluation of the model in an external test dataset is ongoing.

RESULTS
The median overall survival was 12 months (range, 0-64 months). Higher age and larger FET PET tumor volumes were significantly correlated with shorter overall survival (age, r=-0.39, p&lt; 0.001; volume, r=-0.31, p&lt; 0.05). Models solely based on predefined FET PET or MRI radiomics features showed a similar mean concordance index (C-index) as the model based on clinical parameters (C-indices, 0.68±0.04; 0.64±0.03; and 0.69±0.08, respectively). Multimodal radiomics based on predefined and deep features yielded improved C-indices of 0.75±0.06 and 0.72±0.09, respectively. A model based on multimodal radiomics and clinical parameters achieved the best prognostic performance (C-index, 0.80±0.04).

CONCLUSION
Our results suggest an added clinical value of multimodal FET PET/MRI radiomics with clinical parameters for the non-invasive survival prediction in patients with IDH wildtype glioblastoma.
NCMP-04. COMBINATION BRAF/MEK INHIBITION IMPROVES SURVIVAL WITH LEPTOMENINGEAL DISEASE FROM MELANOMA IN A SINGLE INSTITUTIONAL REVIEW AT MOFFITT CANCER CENTER
Authors: Wallace Gerald , Kundalia Ronak , Imran Amna , Smalley Inna , Pina Yolanda , Forsyth Peter 
Published: November 2022

Abstract
Melanoma is third most common cancer to metastasize to the leptomeningeal space and confers a dismal prognosis. We retrospectively identified 87 cases of melanoma related leptomeningeal disease (M-LMD) diagnosed between 2011-2020 at Moffitt Cancer Center. The average age at diagnosis was 54 years (range 28-93 years) with a male predominance (50 men vs 36 women). There was a significant increase in median overall survival (OS) for patients with BRAF V600E mutation, but only if they were treated with combined BRAF/MEK inhibitors after diagnosis of LMD (5.54 months vs 1.39 months; p &lt; 0.01). Immune checkpoint inhibitors also associated with a small but significant increase in OS when given after diagnosis of M-LMD (2.73 months vs 1.38mths; p &lt; 0.01). There was no association between OS and gender (p &gt; 0.05). The current data supports use of BRAF/MEK inhibitors for treatment of BRAF V600E mutated M-LMD. More work is needed to improve OS for these patients and patients without a targetable mutation and M-LMD.
NCMP-11. METASTATIC MENINGIOMA: AN UNUSUAL COURSE OF A COMMON DISEASE
Authors: Bazer Danielle , Zabrocka Ewa , Torres Marielle , Frontario Ariana , Kowalska Agnieszka 
Published: November 2022

Abstract

BACKGROUND
The most common central nervous system (CNS) tumor in adult patients is meningioma, accounting for 30% of all intracranial tumors. Despite this, extracranial meningioma metastases are exceedingly rare, accounting for 0.1% of cases, with common locations for metastases localized to the lungs, liver, lymph nodes, and bone.

RESULTS
We present a 55-year-old female with a past medical history of tobacco use, hypertension and depression, who initially presented due to a generalized tonic-clonic seizure. MRI brain revealed an intracranial lesion in the left occipital lobe with mass effect, requiring craniotomy and resection. Pathology was consistent with WHO grade I meningioma and post-operatively a small area of residual tumor remained. PET/CT found a left lung nodule, which was thought to be due to her smoking history and was followed with annual scans. Four years later, she had an increase in the size of the meningioma on surveillance MRI scans. The patient then required repeat craniotomy which redemonstrated pathology of WHO grade I meningioma, then treated with stereotactic radiation 14 Gy. The subsequent annual surveillance pulmonary scan showed a growth of left pulmonary nodule. She underwent a left lingual wedge resection and was found to have low grade spindle cell tumor, consistent with metastatic meningioma.

CONCLUSION
Although rare, metastatic meningioma should be included in the differential diagnosis of patients with concomitant extracranial lesions. Our case highlights the importance of annual, surveillance scans of extracranial lesions in meningioma patients.
NCMP-22. TREATING PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY (PML) WITH PEMBROLIZUMAB: A SINGLE INSTITUTION EXPERIENCE
Authors: Hanna Sebastian , Thomas Alissa 
Published: November 2022

Abstract

BACKGROUND
PML is a rapidly progressive demyelinating disease, occurring in immunocompromised patients due to the opportunistic JC virus. The highest mortality rates are seen among patients with cancer treated with immunosuppressive therapy and for whom immune reconstitution is not possible. In 2019, the National Institutes of Health reported clinical benefit in patients with PML treated with pembrolizumab. We report our institutional experience with pembrolizumab for three patients with PML after exposure to rituximab and other chemotherapy. CASE PRESENTATION: The first patient was a 75-year-old woman with a history of psoriatic arthritis and bullous pemphigoid treated with rituximab. Eight months after rituximab exposure she presented with right hemiparesis and word-finding difficulty. PML was diagnosed based on positive JC virus DNA in cerebrospinal fluid by PCR. She received two doses of pembrolizumab with improvement in her neurological symptoms. Shortly after her second dose she contracted COVID-19 and died at her nursing home. The second patient was a 47-year-old man with a history of T cell/histiocyte large B-cell lymphoma treated with R-CHOP with salvage DHAP chemotherapy followed by BEAM and autologous stem cell transplant, with complete remission. Seven months post-transplant he presented with a rapidly progressive hemianopsia and aphasia, and PML was confirmed by brain biopsy. He received one dose of pembrolizumab but worsened and died of neurological deterioration secondary to PML. The third patient was a 73-year-old man with a history of mantle cell lymphoma previously treated with rituximab and bendamustine, who presented with acalculia and aphasia 14 months after rituximab exposure. PML was confirmed by brain biopsy, and he was treated with pembrolizumab with improvement in his neuro-cognitive functioning.

CONCLUSIONS
We observed neurological improvement following pembrolizumab treatment for PML in two of three patients, with one patient experiencing a durable response that is ongoing 3 years following PML diagnosis.
NCOG-29. INFLUENCE OF RADIATION DOSES TO HIPPOCAMPAL SUBVOLUMES ON MEMORY OUTCOMES IN PITUITARY TUMORS: DOES THE ENTIRE HIPPOCAMPUS NEED TO BE SPARED?
Authors: Dasgupta Archya , Thomas Ajay , Sahu Arpita , Agarwal Ujjwal , Chatterjee Abhishek , Goswami Savita , Gaikwad Utpal , Singh Vikas , Shetty Prakash , Moiyadi Aliasgar , Sahay Ayushi , Sridhar Epari , Jalali Rakesh , Gupta Tejpal , Goda Jayant Sastri 
Published: November 2022

Abstract

INTRODUCTION
In patients treated with radiation (RT), doses to hippocampus influence neurocognitive outcomes. However, the role of hippocampal subvolumes in memory functioning has not been reported, which prompted the current study.

METHODS
Adults ( &gt; 18 years) with pituitary tumors treated with fractionated RT (45 Gy/ 25 fractions/ 5 weeks) were accrued in the prospective study. Hippocampus was delineated on T1-weighted 3D-FSPGR sequences with 1mm slice thickness. The head, body, and tail of hippocampus were drawn for the current study based on the consensus of two neuroradiologists. The anatomical landmarks were: head (basilar artery to interpeduncular cistern), body (interpeduncular cistern to superior colliculus), and tail (beyond superior colliculus). Memory assessment was done pre-RT and 18 months post-RT by dedicated neuropsychologist using Weschler Memory Scale. The dose-volume parameters (maximum, mean, D10-D100) were extracted from bilateral hippocampus and subvolumes individually, which were correlated with the memory outcomes. Binary endpoints of &gt; 5% drop of memory quotient (MQ) or not at 18 months were used for analysis using an independent t-test or Mann Whitney test as appropriate.

RESULTS
Of 25 patients included in the analysis, 11 had drop of MQ &gt; 5% at 18 months. The left and right hippocampus doses of D10, D20, and D30 were significantly higher in patients with higher memory decline. For the subvolumes, only dose to bilateral head had statistically significant impact on MQ. Mean doses for patients with &gt; 5% MQ drop for left and right heads were 26 Gy and 24 Gy compared to 21 Gy and 19 Gy, respectively, for the other group.

CONCLUSION
Doses to bilateral hippocampus were shown to impact short-term memory. Of the subvolumes, only head appeared significant in memory functioning from the current pilot study, opening a window for exploring stricter dose constraints towards hippocampal head for primary or metastatic brain tumors.
NCOG-41. INTEGRATING NEUROPSYCHOLOGICAL CARE INTO A PEDIATRIC LONG-TERM SURVIVORSHIP CLINIC
Authors: Hess Colleen 
Published: November 2022

Abstract
Pediatric cancer survivors are vulnerable to neurocognitive deficits due to their treatment history including chemotherapy and radiation therapy. These treatments are associated with damage to the brain’s white matter pathways, contributing to neurocognitive “late effects” such as deficits in processing speed, working memory, executive function, visuospatial abilities, and fine motor skills. However, these neurocognitive deficits may go undiagnosed and therefore unsupported due to difficulties accessing neuropsychological care. This study seeks to improve survivors’ access to care, thereby increasing the likelihood of patients obtaining educational and therapeutic supports when needed, by integrating brief neuropsychological screenings into an existing medical clinic. During survivors’ annual oncology clinic visit, patients were administered a neurocognitive screening battery to assess their working memory, processing speed, and executive functions and thereby determine which patients would benefit from more comprehensive neuropsychological testing. The current sample of 22 patients (55% female) ranges from 6 to 21 years of age (M = 14). Based on testing performance, 23% of the sample (n = 5) demonstrated neurocognitive deficits according to the Neuropsychological Impairment Rule (NIR), and therefore was referred for more comprehensive neuropsychological assessment. Additionally, 9% of the sample (n = 2) was referred for further assessment, despite not meeting the NIR threshold, due to report of academic concerns. Importantly, 68% of the sample (n = 15) did not meet the NIR threshold and did not endorse neurocognitive concerns, and therefore did not require referral for further neuropsychological assessment. Current results demonstrate the utility of integrating neuropsychological care into long-term survivorship clinics via a neurocognitive screening battery as the majority of patients did not evidence significant deficits and therefore were adequately served from a neuropsychological lens without requiring additional assessment. In addition to increasing access to care, these efforts help to preserve families’ resources and reduce waitlists for patients in need.
EXTH-58. UNRAVELING THE MECHANISMS UNDERLYING THE THERAPEUTIC EFFICACY OF TIM-3 BLOCKADE IN DIPGS
Authors: Ausejo-Mauleon Iker , Labiano Sara , Laspidea Virginia , de la Nava Daniel , Marco-Sanz Javier , Tallón-Cobos Antonio , Becher Oren , Li Jiang , Filbin Mariella , Pastor Fernando , Alonso Marta M 
Published: November 2022

Abstract
Diffuse intrinsic pontine glioma (DIPG) is an aggressive brain tumor and the leading cause of pediatric death caused by cancer. Despite great strides in the understanding of this disease, the survival is still dismal. One of the objectives of our lab is to modulate the tumor microenvironment (TME) towards a proinflammatory phenotype to render these tumors amenable to immunotherapy. TIM-3 is a member of the TIM-family of immunoregulatory proteins expressed on multiple immune cell types, including T-cells, NK, myeloid populations, and microglia, regulating adaptive and innate immunity. In silico assessment of TIM-3 expression in DIPG mRNA and single-cell datasets showed a robust expression of this gene in tumor cells and microglia uncovering this molecule as a potential target in DIPGs. In vivo studies showed that TIM-3 blockade with an antibody significantly increased the overall survival of two DIPG immunocompetent orthotopic models, led to long-term survivors (50%), and showed immune resident memory. TIM-3 inhibition resulted in a significant increase in the number and proliferative state of microglia, NK, and CD8+ cells and higher levels of IFNγ, GrzB and TNFα corresponding to NK and T-cell activate phenotypes. Interestingly, there was a decrease in the Treg population, which causes an increase in the pro-inflammatory CD8/Treg ratio. Chemokine studies demonstrated an augmentation of CCL5, CCL2 chemotactic cytokines, and CXCL10/IL-1β/IFN-γ pro-inflammatory axis in the tumor microenvironment of treated-mice. Additionally, DCs, CD4+, and CD8+ cells were increased in treated draining lymph nodes and of functional significance, expressed higher amounts of pro-inflammatory cytokines than in control mice. Interestingly, the depletion of the different immune populations did not completely abrogate the treatment efficacy indicating a residual although significant TIM-3 effect in the tumor. In conclusion, these data uncover TIM-3 as a potential target for the treatment of DIPG and its potential as an immune regulator of DIPG TME.
QLTI-03. AN INNOVATIVE APPROACH TO ACCESSIBLE INFORMATION FOR BRAIN TUMOUR PATIENTS AND THEIR LOVED ONES
Authors: Hurwitz Victoria , La Jessica , Hedges Sarah , Robinson Charlotte , Kostick Ellie , Suarez Aeron , Lavrador Jose , Bhangoo Ranjeev , Brazil Lucy 
Published: November 2022

Abstract
Patient information for cancer patients is acknowledged for its vital contribution to informed consent and a positive patient experience. It forms a measure to which UK oncology centres are held to account in the national cancer patient experience survey. It could be argued that this has driven the production of such information rather than it being designed to best meet the need of the neuro-oncology patient. With this in mind a YouTube channel was set up after consulting current High Grade Glioma patients on their preferred medium. Patients wanted short clips in a conversational style explaining aspects of their treatment and the pathway. They wanted it to be available in a medium that they were familiar with either s a podcast or YouTube shorts. The CNS team requested patients choose the name of the channel and began making short videos with patients and professionals on subjects suggested by patients. In twelve weeks, we have produced 23 videos, which have had 2282 views and 105 hours of watch time. The average person watches for two hours and forty-six minutes. It is possible to extrapolate from this that people are engaging with the content. The availability of information in this form has reduced the length of conversations and emails with the CNS’s pre-operatively. Patients have reported a greater sense of comfort from hearing other patient’s stories. The authors acknowledge there is not enough data available yet to formerly support this. In conclusion patient information should be designed to meet the needs of the patient not the guidance. It needs to be accessible to patients who have neurological impairments including changes in vision and concentration and provided in a medium that is current, visual and easily accessible.
QOL-09. NAVIGATING DISABILITY INSURANCE FOR PATIENTS DIAGNOSED WITH LOW-GRADE GLIOMA
Authors: Yogendran Lalanthica , Rudolf Mark , Yeannakis Drew , Fuchs Kathleen , Schiff David 
Published: November 2022

Abstract
Central nervous system tumors and their treatments can cause neurologic, cognitive, and psychiatric symptoms that restrict a patient’s ability to work. In the United States, a diagnosis of high-grade glioma (grade 3 or 4) medically qualifies a patient for disability benefits through Social Security. Low-grade gliomas can be similarly debilitating, with at least 50% of patients presenting with one or more cognitive deficits and 80% of patients with tumor-related epilepsy. In light of these serious symptoms, it is unsurprising at least half of patients with low-grade glioma do not return to work within one year of diagnosis. Yet a diagnosis of low-grade glioma does not in and of itself qualify patients for disability benefits; the burden of proof is substantially higher. Thus, patients with low-grade glioma require special attention as they seek disability benefits. Here, we outline the process of medical documentation to support disability benefits, Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). We provide a template to assist providers in facilitating the application process for patients with low-grade glioma seeking disability benefits. The provider’s role is not to simply “declare” a patient disabled, but rather to provide comprehensive documentation regarding the patient’s diagnosis, treatment, response to treatment, symptoms, and functional status in the medical record. As cognitive symptoms and seizures are two key sources of disability in low-grade glioma patients, referrals to neuropsychology and epileptology, among other sub-specialties, are key to improve patient care and bolster documentation of the patient’s symptoms in these domains. Likewise, connecting patients with social workers and disability claims representatives can assist them in navigating the complicated application process. Providers are better able to help their patients navigate the disability application process when they understand how disability evaluations work and what key information evaluators seek.
QOL-10. NOVEL MULTIMODAL STUDY OF THREE COGNITIVE REHABILITATION INTERVENTIONS IN LOWER GRADE GLIOMA
Authors: Jamora Christina Weyer , Brie Melissa , Bracci Paige , Smith Ellen , Luks Tracy , Phan Stephanie , Braunstein Steve , Villanueva-Meyer Javier , Gehring Karen , Aguilera Adrian , Bush Nancy Ann Oberheim , Butowski Nicholas , Clarke Jennifer , Daras Mariza , de Groot John , Chang Susan M , Hervey-Jumper Shawn L , Taylor Jennie 
Published: November 2022

Abstract

BACKGROUND
Grade 2 and 3 glioma survivors (LrGG) are living longer, yet experience cognitive impairments with diminished quality of life (QOL). We present a novel multimodal study of three cognitive rehabilitation interventions in stable LrGG survivors.

METHODS
Participants were radiologically stable adult LrGG patients who were off medical treatment for ≥ 6 months with subjective and objective cognitive impairments ( &gt;1SD in 2 or more domains). Patients were offered either In-person cognitive rehabilitation (strategy training including telehealth), or randomized to App-based cognitive rehabilitation (retraining and strategy training) versus Text messaging (strategy training). Intervention duration was 3 months. Neuropsychological testing (with parallel forms) and QOL assessments were conducted at baseline (T1), immediate post intervention (T2), and 6-month follow-up (T3), and analyzed with repeated measures regression or Wilcoxon signed rank tests.

RESULTS
Of the 33 analyzed (enrollment ongoing); 15/17 In-person, 5/8 App-based, and 8/8 Texting completed ≥ 80% or greater of interventions. Demographic and clinical characteristics were similar between cohorts. Median age was 48 years (range 27-63), 58% astrocytoma, 30% oligodendroglioma, 15% other (1 pilocytic astrocytoma, 4 diffuse glioma NOS), and 76% had prior radiotherapy. Rehabilitation interventions showed improvements in auditory working memory (T1-T2 In-person p= 0.02, eta2= 0.32-medium effect), verbal learning (T1-T3 App-based p= .06, eta2= 0.54-large effect; T1-T3 Texting p= .01, eta2= 0.75-large effect), and verbal memory (T1-T3 App-based p= .06, rho=0.31-medium effect).

CONCLUSION
Significant improvements in cognitive impairments were found with medium to large treatment effects within each cohort. Cognitive rehabilitation via In-person and Texting showed strongest feasibility and acceptability. In-person cognitive rehab showed earlier posttreatment improvements whereas treatment effects for App-based and Texting were noted, but took longer to realize gains. These interventions may show promise for addressing cognitive impairments in LrGG survivors and warrant further investigation.
SURG-15. MINIMALLY INVASIVE PREFRONTAL APPROACH FOR GLIOMAS: TECHNICAL DESCRIPTION AND ASSOCIATED COMPLICATIONS
Authors: del Pont Francisco Marcó , Merenzon Martin , Morell Alexis , Higgins Dominique , Patel Nitesh , Kader Michael , Eichberg Daniel , Shah Ashish , Silva Michael , Luther Evan , Lu Victor , Komotar Ricardo , Ivan Michael 
Published: November 2022

Abstract

INTRODUCTION
Classical prefrontal approaches exposed the lateral surface of the frontal lobe. Minimally invasive (MI) approaches achieved to reduce soft tissue damage and craniotomy size without affecting tumor resection grade. This is associated with shorter hospital stays and faster return to preoperative daily activities.

OBJECTIVE
To describe the MI prefrontal glioma resection technique developed in our department and to analyze our surgical results.

METHODS
We performed a retrospective review of patients who underwent prefrontal lobe glioma (WHO grade II-IV) resection using an MI approach in 2016-2021 at the University of Miami Hospital. Re-surgery, biopsy-only patients, multicentric tumors, and patients with less than four months of follow-up were excluded. Demographic and clinical data were collected. A 4-5 cm linear incision is done, starting at 1 cm lateral to the sagittal suture and extending towards the superior temporal line. An ellipsoidal-shaped mini-craniotomy is performed.

RESULTS
Thirty-four patients were included. The mean age was 50.2 years old, with 20 male subjects. Twenty-two patients had high-grade gliomas (HGG) and 12 patients had low-grade gliomas (LGG). On average, patients were discharged 1.97 days after surgery. The mean craniotomy area was 15,5 cm2 (7-43 cm2). The mean tumor volume was 64,5 cm2 ( 9 -165.8 cm2). Two wound infections and one case of aseptic meningitis were observed in patients with craniotomies &gt; 15 cm2, while the group with craniotomies &lt; 15 cm2 had no perioperative complications. In the HGG group, a supramaximal resection (SMR) was achieved in 8 patients, 9 HGG patients had gross total resection (GTR) or near-total resection (NTR), and 5 patients had subtotal resection (STR). In the LGG, GTR was achieved in 10 patients and STR in 2 patients.

CONCLUSION
MI prefrontal approach for frontal gliomas is safe and feasible with minor complications, short hospital stay, and without sacrificing tumor resection volume.