bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival Outcomes of Stereotactic Radiotherapy for Ten or More Brain Metastases
Authors: Rozati Hamoun , Williams Matt 
Published: October 2022

Abstract

AIMS
Discrepancies exist in the use of stereotactic radiotherapy (SRT) for patients with 10 or more brain metastases. Concerns include multiple metastases being associated with poor survival and the lack of prospective data. We analysed survival outcomes of these patients in a multi-centre cohort.

METHOD
We performed a retrospective cohort study of 511 consecutive patients from three SRT centres treated for brain metastases between January 2010 - August 2021, censored in January 2022. We assessed survival post-SRT of patients with ≥10 metastases against a matched group of 5-9 and 1-4 metastases using the logrank test for statistical testing. We used a multivariate Cox model to assess the relationship between overall survival and: number of metastases; total volume; primary malignancy; use of systemic anti-cancer therapies with intracranial penetrance; controlled extracranial disease. Results with p-values &lt;0.05 were considered significant.

RESULTS
Survival data was available for all patients, and for 85-100% of factors in multivariate analysis. 63 patients had ≥10 metastases (median 19). Median survival was 13.3 months, compared with 15.1 and 19.0 months for the 5-9 and 1-4 metastasis groups respectively. Differences were not statistically significant (p-value 0.14). Increasing volume of disease (HR 1.05 [1.01-1.09], p-value: 0.01), non-small cell lung cancer (HR 3.5 [1.35-9.09] p-value: 0.01) and use of systemic anti-cancer therapy with intracranial penetrance (HR 0.239 [0.105-0.547] p-value: &lt;0.01) had a statistically significant effect on survival in multivariate analysis.

CONCLUSION
Carefully selected patients with multiple metastases have acceptable survival outcomes following SRT and this approach should be more widely considered.
Clinical Evaluation of Gamma Knife Stereotactic Radiosurgery for Metastatic Disease in Elderly Patients
Authors: Bishr Mai , Tancu Cornel , Fersht Naomi , Kitchen Neil , Kosmin Michael 
Published: October 2022

Abstract

AIMS
Gamma Knife Stereotactic Radiosurgery (GK-SRS) is an effective treatment option for limited brain metastases (BM); however, there is a paucity of data about its use in the elderly. Our aim is to explore the clinical outcomes of elderly cancer patients treated for BM with GK-SRS at our institution.

METHOD
We identified cancer patients aged ≥80 years at the time of receiving GK-SRS to BM between July 2017 and August 2021 from our electronic institutional database. Descriptive statistics and Kaplan–Meier analysis were performed using SPSS v.22.

RESULTS
A total of 24 patients were identified, with a median age of 83 years (range 80.1-89.9). The most common primary tumours were melanoma (58.4%) and lung (20.8%). In 14 patients (58%), multiple BM were treated simultaneously with a median of 2 lesions (range 2-15). The median target volume was 1.34cc (range 0.03-15.06). Prescribed doses ranged from 18Gy – 25Gy, prescribed to the 41-97% isodose line. After a median follow-up of
6.9 months (range 1.9-49.4 months), the local control rate (LCR) was 91.3% and the median post-GK-SRS overall survival was 9.8 months (95%CI 5.4-14.3). This compares to our previously published data from our wider GK-SRS-treated BM patient cohort, which showed a median survival of 15.6 months and LCR of 94.6%.

CONCLUSION
GK-SRS is an effective treatment modality for selected cancer patients with BM, including those over 80 years of age. Multi-institutional prospective studies are warranted to further explore the safety and functional outcomes of GK-SRS in elderly cancer patients.
The Usefulness of Pre-Operative Extra-Cranial Imaging in Radiologically Suspicious Glioblastoma Multiforme in the West of Scotland: and a Proposal of an Imaging Diagnostic Pathway
Authors: Lammy Simon , McPartlin Rebecca , Bridgman Elsie , Bouttell Janet , Brown Jennifer 
Published: October 2022

Abstract

AIMS
Objective: a CT chest, abdomen and pelvis (CT CAP) is probably unnecessary if a glioblastoma multiforme (GBM) is detected on initial CT brain (CTB) prior to definitive MRI. We audited its frequency to develop a management pathway

METHOD
Methods: 12-month retrospective case series from 2018 of patients having an initial CTB suspicious for GBM. We dichotomised patients into two groups a) tissue proven and b) non-tissue proven, due to these representing distinct patient profiles. We quantified frequencies of plain and contrast CTBs, CT CAPs and extra-cranial malignancy.

RESULTS
Results: Group 1 (total n=84 [mean age 59 years]): 64% had a CT CAP. Plain CTB occurred in 24% and contrast CTB in 76%. Extra-cranial malignancy was 8% and 12%. Group 2 (total n=47 [mean age 73 years]): 85% had a CT CAP. Plain CTB occurred in 22% and contrast CTB in 78%. Extra-cranial malignancy was 33% and 23%. Negative CT CAPs in ~88% of CTBs in Group 1 and ~75% of CTBs in Group 2.

CONCLUSION
Conclusions: patients having a contrast CTB as their initial imaging modality, being suggestive of GBM, prior to definitive MRI, and managed surgically, having no history of extra-cranial malignancy, do not need a CT CAP unless MRI is non-diagnostic.
Evaluation of a Panel of 105 Cytokines from Human Glioblastoma (GBM) Tissue Maintained, and Treated, on a Unique Microfluidic Platform
Authors: Moursi Amr , Barry Antonia , Achawal Shailendra , Rajaraman Chittoor , Feugere Lauric , Beltran-Alvarez Pedro , Greenman John 
Published: October 2022

Abstract

AIMS
The first aim was to measure the changes in the levels of 105 cytokines potentially released by GBM tissue maintained on-chip. The second aim was to compare the cytokine profiles from control GBM tissue and tissue treated with anti-GBM drugs {temozolomide (TMZ) at 1 and 10μM both with 1μM arginine methylation inhibitors}.

METHOD
Intra-operative tissue biopsies were taken from the tumour and transferred immediately from the operating theatre to Hull University laboratories (&lt; 1 hour). Tissue samples were maintained in a viable state in a bespoke chip device for eight days. The biopsy was perfused (3μl/min) with culture medium, with or without drug treatment. Eﬄuents from the biopsies were collected at 24h intervals. Cytokines levels were measured using the Proteome Profiler Human XL Cytokine Array Kit (R&D Systems), each membrane is spotted with 105 different cytokine antibodies in duplicate.

RESULTS
Six GBM diagnosed patients (five negative for MGMT) were recruited and studied. Eleven cytokines showed consistent, high level, release from GBM tissue either in control or treated samples: Chitinase3-like1, IL8(CXCL8) ,MCP-1(CCL2 ),MIF(Macrophage migration inhibitory factor), MMP-9(Matrix metallopeptidase 9), Osteopontin(OPN), Serpin E1, VEGF(Vascular endothelial growth factor) ,Apolipoprotein A-I, Angiogenin and Emmprin. Multivariate analysis (PERMANOVA) did not show evidence for differential cytokine release profiles with time (P=0.113), treatment (P=0.629), , nor the combined interaction (P=0.936).

CONCLUSION
GBM biopsies remained viable on the microfluidic platform, shown by sustained cytokine production cytokines. We have also shown that treatment with TMZ plus arginine methylation inhibitors does not significantly affect cytokine release over an eight day period.
CONSENT - A Randomised Controlled Trial of Enhanced Informed Consent Compared to Standard Informed Consent to Improve Patient Understanding of Early Phase Oncology Clinical Trials – GBM Cohort (Nonrandomised) Analysis
Authors: Pal Abhijit , Daly Robert , Mohamedkhan Shybi , Grochot Rafael , Stapleton Sarah , Yap Christina , Magkos Dimitrios , Baikady Bindumalini Rao , Minchom Anna , Banerji Udai , De Bono Johann , Karikios Deme , Boyle Frances , Lopez Juanita 
Published: October 2022

Abstract

AIMS
Early phase cancer clinical trials have become more complicated and patients often misunderstand their nature and purpose. CONSENT (NCT04407676) is a randomised controlled trial testing whether enhanced informed consent for patient education can improve comprehension – since patients with glioblastoma multiforme (GBM) have a higher rate of baseline cognitive impairment, we studied this group separately.

METHOD
GBM patients (from the ICE-CAP Phase 1 study - NCT03673787), underwent the schedule for the standard CONSENT arm - full length trial PIS, Quality of Informed Consent Questionnaire Parts A and B (QuIC-A and QuIC-B), experimental intervention (2 page study aid and 10 educational videos), and a repeat QuIC-A and QuIC-B. The primary endpoint for this subgroup was the difference in QuIC-A scores before and after the intervention using a paired t-test.

RESULTS
6 patients with GBM were recruited - 3 did not complete any study questionnaires. The three pre intervention QuIC-A scores were 70, 81, 88, with a mean of 75 (unit reference 76). The three pre intervention QuIC-B scores were 69, 62, 75 with a mean of 69 (unit reference is 91). Only one patient completed the post intervention questionnaire - their QuIC-A score moved from 88 to 100.

CONCLUSION
This study demonstrates the significant difficulties in studying comprehension in patients with GBM considering early phase trials. There is a need for creative multi-modality solutions to provide information to GBM patients considering clinical trials, and novel tools to assess the effectiveness of these solutions.
Patient Information on Awake Craniotomy: A Video Leaflet
Authors: Wall Gemma , Cooke Gill , Albanese Erminia , Merron Stephen , Chan Huan , Craker Lloyd , Owen Michael 
Published: October 2022

Abstract

AIMS
An Awake Craniotomy is a neuro-surgical procedure where the patient remains awake for all or part of their surgery to allow a lesion to be maximally resected without damaging healthy brain functioning. An annual audit of our Patient Satisfaction Survey demonstrated that ‘Receiving Written Information’ was scoring below standard. A new leaflet was designed to address this and it was developed into a ‘Video Leaflet’ comprising a 10 minute audio-visual production, accessed by QR code.

METHOD
The team created a scripted description of the patient Awake Craniotomy experience. The script was coded into: audio narration, written information or video content. The areas covered were: consultations with the team; pre and intra-operative testing; fMRI scanning; hospital environments; and follow-up. The script was filmed with written consent from all involved and then collated by the Communications Department. There were several revisions made based on feedback from all involved resulting in the final product.

RESULTS
The Video Leaflet is ready to be demonstrated to and evaluated by patients using a structured questionnaire. The annual audit of Satisfaction Surveys will be compared prior to and post the introduction of the Video Leaflet to determine whether ratings for ‘Receiving Written Information’ have improved. Questionnaire results which are available by the conference date will be presented as preliminary findings.

CONCLUSION
It is anticipated that the Video Leaflet will further optimise patient preparation, facilitate informed consent and contribute to maximising coping and engagement from a patient perspective to improve patient experience for a complex and daunting procedure.
Management of Low-Grade Gliomas – Extent of Resection Matters But Not All Tumours Are Amenable to Surgery
Authors: Sokratous Giannis , Sokratous Jill , Bakhsh Ali , Brodbelt Andrew , Chavredakis Emmanuel , Lawson David , Farah Jibril , Shenoy Aditya , May Chloe , Jenkinson Michael , Mehta Shaveta 
Published: October 2022

Abstract

AIMS
To present and review our experience in the management of low-grade gliomas.

METHOD
Retrospective case note review of all patients with WHO grade 2 glioma from 2011 to 2018 (based on WHO criteria at time of diagnosis). Data collected on demographics, presentation, location, initial management, histology, treatment, progression free (PFS) and overall survival (OS).

RESULTS
130 eligible patients. Median follow 4.6 years (up to 10.5). Median age 40 years (range: 18-83). There were 70 (53.8%) astrocytomas, 44 (33.8%) oligodenrogliomas, 16 (12.3%) oligoastrocytomas. 66%(n=86) presented with seizures, 10.7%(n=14) with sensory symptoms, 8.5%(n=11) with speech disturbance, 5.3%(n=4) with motor symptoms and 12.3%(n=16) were identified incidentally. 50.1%(n=65) were frontal, 27.7%(n=36) temporal and 9.2%(n=12) parietal. 1st line treatment was resection in 70.7%(n=92), biopsy in 23.8%(n=31) and observation in 4.6%(n=6). 15.4%(n=20) received adjuvant radiotherapy alone and 6.1%(n=8) received adjuvant radiotherapy followed by chemotherapy . At first recurrence, 31.6%(n=12) received further surgery and 95%(n=38) received radiotherapy and/or chemotherapy . Median PFS from 1st line treatment 66, 44 and 33 months for gross total resection (GRT), subtotal resection (STR), and biopsy respectively. Overall survival was 95.1%, 79.3% and 69.% for GTR, STR and biopsy respectively.

CONCLUSION
Management of low-grade gliomas remains challenging. Extent of resection impacts prognosis but not all patients have gliomas amenable to surgery. The effects of chemoradiotherapy will be presented in future meetings as this is an ongoing project.
Survival and Prognostic Factors in Melanoma Brain Metastasis (MBM) Treated With Stereotactic Radiosurgery (SRS)
Authors: Fitzpatrick Amanda , Bartram Alex , Rockall Louise , Mitchell Adam , Palmer Kieran , Crusz Shanthini , Plowman Nick , Lewis Rachel 
Published: October 2022

Abstract

AIMS
Brain metastasis is a frequent complication in melanoma, ultimately affecting 40–60% of patients with metastatic disease1. In the era of immune checkpoint and small molecule inhibitor therapy, there is a need to identify patient, tumour and treatment characteristics which may predict an improved prognosis in patients receiving stereotactic radiosurgery (SRS) for melanoma brain metastases (MBM).

METHOD
Retrospective casenote review was carried out for all patients receiving SRS, including gammaknife and cyberknife, for MBM between 2014 – 2020 at Barts Cancer Centre. Overall survival (OS) was calculated using the Kaplan-Meier method. Differences between groups were assessed using the Log-rank (Mantel-Cox) test.

RESULTS
93 patients were treated with SRS for MBM, with a median of 15 patients treated per year. The median age at treatment decision was 60 years (range 26 – 90): 59% were male; 41% female. Median number of lesions treated was 2 (range 1 – 15). Survival data was available for 74 patients: median overall survival for all patients was 9.5 months, with no significant survival difference by gender nor treatment year (pre-2017 vs. post-2017). However, treatment of 1-2 brain lesions carried a better prognosis compared to 3 or more lesions (median 12.2 vs. 5.7 months, p = 0.0292).

CONCLUSION
Initial analysis reveals an improved overall survival when fewer MBM are present. Further analyses will examine the impact of the following factors on patient survival: status of extracranial metastases, symptomatic vs. asymptomatic brain metastasis, intratumoral haemorrhage, systemic therapy pre- and post-SRS, and corticosteroid use during and after SRS.
CyberKnife Stereotactic Radiosurgery for Spinal Haemangioblastoma: A Single Centre Experience
Authors: Palmer Kieran , Whitelaw Gemma , Krishnan Anant , Dean Chris , De Luna Paolo Jose , Mitchell Adam , Plowman Nick , Lewis Rachel 
Published: October 2022

Abstract

AIMS
‘CyberKnife’ stereotactic radiosurgery (SRS) is increasingly being used as a treatment for spinal haemangioblastoma to avoid complex surgery, especially in patients with multi-focal tumours associated with von Hippel-Lindau syndrome (VHL). Here we present the outcomes of patients treated in our centre.

METHOD
Retrospective review of patients treated at St Bartholomew’s Hospital, London. Assessment of radiological response was based upon RECIST criteria. The development of a symptomatic new or worsening cyst was included in the definition of progression when determining overall tumour control. Solid and overall tumour control rates were calculated using the Kaplan-Meier method.

RESULTS
14 tumours in 10 patients were included. 70% of patients were male and 90% had VHL. 9 (64%) tumours had an associated cyst. The median (IQR) age at treatment was 45.5 (43.5 – 53). The median gross tumour volume was 0.355cc. Patients received a mean marginal prescribed dose of 9.6Gy in a single fraction (mean central dose 14Gy) – dose constrained by spinal cord tolerance. Mean follow up was 15.4 months. 7 patients’ symptoms improved or were stable and 3 worsened. Radiologically, 11 (78.6%) of tumours were stable or regressed, and 3 (21.4%) progressed. The 1-year solid tumour and overall tumour control rates were 92.3% and 75.7% respectively. All patients were alive at most recent follow up. 2 patients developed grade 1 adverse related events.

CONCLUSION
SRS is a safe and effective treatment modality for spinal haemangioblastoma. Further prospective randomised trials with longer follow up are required to determine the optimum management strategy.
The Measurement and Reporting of Outcomes in Clinical Studies of Incidental and Untreated Meningioma Are Heterogeneous and Prevent Knowledge Progress: A Systematic Review
Authors: Millward Christopher , Islim Abdurrahman , Keshwara Sumirat , Srikandarajah Nisaharan , Brodbelt Andrew , Marson Anthony , Williamson Paula , Jenkinson Michael 
Published: October 2022

Abstract

AIMS
There is increasing interest in the clinical management of patients with incidental and untreated intracranial meningioma. Determining balance between observation and intervention is a key research priority. However, heterogeneity of outcome measurement and reporting has hampered knowledge progress. This systematic review aimed to summarise the outcomes measured and reported in such studies.

METHOD
A systematic literature search was performed to identify published full-texts describing active monitoring of adult cohorts with incidental and untreated intracranial meningioma. Reported outcomes were extracted verbatim, along with an associated definition and method of measurement if provided. Deduplication, grouping, and classification of verbatim outcomes was performed to identify unique outcomes reported in the literature.

RESULTS
Thirty-three published articles and one ongoing study were included, describing 32 unique studies: retrospective n=27, cross-sectional n=3, prospective n=2. 271 verbatim outcomes were reported, of which 90 were defined. Following deduplication, 181 unique verbatim outcomes remained and were grouped into 53 unique ‘non-verbatim’ outcomes. Those reported most frequently included: volume of tumor n=18, growth of tumor n=30, absolute growth rate n=18, relative growth rate n=17, need for surgery n=21, and progression-free survival n=11.

CONCLUSION
Harmonisation of outcome measurement and reporting across clinical studies of incidental and untreated intracranial meningioma could facilitate knowledge progress for this priority research area. The unique outcomes identified from this systematic literature review will be prioritised through an eDelphi survey and consensus meeting of key stakeholders (including patients), in order to develop a Core Outcome Set (COS) for use in future clinical studies.
Assessment of the Efficacy of an Alternative Regimen of Lomustine in Recurrent GBM – A Single Centre Experience
Authors: Tan Chevonne , Wong Helen , Flint Helen , May Chloe , Shenoy Aditya , Eswar Chinnamani , Mehta Shaveta 
Published: October 2022

Abstract

AIMS
Lomustine (CCNU) based regimens are frequently used for recurrent glioblastoma multiforme (GBM). The usual CCNU regimen is 100-130mg/m2, day 1 x 6-weekly cycle for up to 6 cycles. Efficacy is limited, with median progression-free survival (PFS) approximating 1.0-3.0 months with higher haematological toxicities, particularly thrombocytopenia around 13-25%. The Clatterbridge Cancer Centre, UK, has adopted the regimen of 40mg once a day over 4 days x 4-weekly for up to 6 cycles. This study aims to identify the efficacy and toxicity profile of this regimen in recurrent GBM.

METHOD
A retrospective analysis on 113 recurrent GBM patients, treated with single-agent CCNU as a second-line, between June 2016 and January 2020. Kaplan-Meier survival estimates identified PFS, PFS at 6 months (PFS6) and Overall Survival (OS) using SPSS v.27. Overall Responses were based on imaging or clinical assessment in patients with at least 2 CCNU cycles. SACT assessments and blood test records, using CTCAE v5.0 grading, identified clinical adverse events.

RESULTS
We observed an 18.8% overall response rate with 2.4% partial response and 16.5% stable disease. There was a CCNU-specific 8-month median OS, 4-month median PFS, and 20.4%% PFS6. This regimen was well-tolerated. The most common toxicity was grade 1 fatigue (38.9%). The Grade 3 or 4 haematological toxicity was low with 12% thrombocytopenia and 2.7% neutropenia rates in patients.

CONCLUSION
This study suggests a reasonable alternative to the usual regimen, offering improved tolerance, lower toxicity rates, and equivalent efficacy. We propose prospective studies comparing differing CCNU regimens to mitigate retrospective studies’ limitations.
Neurosurgery Database for Brain Tumour Patients
Authors: De Luna Paolo Jose , McKintosh Edward , Scandura Glenda , Hilling Molly , Ghosh Arnab 
Published: October 2022

Abstract

AIMS
We develop an electronic database system for brain tumour patients. This aims to provide accessible and comprehensive data in a unified database for all neuro-oncology patients at Barts Health NHS Trust.

METHOD
The database was created using Microsoft Access with data categorised using forms and tables. Initially, patients were added retrospectively using the neuropathology list and the neuro-oncology multi-disciplinary team patient lists. Once creation and validation was complete, patients were added prospectively. Queries on neuro-oncology patients can be launched to produce datasets which can be copied to Microsoft Excel spreadsheets for sorting, calculation, and graph creation.

RESULTS
At the time of writing, records of 1171 neuro-oncology patients who were accepted for MDT discussion at Barts Health NHS Trust are included in the database. It is used to routinely run data queries more efficiently and complete in a shorter time. Queries include post-operative complications, overall survival, histological diagnosis, and average surgery waiting time. These queries have already been used to publish audit-based research papers and will be used increasingly as part of routine clinical governance.

CONCLUSION
The database yields data about treatment of our brain tumour patients with increased completeness and significant reduction in time to return queries, compared to using standard data management. The database has been used to produce data, including tumour types, seizure incidence, and post-operative complications. We have been successful in producing published research, although low absolute complication numbers in the current dataset have not yet allowed comparison of complications rates at individual clinician and team level.