bluuebunny/crossref_metadata_2025_split huggingface dataset:
NIMG-104. PRE-OPERATIVE LANGUAGE FUNCTIONAL MRI (FMRI) FOR LOCALIZATION OF THE RIGHT VENTRAL PREMOTOR CORTEX (VPMC) IN COMPARISON WITH DIRECT CORTICAL STIMULATION
Authors: Sahu Arpita , Vijan Antariksh , Shetty Prakash , Velayutham Parthiban , Moiyadi Aliasgar 
Published: November 2022

Abstract

PURPOSE
To assess the concordance of pre-operative language functional MRI (fMRI) for localization of the right ventral premotor cortex (vPMC) in comparison with Direct Cortical Stimulation.

METHODS AND MATERIALS
Prospective analysis was performed for 11 (n=11) patients with right-sided tumors who underwent language mapping by fMRI, followed by awake neurosurgery and intra-operative mapping by Direct Cortical Stimulation (DCS). Multi-paradigm language fMRI was performed using a standard 3-paradigm language protocol, with additional tongue movement paradigm on a Phillips Ingenia, 1.5T Scanner. The vPMC was identified as BOLD signal activation seen in at least two paradigms anterior to and discrete from the motor orofacial cortex. Pre-operative fMRI findings were validated intra-operatively using DCS with the intra-operative responses of anarthria (speech arrest) and dysarthria recorded separately.

RESULTS
We obtained moderate concordance (sensitivity) of 72.2% (n=8) for anarthria (speech arrest). The vPMC was the site of speech arrest in 75% cases (n=6), followed by the oro-facial motor cortex in the remainder (n=2, 25%). Higher frequency of vPMC activation was seen with Tongue Movement and Number Counting paradigms, while that of Broca’s area with Verb Generation. Tumour size &gt;5cm, presence of peritumoral edema and intra-tumoral haemorrhage were some of the features associated with fMRI-DCS discordance.

CONCLUSIONS
vPMC detection by fMRI shows good concordance (sensitivity) with anarthria responses on Direct Cortical Stimulation. Thus, fMRI serves as a useful non-invasive tool in pre-operative planning for maximal safe resection of brain tumors.
NCMP-07. CASE SERIES OF REGULARLY SCHEDULED MANNITOL INFUSIONS SHOWING WITH PROLONGED CLINICAL BENEFIT FOR MANAGEMENT OF CEREBRAL EDEMA IN GLIOMAS
Authors: Chow Jared , Carrillo Jose , Kesari Santosh , Sharma Akanksha , Nguyen Minh , Truong Judy , Wagle Naveed 
Published: November 2022

Abstract
Gliomas account for the vast majority of malignant primary tumors arising in the central nervous system. Elevated intracranial pressure (ICP) may be a potentially devastating complication of brain tumors and hydrocephalus. Brain tumors may occupy significant space causing displacement and compression of delicate structures within a finite intracranial compartment. The compliance relationship is nonlinear and decreases as the combined volume of the intracranial contents increases. When these compensatory mechanisms have been exhausted, significant increases in pressure develop with relatively small increases in volume. The diagnosis of elevated ICP is generally based on clinical findings and corroborated by imaging studies and the patient's medical history. The best therapy for intracranial hypertension (ICH) is the resolution of the proximate cause of elevated ICP such as the evacuation of a blood clot, resection of a tumor, or cerebrospinal fluid (CSF) diversion in the setting of hydrocephalus. If these modalities have been exhausted or unavailable, osmotic diuretics such as mannitol can be utilized. This medication reduces brain volume by drawing free water out of the tissue and into the circulation, where it is excreted by the kidneys, thus dehydrating brain parenchyma. The common belief is that effects are usually present within minutes, peak at approximately one hour, and last 4 to 24 hours. We report a series of 33 patients treated for a minimum of 1 month of regularly scheduled maintenance infusions of Mannitol 1g/kg every two weeks, 64% showed improved clinical outcomes or stabilization of edema clinical symptoms. Patients expressed improvements in headaches, dizziness, and cognitive ability. This supports the bi-weekly maintenance use of Mannitol in glioma patients with symptomatic cerebral edema. A controlled trial should be supported. This series also suggest a mechanism of action with a more durable response than osmotic diuresis.
NCMP-18. NEUROLOGICAL SEQUELAE IN THE ID8 OVARIAN CANCER MOUSE MODEL: P38/JNK MAPK INHIBITION AS A POTENTIAL THERAPEUTIC FOR CANCER-RELATED COGNITIVE IMPAIRMENTS AND CHEMOTHERAPY-INDUCED PERIPHERAL NEUROPATHY
Authors: Lomeli Naomi , Garcia Martha , Argueta Donovan , Gupta Kalpna , Bota Daniela 
Published: November 2022

Abstract

OBJECTIVES
Chemotherapy-related cognitive impairment (CRCI) and chemotherapy-induced peripheral neuropathy (CIPN) are neurological sequelae of platinum-based chemotherapy. To examine the contribution of cancer itself and additional neurological impairment with chemotherapy, we used the ID8 syngeneic ovarian cancer mouse model and assessed cognition and hyperalgesia +/- cisplatin treatment. We examined the effect of p38 and c-JUN N-terminal kinase (JNK) mitogen-activated protein kinase (MAPK) inhibition on cisplatin-induced neuronal damage.

METHODS
B6 female mice were injected with 107 ID8 cells or 0.9% saline, i.p. Mice received cisplatin (2.3 m¬¬¬g/kg/day, i.p.) or 0.9% saline (OvT+CIS, OvT+VEH, respectively) for 5d, followed by 5d of rest for two cycles. Cognition was assessed longitudinally at 69d by the open field test (OFT), novel object recognition (NOR) at 75d and 104d, and novel place recognition (NPR) at 106d post-ID8 implantation. Hyperalgesia was assessed at 113d. Primary mouse and rat hippocampal neurons were pre-treated with VX-745 or SP600125, followed by cisplatin, and neuronal morphology was assessed.

RESULTS
OvT+VEH mice had detectable abdominal tumors 90d post-implantation. At 75d, OvT+VEH and OvT+CIS had impairments in NOR, with discrimination ratios (DR)= 0.52, 0.51, respectively. OvT+VEH showed trending differences vs. OvT+CIS (DR=0.39, DR=0.62, p=0.079) on NOR on 104d, and impairments on NPR on 106d (DR=0.41, DR=0.63, p=0.03). Cisplatin decreased mechanical (p&lt; 0.05) and cold hyperalgesia (p&lt; 0.07, n.s.) in OvT+CIS vs. OvT+VEH. VX-745 and SP600125 pre-treatment in mouse and rat hippocampal neurons prevented cisplatin-induced dendritic branching and spine density loss (p&lt; 0.05).

DISCUSSION
While cisplatin transiently increased anxiogenic behavior, cognitive impairments, and hyperalgesia in OvT+CIS, these deficits persisted longitudinally in OvT+VEH, suggesting ovarian cancer may evoke sensory and progressive neurocognitive deficits in the absence of chemotherapy. Future studies will address hyperalgesia and cognitive differences between healthy control and ovarian cancer mice +/- cisplatin, and whether VX-745 and SP600125 administration ameliorates CRCI/CIPN in this model.
NCMP-19. VON HIPPEL-LINDAU DISEASE ASSOCIATED INTRACRANIAL HEMANGIOBLASTOMAS IN PREGNANCY: TREATMENT CHALLENGES AND OUTCOMES
Authors: Gvazava Nanuli 
Published: November 2022

Abstract
Von Hippel-Lindau disease is an autosomal dominant disorder characterized by development of variety of benign and malignant tumors and cysts including brain stem, cerebellum, spinal cord as well as pancreas, kidneys, and retina. The most common tumors associated with the disorder are hemangioblastomas. Symptomatic CNS hemangioblastomas maybe the first presentation of Von Hippel-Lindau disease. Initial presentation during pregnancy is uncommon and presents unique challenges with regard to early diagnosis and management. We report a case of a young woman with cerebellar hemangioblastoma, complicated by obstructive hydrocephalus, who first presented with signs and symptoms of increased intracranial pressure during pregnancy and was eventually diagnosed with Von Hippel-Lindau disease. We propose increase on size of Von Hippel-Lindau disease related hemangioblastomas during pregnancy and explore the pathophysiology of this disorder. Specific diagnostic challenges imposed by pregnancy and approach to management of these complex patients are also reviewed. Increase in tumor size as well as rare but life-threatening complications such as tumor hemorrhage are most likely to happen during the 3rd trimester of pregnancy. Unfortunately, non-specific symptoms like nausea and vomiting, which are common obstetric complaints, can be confounding and pose challenges to early diagnosis. Careful neurological examination is critical in pregnant patients with new onset neurological symptoms. When a hemangioblastoma is suspected, pregnant patients should be screened for Von Hippel-Lindau disease to identify other potentially life-threatening tumors, and when near term, elective delivery should be considered to avoid both maternal and fetal complications. In complicated cases such as obstructive hydrocephalus, CSF diversion may be indicated and will result in rapid symptom improvement and prevention of severe neurologic sequelae. Unlike sporadic hemangioblastomas, surveillance may be the preferred approach in Von Hippel-Lindau in the absence of symptoms, as these patients have multiple tumors and a high risk of recurrence, making repeat surgeries of unclear benefit.
NCOG-02. STEREOTACTIC RADIOSURGERY (SRS) FOR BRAIN METASTASES FROM MELANOMA: AN EVALUATION OF OUTCOMES AT A UK TERTIARY CENTRE
Authors: Haris Puteri Abdul , Al-Salihi Omar , Blythe Kirsty , Chia Kazumi , Hassan Sheila , Sisodia Caroline , Brazil Lucy 
Published: November 2022

Abstract

INTRODUCTION
Brain metastases (BM) are common in melanoma and historically associated with poor prognosis. Targeted systemic treatment have improved prognosis, and stereotactic radiosurgery (SRS) may offer an effective and less neurotoxic option. We evaluated the outcomes and potential prognostic factors of patients treated with SRS.

METHODS
Retrospective study of patients treated with linac-based SRS for BM from melanoma in a UK tertiary centre between August 2017-September 2021. Overall survival (OS), intracranial progression-free survival (IPFS), and prognostic factors were evaluated using Kaplan–Meier analysis, log-rank test, and Cox proportional-hazards model.

RESULTS
Median follow up was 32 months. 69 patients were included. Median age was 59 years old (range 30-93), and 63% were male. 99% had performance status of 0/1. 45% had BRAF mutation, and 68% had stable extracranial disease at SRS. 62 patients had first-line treatment with SRS. 133 BM were treated, with mean volume of 0.39 cm3(range 0.02-18.82). Median prescription dose was 23 Gy (range 14-24Gy), prescribed to 100% isodose. Median OS and IPFS from SRS was 18 months (95% CI 5-31), and 12 months (95% CI 6-18), respectively. 6 months and 1 year local control (LC) rate were 79% and 64 %, respectively. 91% had out-of-field recurrences. Patients with BRAF mutation had shorter IPFS compared to BRAF WT (7 months vs 18 months, HR 2, p=0.04). 36% were on BRAF inhibitors, and IPFS were longer for patients on immunotherapy within 3 months of SRS (15 months vs 4 months, HR 2.6, p=0.03). There was non-significant trend towards shorter OS and IPFS for patients who were male, ≥ 65 years old, BRAF mutant, progressive extracranial disease, &gt; 4 BM, and total volume of ≥ 5cm3.

CONCLUSION
SRS demonstrates good OS and LC for treatment of BM from melanoma. Prospective studies should establish the synergistic effects between targeted treatment and SRS.
NCOG-18. OVERALL SURVIVAL VARIATION DUE TO THE TIMING OF POST-SURGICAL RADIATION IN HIGH-GRADE GLIOMAS
Authors: Lowman Allison , Bobholz Samuel , Duenweg Savannah , Kyereme Fitzgerald , Cochran Elizabeth , Coss Dylan , Connelly Jennifer , Mueller Wade , Agarwal Mohit , Banerjee Anjishnu , LaViolette Peter 
Published: November 2022

Abstract

PURPOSE
Grade III and IV astrocytomas and glioblastomas are recognized as high-grade gliomas with aggressive heterogenous natures that carry with them a low overall survival (OS). Standard treatment currently involves surgical resection followed by radiation (RT) and concomitant chemotherapy. Despite this standard pathway, there is often disagreement in the optimal timing of radiation initiation post-surgery. In this study, we examined a subset of patients diagnosed with primary high-grade gliomas that underwent radiation following surgery at varying time frames.

METHODS
53 patients from our brain cancer bank with surgical diagnosis of high-grade gliomas were retrospectively analyses for this study. All patients were grouped into three cohorts based on the timing of the initiation of radiation post-surgery. Group 1 RT &lt; 4 weeks, Group 2 RT 4-5 weeks, and Group 3 RT &gt; 5 weeks post-surgery. Overall survival was calculated in days from initial surgical resection to time of death.

RESULTS
Across the three patient cohorts, Group 1 included 9 patients (mean OS 430 days), Group 2 had 18 patients (mean OS 597 days), and Group 3 had 26 patients (mean OS 895 days). Overall survival trended towards a difference between the three radiation timing groups, with Group 3 showing better survival outcomes compared to Group 1 (p=0.07).

CONCLUSIONS
This current study demonstrates a positive outcome with increased time between surgical intervention and initiation of radiation and concomitant chemotherapy. While we did not correct for additional treatment outside of standard clinical care, we would expect to observe similar trends. Despite these promising results for treatment planning, future research in larger cohorts is necessary to investigate possible molecular markers that may also impact treatment response and overall survival.
NCOG-19. TUMOR INVASION INFLUENCES ON COGNITIVE FUNCTION IN RIGHT CEREBRAL HEMISPHERIC GLIOBLASTOMAS
Authors: Nakajima Riho , Kinoshita Masashi , Okita Hirokazu , Nakada Mitsutoshi 
Published: November 2022

Abstract

INTRODUCTION
Glioblastoma cells broadly infiltrate into surrounding brain parenchyma. In this study, we investigated the influence of tumor invasion on cognitive function in glioblastomas, using diffusion tensor imaging (DTI) .

METHODS
Participants were 32 patients with right hemispheric glioblastoma who underwent surgery in Kanazawa University Hospital (mean age, 61.8 years). We evaluated the differences in p-map and q-map, which represent diffusion isotropy and anisotropy with the patients' preoperative DTI. The patients were divided into two groups: less-invasive and highly-invasive types. Following clinical and demographic factors were collected retrospectively: age, sex, volume of enhanced lesion, tumor location, and methylation status of MGMT promoter. Several kinds of cognitive functions mediated by right cerebral hemisphere were assessed preoperatively. All these factors were compared between two groups. Moreover, voxel-based lesion symptom (VLSM) analyses were performed to investigate brain regions relate to decline of cognitive function by tumor invasion.

RESULTS
All clinical and demographic factors were not significantly different between two groups. Tumor cells significantly infiltrated to insula and basal ganglia in highly-invasive group. Verbal fluency, executive function, attention, and social cognition were impaired in highly-invasive group (p=0.0067, 0.036, 0.0064, and 0.030, respectively). Score of verbal fluency and social cognition were significantly lower when tumor infiltrated to the medial frontal region including cingulate cortex, and deep part of posterior middle and inferior frontal gyrus. Invasion to the sagittal stratum influenced on deterioration of attention and executive function.

CONCLUSION
The present study revealed that tumor invasion extending beyond the enhanced lesion causes deterioration of cognitive functions such as verbal fluency, executive function, attention, and social cognition in right hemispheric glioblastoma.
NCOG-20. BRAIN ATROPHY IN GLIOBLASTOMA PATIENTS FOLLOWING TREATMENT WITH CHEMORADIATION OR CHEMORADIATION WITH ANTI-ANGIOGENIC THERAPY IN NRG/RTOG 0825 PARTICIPANTS
Authors: Akintola Oluwatosin , Dietrich Jorg , Muzikansky Alona , Gardner Melissa , Youssef Gilbert , Huang Raymond , Gerstner Elizabeth , Wen Patrick Y , Parsons Michael , Gilbert Mark , Rogers Leland , Lieberman Frank , Wendland Merideth , Puduvalli Vinay , Shrieve Dennis , Stieber Volker , Pugh Stephanie , Mehta Minesh 
Published: November 2022

Abstract

BACKGROUND
The clinical trial NRG/RTOG 0825 sought to determine if the addition of bevacizumab to temozolomide and radiation improves survival in patients with newly diagnosed glioblastomas. Tertiary objectives included measuring the effect of the addition of bevacizumab to standard chemoradiation on neurocognitive function and quality of life. In this study, we describe brain atrophy changes as measured by ventricular volume expansion.

METHODS
We analyzed longitudinal MRI brain studies obtained from NRG/RTOG-0825. Volume changes in the contralesional (non-tumor) lateral ventricle were measured. Patients were included if they had either a scan at post operative (week 0) or post radiation baseline (week 10). Patients were also required to have at least one follow-up MRI brain scan 6 months or more from their baseline scans (at Week 0 or Week 10). Volumes were delineated using tissue segmentation in Slicer software.

RESULTS
177 patients were identified with eligible baseline scans at Week 0 and 162 patients at Week 10. For participants analyzed at 6 months from the Week 0 scan, mean ventricular volume increased by 54.70% (SEM: 3.21%, t = 6.41, p &lt; 0.001, N = 135). For patients analyzed at 6 months from the Week 10 scan, mean ventricular volume increased by 31.89% (SEM: 2.52%, t = 3.96, p &lt; 0.001, Nf117).

CONCLUSIONS
This study presents evidence of progressive brain volume loss in patients with glioblastoma treated with standard chemoradiation with or without anti-VEGF therapy. This is one of the largest sample sizes of volumetric analysis in real world patients with glioblastoma. These volume changes begin early in the disease course and may precede treatment. Next directions include correlating these volumetric changes with neurocognitive score changes, quality of life scores and analyzing these changes by treatment arm.
NCOG-35. A SINGLE INSTITUTION SERIES ON PINEAL PARENCHYMAL TUMORS OF INTERMEDIATE DIFFERENTIATION (PPTID)
Authors: Webb Mason , Campian Jian , Sener Ugur 
Published: November 2022

Abstract

INTRODUCTION
First classified in 2000, pineal parenchymal tumor of intermediate differentiation (PPTID) is an uncommon intracranial malignancy. Given recent codification and rarity, there is no consensus on management and treatment is often provider dependent.

METHODS
Within an institutional database, we identified 10 patients with PPTID diagnosed between 2009 and 2022. Medical records were reviewed for demographic data, presenting symptoms, extent of disease, surgical interventions, radiation therapy, and chemotherapy. Progression free survival, overall survival, and neurocognitive outcomes were reviewed.

RESULTS
Median age at diagnosis was 36 (range 13-73), 40% women, 60% Caucasian. Nine patients had tumor involvement limited to the pineal region and one patient had multifocal intracranial tumor involvement with leptomeningeal disease. Two patients had gross total resection (GTR) alone, three had GTR followed by adjuvant radiation therapy (RT), two had subtotal resection (STR) followed by craniospinal irradiation (CSI), two had biopsy followed by adjuvant RT, and one had biopsy with CSI and chemotherapy. At median follow up of 31 months (range 3-88 months), only one patient, who had received biopsy, CSI, and chemotherapy, had progression of disease and no patients are deceased. Two patients treated with CSI had adverse neurocognitive outcomes, which was not observed with focal RT.

CONCLUSIONS
Our limited case series suggests GTR followed by surveillance, GTR followed by focal RT, and any extent resection followed by CSI may all achieve durable disease control in patients with PPTID. Treatment selection should be individualized and potential neurocognitive toxicities should be considered.
NCOG-36. DOSIMETRY AND COGNITIVE FUNCTION AFTER RADIATION THERAPY IN LOW GRADE GLIOMAS
Authors: Asha Wafa , Koro Sami , Asha Wafa , Wei Wei , Chen Yanwen , Murray Eric , Murphy Erin , Suh John , Chao Samuel , Angelov Lilyana , Peereboom David 
Published: November 2022

Abstract

PURPOSE
We found that cognitive function remained stable following radiotherapy with concurrent and adjuvant temozolomide (RT+TMZ) in low-grade glioma (LGG) patients evaluated prospectively up to 2 years. This study evaluates the effects of radiotherapy dosimetry on neurocognitive function in a larger group of molecularly defined LGG patients treated with radiotherapy (RT).

METHODS
A total of 39 LGG patients were evaluated with comprehensive psychometric tests at baseline (prior to RT) and at various time intervals following RT. Patients served as their own controls by evaluating change in scores over time. Dosimetric parameters included mean and maximum dose to the pituitary, mean and maximum dose to the hypothalamus, mean dose to contralateral hippocampus, brain, cochlea, and PTV volume. Correlation between dosimetry and neurocognitive tests were assessed by Spearman correlation for the baseline correlation and Cox proportional hazard regression analysis for the survival analysis.

RESULTS
Patients were followed for a median of 60 months. Overall, patients showed group mean test scores similar to their initial performances following radiotherapy on all psychometric measures. There was a significant correlation between mean dose to cochlea (p=0.006), pituitary (p=0.035), mean PTV volume (0.019) and neurocognitive outcome..

CONCLUSION
Cognitive function remained stable following radiotherapy in LGG patients evaluated prospectivelys. There was a significant correlation between specific dosimetric endpoints and neurocognitive outcomes over time. Further study needs to be done in a larger population to validate these findings.