bluuebunny/crossref_metadata_2025_split huggingface dataset:
NCMP-14. NEUROTOXICITY AFTER A SINGLE CYCLE OF INTRAVENOUS CYTARABINE
Authors: Herbst John , Grommes Christian , Schaff Lauren 
Published: November 2022

Abstract
Cytarabine neurotoxicity is well-documented, typically occurring after intrathecal treatment or a cumulative systemic dose of 36 g/m2. Encephalopathy, myelopathy, and acute cerebellar syndrome have all been described, with risk factors including advanced age and renal dysfunction. Here, we report a case of acute cerebellar syndrome after a single cycle of intravenous cytarabine 3 g/m2. This 65 year old man with history of chronic kidney disease (baseline creatinine 2.0 mg/dL) and primary central nervous system lymphoma had unconfirmed complete response after induction therapy with rituximab, methotrexate, and vincristine. Methotrexate was dosed between 1 -2 g/m2 due to renal dysfunction and delayed clearance. Given patient’s performance status and comorbidities, high-dose cytarabine consolidation was chosen. He received 3 g/m2 intravenously on days 1 and 2 of a 28-day cycle. On day 5, he developed acute truncal ataxia and was no longer able to sit or stand unsupported. He then presented to the emergency department on day 8 with persistent symptoms. Vital signs showed mild hypertension without orthostatic hypotension. Neurologic exam revealed postural instability, titubation, and inability to maintain seated posture with eyes closed. He had no dysmetria on finger-nose or heel-shin testing. Blood values were notable only for an elevated creatinine of 2.1 mg/dL. CT head revealed no acute pathology. MRI brain showed no infarct or recurrent disease. He was discharged home and symptoms resolved by day 10. Given clinical syndrome of truncal ataxia shortly after cytarabine, we diagnosed cytarabine-related neurotoxicity. Further cycles of consolidation were withheld for close observation. While cytarabine-related neurotoxicity is more common after an increased cumulative dose, it can occur after only a single cycle of 3 g/m2. Our patient’s age and baseline renal dysfunction likely predisposed him. Cytarabine dose-reduction can be considered in patients with these risk factors.
NCMP-16. UNIQUE PARANEOPLASTIC SYNDROME ASSOCIATED WITH CLL
Authors: Boldig Catherine , Warman Mark , Verma Neha , Mokhtari Sepideh 
Published: November 2022

Abstract
Chronic lymphocytic leukemia is a hematologic malignancy characterized by overproduction of monoclonal B cells. Most people diagnosed with CLL do not immediately undergo treatment due to treatment guidelines. There are few cases of paraneoplastic syndrome associated CLL. This case is unique in that it is a paraneoplastic KLHL 11 antibody associated CLL. The patient is a 68-year-old female who originally presented to the hospital with abdominal pain and upon further imaging was found have retroperitoneal lymphadenopathy. After further studies including flow cytometry, she was diagnosed with CLL. She failed trials of Pembrolizumab, ibrutinib, and Obinutuzumab due to side effects. The patient then started experiencing excessive fatigue, bilateral temporal headache, nausea, vomiting, vertigo, tremor of bilateral upper extremities, and head bobbing. Her brain imaging was negative for acute abnormalities. Lumbar puncture was positive for CLL cells and the paraneoplastic panel came back positive with KLHL 11 antibodies. The patient’s symptoms continued to persist and her tremor and dysmetria continued to worsen. Due to the positive paraneoplastic panel, the patient was started on intravenous immunoglobulin but did not experience improvement. She was then trialed on intravenous methylprednisolone and still experienced no relief. She then underwent plasma exchange. Finally, she was given rituximab infusions with slight improvement. Her imaging remained negative for signs of leptomeningeal enhancement. Given the patient’s symptoms, negative brain imaging, and positive paraneoplastic panel, it was determined that the patient developed an irreversible paraneoplastic syndrome related to her CLL versus possible leptomeningeal disease. There are a few cases of paraneoplastic syndrome associated CLL involving paraneoplastic phemphigus, hypercalcemia, and nephrotic syndrome. This case is unique in that her symptoms presented with an ataxic syndrome with positive KLHL11 antibodies. It is important to be aware that some cases of CLL can present with unique paraneoplastic syndromes.
NCMP-20. NUMB CHIN SYNDROME: ATYPICAL PRESENTATION OF METASTATIC BREAST CANCER
Authors: Bureau Britta , Connelly Jennifer , Barkhaus Paul , Brennan Ryan 
Published: November 2022

Abstract

OBJECTIVES
1. To report a variation of Numb Chin Syndrome (NCS) 2. Raise awareness and early localization of NCS to more efficiently develop a targeted treatment plan to prevent tumor spread and potentially improve clinical outcomes and survival.

INTRODUCTION/BACKGROUND
NCS is an uncommon but known complication of cancer. Prompt recognition is imperative to directed treatment. In some instances, numb chin may be complicated by other findings.

CASE REPORT
A 53-year-old female with past medical history of estrogen receptor positive invasive ductal breast carcinoma underwent partial mastectomy, chemotherapy, and radiation. After 6 years remission, new lung and liver metastases occurred, and chemotherapy resumed. Imaging was negative. Eight weeks later, she developed left chin numbness followed by progressive difficulty retaining food and drink. Her left lower lip weakened. Neurological examination revealed left lower lip weakness (showing a “droop” with attempted smile). The area of decreased sensation to sharp touch had expanded from the left chin to the nasolabial fold. The remainder of her neurological examination was unremarkable. Contrast-enhanced MRI was repeated which revealed a 1.9 cm enhancing left parotid mass. SUMMARY/

CONCLUSION
NCS is defined as an ipsilateral loss of chin sensation. If there is no history of trauma or dental injury and especially if the presentation is atypical, then cancer is the most likely etiology. This case began as an uncomplicated NCS that rapidly expanded to involve a greater portion of the trigeminal nerve distribution, in addition to a branch of the facial nerve. Thus, each focal deficit was not the result of separate distal nerve lesions, but rather partial proximal cranial neuropathies at their parotid gland propinquity.
NCMP-24. RISK FACTORS OF SURGICAL SITE INFECTION IN GLIOMA SURGERY
Authors: Kuwano Atsushi , Nitta Masayuki , Saito Taiichi , Ikuta Soko , Tsuzuki Shunsuke , Koriyama Shunichi , Kawamata Takakazu , Muragaki Yoshihiro 
Published: November 2022

Abstract

BACKGROUND
Surgical site infection(SSI) in neurosurgery can increase mortality and worsen functional outcome. There are few reports on risk factors for SSI in glioma surgery. In this study, we investigated the risk factors for SSI in glioma surgery at our institution.

METHODS
We included 1013 patients with gliomas who underwent craniotomy between November 2013 and March 2022 at our institution. SSI was defined as requiring surgical treatment. Various factors including age, gender, number of operations, prior radiology, prior chemotherapy, use of intraoperative MRI, operation time, tumor WHO grade were investigated.

RESULTS
Among 1013 craniotomies, 31 (3.06%) cases of SSI required surgical procedure. In univariate analysis, the most significant factors were multiple prior craniotomy (p = 0.0067) and prior radiation therapy ( p = 0.0286). Among these factors, multivariate analysis revealed the number of surgeries ( p = 0.0151) as a significant independent factor for infection.Discussion and

CONCLUSION
Patients with gliomas often requires multiple craniotomy due to tumor recurrence. Although there have been reported the reoperation is an independent risk factor for postoperative infection, the is the first time that a specific number of prior surgeries ( 2 or more) has been reported. Radiotherapy is said to cause skin damage at a threshold of 10 Gy or less. Since radiation therapy for gliomas is given a dose of 50 Gy or more and irradiated scalp causes radiation dermatitis, and patients who have undergone prior radiotherapy must be carefully monitored.
NCOG-04. RANO-BM RESPONSE CRITERIA VERIFICATION STUDY IN A SRS-TREATED COHORT
Authors: Douri Keiss , Iorio-Morin Christian , Mercure-Cyr Rosalie , Figueiredo Gabrielle , Touchette Charles , Masson-Côté Laurence , Mathieu David 
Published: November 2022

Abstract
Brain metastases are frequently seen in neurosurgical practice. Standardised criteria are created to better classify these common pathologies in research studies. This study’s goal was to evaluate RANO-BM (Response Assessment in Neuro-Oncology - Brain Metastases) criteria’s current thresholds in a cohort of patients with brain metastases managed by stereotactic radiosurgery (SRS). We performed a retrospective metastasis-level analysis of patients treated with SRS for brain metastases. The data collected included cohort demographics, metastases characteristics, outcomes, and the rate of true positives, false negatives, true negatives and false positives as defined by RANO-BM criteria at last follow-up before second SRS. 251 metastases in 50 patients were included in the analysis. RANO-BM criteria using current thresholds yielded a sensitivity of 38%, a specificity of 95%, a positive predictive value of 71% and a negative predictive value of 84%. Modified RANO-BM criteria using absolute diameter differences of 2.5 mm yielded a sensitivity of 83%, a specificity of 87%, a positive predictive value of 67% and a negative predictive value of 94%. Pseudoprogression occurred significantly earlier than tumor progression, with a median time of onset of 6.9 months and 12.1 months respectively. Current RANO-BM criteria unreliably identifies clinically relevant tumor progression, but are useful in assessing diameter increases caused by tumor progression and pseudoprogression.
NCOG-08. IMPACT OF IMMUNOTHERAPY ON PREVALENCE OF BRAIN METASTASES IN MALIGNANT MELANOMA: A REAL-WORLD POPULATION-LEVEL ANALYSIS
Authors: Bhanja Debarati , Baroz Angel , Stahl Caleb , Wilding Hannah , Mansouri Alireza 
Published: November 2022

Abstract

INTRODUCTION
Melanoma brain metastases (MBM) are often associated with poor prognosis. Over the last decade, the treatment paradigm for malignant melanoma shifted with the introduction of immunotherapies (ITs), including ipilimumab (ipi) and nivolumab (nivo). Recent clinical trials suggest that IT offers a survival benefit in MBM and may suffice as the sole intervention in those with small, asymptomatic lesions. Secondary trial analyses suggest IT may reduce rates of BM. The goal of this study was to assess the potential impact of IT in reducing prevalence of MBM in a real-world population-level analysis.

METHODS
A retrospective query of TriNetX, a database that collates clinical data from 92 healthcare organizations, was performed. Melanoma patients without brain metastases at diagnosis were stratified as: 1) ipi and nivo (dual-IT), 2) ipi alone (single-IT), or 3) no IT treatment (no-IT). A new diagnosis of MBM, from one month of initiating IT to any time after, was compared among cohorts. Median overall survival (OS) of MBM patients were calculated and compared using Kaplan Meier analysis and log-rank tests.

RESULTS
732,555 melanoma patients were included (717,408 no IT, 4,585 dual-IT, 4,101 single-IT). Mean ages at MBM diagnosis were 66.9, 61.5, and 63.2 years, respectively. MBM prevalence was 1.5%, 9.6%, and 15.6%, for the respective cohorts (p &lt; 0.0001). Dual-IT was associated with a lower rate of MBM compared to single-IT (OR [95%CI], 0.64 [0.61-0.77]). After propensity score matching for age, sex, and comorbidities, median OS were not statistically different between the no-IT, dual-IT, and single-IT cohorts (347, 400, 414 days) for MBM patients.

CONCLUSION
This analysis of real-world data suggests that dual-IT for malignant melanomas decreased the incidence of MBMs compared to single-IT. However, survival outcomes remain comparable once patients succumb to the MBM diagnosis. Prospective studies are underway to look at MBM prevalence given various dual-IT.
NCOG-10. SURGERY FOR RECURRENT GBM: A RETROSPECTIVE CASE-CONTROL STUDY
Authors: Voisin Mathew , Zuccato Jeffrey , Wang Justin , Zadeh Gelareh 
Published: November 2022

Abstract

OBJECTIVE
The role of surgery in recurrent GBM remains a controversial topic. The goal of this study was to perform a case-control analysis including time to tumor recurrence as an additional prognostic factor in order to determine which patients benefit most from repeat surgery.

METHODS
Our brain tumor database was reviewed over a ten-year period for all adult (≥ 18 years old) patients with primary IDH wildtype GBM that received surgery for recurrent disease. These patients were then age, sex, and treatment-matched to case-controls from our institution that received medical therapy for recurrent disease.

RESULTS
A total of 174 adult patients with GBM were included in the study, 87 patients that received surgery for recurrent GBM (surgery cohort) and 87 patients that did not receive surgery for recurrent GBM (non-surgery cohort). The surgery cohort had longer overall survival (p = 0.0003) and post recurrence survival (p = 0.001) than the non-surgery cohort. When the surgery cohort was split into two groups based on time to tumor recurrence, the long time to recurrence group ( &gt; 6 months) demonstrated significantly increased survival compared to the short time to recurrence group (p &lt; 0.0001). Multivariate analysis of both cohorts demonstrated surgery for recurrent GBM was independently significant after adjusting for age, KPS, and time to tumor recurrence (p &lt; 0.0001).

CONCLUSIONS
Surgery for recurrent GBM leads to improved survival independent of age, KPS, and time to tumor recurrence. Patients with time to tumor recurrence greater than 6 months benefit most from additional surgery.
NCOG-12. IMPACT OF TUMOR-RELATED SEIZURES ON MENTAL HEALTH DISORDER ORDER IN LOW-GRADE GLIOMA
Authors: Bhanja Debarati , Ba Djibril , Tuohy Kyle , Wilding Hannah , Trifoi Mara , Padmanaban Varun , Liu Guodong , Sughrue Michael , Zacharia Brad , Leslie Douglas , Mansouri Alireza 
Published: November 2022

Abstract

INTRODUCTION
Majority of LGG patients experience seizures during their disease course, requiring anti-epileptic drugs (AEDs). Frequent seizures negatively impact health-related quality of life (HRQoL). AEDs, moreover, are hypothesized to have mood-modulating effects. As survival for LGG patients has been improving, it is essential that the impact of seizure burden and AEDs on mental health disorders (MHD) be considered. The objective was to measure an association of tumor-related seizures with MHD onset among LGG patients.

METHODS
This retrospective cohort study queried data from the IBM Watson Health MarketScan® Claims and Encounters Database (2005-2014) to identify LGG patients without prior MHD history who experienced glioma-related seizures. Presence of seizures was determined by anti-epileptic drug fills within one year following LGG diagnosis. Patients with new onset of MHDs were identified using ICD-9 codes for MHDs and psychotropic drug fills in the 12 months post-LGG diagnosis period. Unadjusted odds ratios measured associations between seizures and MHD prevalence.

RESULTS
11,458 LGG patients with no history of MHD were included; 1,799 (15.7%) experienced seizures within 12 months of LGG diagnosis. Among them, 494 (27.5%) developed MHD in the post-LGG diagnosis period. Patients who experienced seizures were more likely to develop an MHD compared to patients who did not (OR, 2.19, 95% CI, 1.95–2.47). MHD incidence was significantly associated with female gender (OR, 1.14, 95%, 1.03–1.26) and age range of 35–44 (OR, 1.20, 95%, 1.03–1.39) compared to 18–34.

CONCLUSION
These findings demonstrated that tumor-related seizures were associated with MHD onset. This highlights the burden of seizures and regular AED use on mental health. The psychosocial and neurological aspects related to seizures and AEDs likely contribute to the multifaceted mental health disorder onset seen among these LGG patients. Proactive counseling, diagnosis, and management of MHDs in LGGs, particularly those with seizures, is warranted.
NCOG-15. A PILOT STUDY ON RETINAL FEATURES AND COGNITIVE FUNCTION IN PATIENTS WITH LOW GRADE GLIOMAS
Authors: Liu Yin Allison , Aboud Orwa , Daly Megan , Bloch Orin , Yiu Glenn 
Published: November 2022

Abstract

BACKGROUND
Retinal structure and vascular changes are used as biomarkers for preclinical Alzheimer disease. We conducted a cohort study to evaluate the feasibility of obtaining these data in patients with low-grade gliomas (LGGs) who completed chemoradiation therapy with and without self or family reported cognitive concerns.

METHODS
Optical coherence tomography (OCT) and angiography (OCTA, OptoVue, Inc.) images were obtained from 6 LGG patients and 2 healthy controls using 4.5 x 4.5 mm peripapillary and 6x6 mm macular scan patterns. We measured OCTA parameters including radial peripapillary capillary density for the peri-optic disc region, whole macular density, and foveal avascular zone (FAZ).

RESULTS
We analyzed two eyes of two control subjects, an LGG patient with normal cognition, and 5 LGG patients with cognitive impairment (mean age 45 years, range of 3 months to 10 years after chemoradiation). Both controls had normal eye exams. Average retinal nerve fiber layer thickness was thinner in patients with and without cognitive dysfunction (104 um and 106 um, respectively) than controls (123 um). A similar pattern was seen in macula thickness (283 um and 290 um vs. 325 um). The average peripapillary vessel densities were lower in patients with and without cognitive dysfunction (47.7% and 48.3%, respectively) than controls (51.9%). The whole macular vessel densities were similar in three groups (46.7 %, 48.0%, and 48.0 %). Average FAZs were larger in patients with cognitive dysfunction (0.254 mm2) than the patient with normal cognition (0.204 mm2) and controls (0.226 mm2).

CONCLUSIONS
Retinal architecture and microvascular changes measured by OCT/OCTA is feasible in LGG patients after chemoradiation. A larger prospective study is needed to investigate the role of OCT/OCTA in detecting peripapillary and perifoveal changes in brain tumor patients with treatment-associated cognitive dysfunction.
NCOG-21. EFFECT OF PNEUMOCYSTIS JIROVECII PNEUMONIA PROPHYLAXIS ON HEMATOLOGIC TOXICITY IN PATIENTS RECEIVING CHEMORADIATION FOR PRIMARY BRAIN TUMORS
Authors: Arnold Lisa , Hoshina Yoji , Lee Hyejung , Haaland Benjamin , Colman Howard , Mendez Joe 
Published: November 2022

Abstract

INTRODUCTION
Management of diffuse gliomas often includes radiation plus concomitant and adjuvant temozolomide. Hematologic toxicities are common from this therapy. Patients frequently receive prophylaxis against pneumocystis jirovecii pneumonia (PJP) during chemoradiation; however, some PJP prophylaxis drugs have the potential to independently cause myelosuppression which could exacerbate the hematologic toxicities from chemoradiation requiring chemotherapy dose reduction or cessation. We seek to understand differences in the frequency of hematologic toxicities during chemoradiation when either trimethoprim/sulfamethoxazole (TMP/SMX) or pentamidine are used for PJP prophylaxis.

METHODS
This was a retrospective chart review of patients with primary brain tumors who were treated with first-time radiation and concurrent temozolomide between April 2014-August 2021 at the Huntsman Cancer Institute. Chi squared analysis was used to evaluate effect of choice of PJP prophylaxis on risk for neutropenia, lymphopenia, or thrombocytopenia within one month of finishing chemoradiation. Logistic regression was performed to evaluate the effect of PJP prophylaxis on the Common Terminology Criteria for Adverse Events (CTCAE) score for the lowest neutrophil, lymphocyte, and platelet count.

RESULTS
217 patients were included in analysis. 144 patients received TMP/SMX, 69 received pentamidine, 1 received dapsone, and 3 received no prophylaxis at initiation of chemoradiation. Of patients who received TMP/SMX, 15.4% developed an absolute neutrophil count &lt; 1,500 cells/µL while this occurred in 7.2% of patients receiving pentamidine (p=0.10). Platelet count &lt; 100,000 occurred in 18.1% of patients who received TMP/SMX and 20.3% of patients who received pentamidine (p=0.70). Worst CTCAE scores for hematologic toxicities were similar between PJP prophylaxis groups.

CONCLUSION
Our study provides preliminary evidence that the type of PJP prophylaxis does not appear to significantly impact risk for hematologic toxicity in patients receiving radiation and concurrent temozolomide; however, there was a trend toward higher rates of neutropenia with TMP/SMX and larger analyses are needed to further evaluate these findings.
NCOG-24. TIME TO FIRST RECURRENCE AND SURVIVAL IN IDH-WILDTYPE GLIOBLASTOMA
Authors: Pan Peter , Joanta-Gomez Adela , Yuen Carlen , Donovan Laura , Haggiagi Aya , Welch Mary , Iwamoto Fabio , Lassman Andrew 
Published: November 2022

Abstract

INTRODUCTION
Time to recurrence is a source of considerable anxiety in glioblastoma. Assuming survival to a certain timepoint without tumor progression, how do odds/outcomes change relative to initial starting conditions? Is there a single timepoint with highest risk of tumor progression, after which "the longer you go, the longer you go"?

METHODS
Newly-diagnosed glioblastomas were retrospectively reviewed (n=209). Pre-2012 diagnoses (n=2) & IDH-mutants excluded (n=8). Median PFS/OS and remaining time to mPFS were calculated for sub-populations without disease progression (POD) at 0, 3, 6, 8, 12, and 24 months post-surgery.

RESULTS
199 IDH-wildtype glioblastomas identified -- 40% women, median age 63 years (range 26-91), 43% gross-total resection, 65% MGMT unmethylated, 65% upfront RT 60Gy (23% 40Gy) -- mPFS 8 months / mOS 19 months. Patients without POD within 3 months had mOS 20 months. Outcomes progressively improve at later timepoints-- mPFS 10/13/20/39 months and mOS 23/27/39/65 months, for patients without POD at 6/8/12/24 months post-surgery respectively. Patients without POD at 24 months comprised 10% of original cohort (n=20; 8 deaths). As a surrogate for risk of tumor progression, remaining time to mPFS was calculated (taken as difference between timepoint in question, and mPFS for the population of patients without POD up to that timepoint) and followed a J-shape curve -- 8 months (at 0 months post-surgery), 4 months (for patients without POD at 6 months post-surgery), 7-8 months (for patients without POD at 10-14 months post-surgery), to 13 and 15 months (for patients without POD at 18 and 24 months post-surgery, respectively).

DISCUSSION
Sub-populations without early progression appear to have improved survival relative to baseline, which has implications for clinical trials without internal controls. Nevertheless, highest risk for tumor progression seems to be at 6 months post-surgery, after which it appears "the longer you go, the longer you go."