tbuckley/cabot-search huggingface dataset:
P22.06.A DOES ADDING INFORMATION ON PATIENT GOALS VIA AN APP IMPROVE SHARED DECISION-MAKING IN NEUROSURGICAL CONSULTATIONS WITH BRAIN TUMOR PATIENTS?
Authors: I J Bras, G J Rutten, M M Sitskoorn, A P Hoogendoorn, K Gehring
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND In shared decision-making (SDM), the patient serves as the expert on their own life, while the health care professional (HCP) provides medical expertise. Recent models of SDM propose incorporating patient “goals” into the decision-making process (i.e. what patients find important activities or roles in everyday life), to better align treatment with patient preferences and everyday life priorities. This study aims to evaluate the effect of an intervention for tracking patient goals and symptoms (the Goings-On app). We will assess the number and nature of goals that brain tumor patients enter into the app, their experiences with using the app and the degree of SDM. We hypothesize that the use of the Going-on app leads to more goal-oriented discussions and will improve SDM. MATERIAL AND METHODS Data was collected for an observational and an intervention cohort of non-treated patients with a newly diagnosed presumed glioma or meningioma. The Goings-On app allows patients to enter their own goals (including personal photos), and symptoms, and log them daily. This information is made available to the neurosurgeon in the electronic patient file for use during the consultation. Consultations were audio-recorded and evaluated using the OPTION-MCC. This observer-based coding scheme is used to rate SDM behaviors of the HCP, patient and informal caregiver regarding: (1) goal talk: eliciting and identifying patient goals, (2) option talk: alternate options and information about options, (3) team talk: support deliberation/forming a partnership, (4) decision talk: eliciting preferences and integrating preferences and (5) evaluation talk. Following the consultation, questionnaires concerning Goings-On app usage were administered. RESULTS Patients in the intervention cohort (n=49) entered on average 4.7 ± 1.8 [range 1-9] goals into the Goings-On app, with the majority of goals belonging to the categories: Social/Role/Relationship (32%), Leisure/Pleasure (26%) and Everyday/Practical (22%). Of the patients who completed the questionnaires (n=44), 61% reported that their goals were discussed during the consultation, with 84% of them finding the experience pleasant and 85% considering it meaningful. Rating of SDM behaviors for the observational cohort (n=66) and the intervention cohort and analysis of between-group differences, from the audio-recordings is ongoing. Results will be expected end of July 2024. CONCLUSION In this study, patients reported various goals via the Goings-On app that were discussed in over half of the neurosurgical consultations, with predominantly positive patient experiences. Further investigations will show whether eliciting and depicting patient goals improves SDM for brain tumor patients during neurosurgical consultations.
P27.25.A THE UTILITY OF INTRAOPERATIVE MRI IN THE RESECTION OF RECURRENT GBM: A SINGLE-CENTER RETROSPECTIVE ANALYSIS
Authors: O Alhalabi, P Dao Trong, K Mironov, K Nabiev, A N Gareib, M Jordan, S Joser, S M Krieg, A W Unterberg, C Jungk
Journal: Neuro-Oncology (2024)

Abstract BACKGROUD Intraoperative magnetic resonance imaging (iMRI) guidance for the resection of newly diagnosed glioblastoma (GBM) has been shown to be comparable to fluorescence guidance. However, the role of iMRI-guided resection in the recurrent setting remains unclear. In this study, we aimed to examine the utility of iMRI in the resection of recurrent GBM. METHODS Patients undergoing re-resection for the first recurrence of WHO grade 4 IDH-wildtype GBM were retrospectively analyzed. The utility of iMRI (1.5T) guidance with respect to intraoperative decision-making for additional tumor resection and residual nodular contrast enhancing (CE) tumor on early postoperative MRI (epMRI, within 48 hours, 3T) scans was assessed. RESULTS 103 consecutive patients (mean age: 59 years; 64 males and 39 females) undergoing re-resection for first GBM recurrence in the years 2018 to 2022 were included. iMRI-guided resection was performed in 84 (81%) cases and 5-ALA was applied in 8 (8%) cases. In 11 cases (11%), neither was applied. In 77/84 (92%) patients of the iMRI group, a gross total resection (GTR; defined as no residual nodular CE tumor) was intended. After iMRI, additional resection was carried out in 53/84 cases (63%) while a GTR was already achieved in 28/84 cases (33%). In the remaining 3 cases, additional resection was not possible due to functional reasons. On epMRI, a GTR was achieved in 63/84 (75%) cases. In 17 cases (20%), residual CE was detected on epMRI (GTR not intended in 3 cases). In 28 cases with intraoperatively assumed GTR, epMRI confirmed GTR in 25 cases (89%, mismatch in 3 cases, 11%), which was higher than in cases with additional intraoperative resection after iMRI (GTR in 42 out of 53 cases, 82%, p=0.07). In the remaining 11/53 cases, residual CE tumor was detected despite additional intraoperative resection (18%). Hence, GTR was achieved in 63 out of intended 77 patients (81%). Postoperative neurological deficits were noted in 11/53 patients with additional resection (20%) compared to 3/28 patients without additional resection (10%, p=0.126) and were mostly transient (permanent deficits 3/53 and 1/28 patients, respectively). In this cohort, median survival after repeat surgery was 220 days. CONCLUSION iMRI provides valuable information on residual CE tumor for intraoperative decision making concerning additional tumor resection in the setting of recurrent GBM. A mismatch between GTR assessed on iMRI and epMRI could be attributed to different magnetic field strengths.
P23.01.A ANCIENT SCHWANNOMA MASKING DIAGNOSIS OF SECONDARY NORMAL PRESSURE HYDROCEPHALUS IN A 65-YEAR-OLD MALE PRESENTING WITH GAIT INSTABILITY: A SYSTEMATIC REVIEW AND ILLUSTRATIVE CASE
Authors: J R Torio, Y Rabe, E Meceda, E Fandialan
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND NPH can present as primary or secondary. Recent studies indicated that most symptoms can emerge early, while some showed delayed onset. These differences in patterns underscores the complexity of NPH relationship with its underlying causes and highlights the need for further research to elucidate the temporal dynamics of its development, aiding in early detection and appropriate management strategies. MATERIAL AND METHODS We report a case of a 65-year-old male diagnosed of sNPH, initially treated for a confounding left cerebellopontine angle schwannoma. A systematic search was conducted using MeSH keywords “Secondary Normal Pressure Hydrocephalus”, “Intracranial Tumors” and “Normal Pressure Hydrocephalus” on February 2024, across multiple databases. A total of 504 records were identified, wherein 110 articles were excluded and only four studies satisfied the inclusion criteria. RESULTS A total of 1312 cases were identified and diagnosis of NPH made through clinical history, PE and imaging studies. Of the etiologies identified in 2 studies, SAH accounted for 46.5%, post-traumatic 29%, and malignant pathology for 6.2% only. VPS insertion was the preferred treatment in all of the studies. In the study of Daou, 84.2% of patients with sNPH from SAH improved after shunt insertion, while 83% of patients with post-traumatic sNPH and 86.4% of patient with tumors, which is similar to the other studies. CONCLUSION Prompt identification of sNPH is crucial because its outcomes differ from iNPH. A comprehensive evaluation to determine the etiology of sNPH is indispensable in guiding appropriate management strategies to ensure optimal outcomes for affected individuals.
P18.06.A AUTOMATED DETECTION OF RESIDUAL GLIOMA TISSUE IN RECEPTION CAVITY USING OF RAMAN SPECTROSCOPY. PRELIMINARY DATE FROM SINGLE INSTITUTION STUDY
Authors: O Kalita, V Ranc, O Pavlacka, D Hrabos, L Hrabalek, T Kazda
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Gliomas are the most common and the deadliest brain tumors. The most aggressive multimodal therapy (maximally radical and safe tumour resection, followed by the Stupp protocol oncotherapy) has yielded the best treatment outcomes. Neurosurgeons, thus, must compete with a considerable challenge to correctly identify the existing margins of the glioma tissue. The residues of the primary tumor or eventually formed small satellites being left aside are one of the main reasons leading to a recurrence of the disease. MATERIAL AND METHODS We performed, during the routine glioma resection, the tumor tissue detection on walls of the resection cavity using Raman spectroscopy. For on-site exposure we used fiberoptic probes transmit laser light and collect Raman scattering. The spectral analysis of Raman data consists of removing the spectral background, data smoothing, and a machine-learning-based discrimination model based on the decision tree learning approach. The presence of tumor tissue was confirmed by histology samplings. and/or fluorescence activity using fluorescence-guided resection (ALA). Perioperative, the results were compared with ALA activity (fluorescence-guided resection). Postoperative, the results were evaluated with an early MRI and time-to-recurrency of tumor. RESULTS The developed approach was first tested on more than 100 Raman spectra obtained from 15 HGG patients and showed statistically relevant results. According to our current data, Raman-guided resection is reliable and more sensitive technique than ALA-guided resection in HGG patients. To confirm our thesis we are continuously gathering data of HGG. Due to a rare occurrence of LGG patients and much more delicate distinctions in Raman spectra, now, we are in preliminary part of study. CONCLUSION Using Raman spectroscopy, we developed a new systematic approach for spectrally characterizing of the glioma and its surrounding tissue in real time during brain surgery. An optical-fiber-equipped instrument allows one to probe the targeted tissue spectrally before its extraction. It correctly discriminates between gliomas and surrounding healthy tissue, allowing surgeons to perform a more precise surgery.
P18.32.B OUTCOME OF NIMOTUZUMAB USE ON NEWLY DIAGNOSED AND RECURRENT MALIGNANT GLIOMAS: A PHILIPPINE RETROSPECTIVE STUDY ON TWO TERTIARY INSTITUTIONS
Authors: M Imperial, J Batara, P Opinaldo
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND High Grade gliomas have poor overall survival with no standard of care for recurrent disease. Despite treatment, recurrence is inevitable and prognosis remains poor with median survival rate of 12-15 months. EGFR is a membrane bound receptor that is greatly expressed in high grade glioma patients and gene amplification is one of the most frequent alterations of this tumor type. EGFR is present in 60% of GBMs. Nimotuzumab is a humanized monoclonal antibody targeting EGFRV3 with high penetration into the blood brain barrier that has been shown in phase 2 trials to benefit high grade gliomas especially unmethylated gliomas. This study determined if there is an added survival benefit in combining nimotuzumab with the current treatment practices available to our local neuro-oncologists. METHODS Chart review was done for all patients with newly diagnosed or recurrent IDH wild type glioblastoma, and recurrent IDH positive malignant gliomas treated with nimotuzumab plus either radiation + chemotherapy with temozolomide followed by adjuvant temozolomide, metronomic temozolomide or bevacizumab alone from 2007-2022 in two institutions in the Philippines. A total of 53 patients were given nimotuzumab, 48 patients were analyzed. Patients included were given Nimotuzumab 200-400 mg intravenously every two weeks for at least four sessions either until recurrence, continuous for six to 12 months or until death. Patients who received less than four sessions of Nimotuzumab and mortality from other causes were excluded from the analysis. Patient’s demographic data, date of surgery and recurrences, histopathologic reports, nimotuzumab doses, and date of death were collected. Primary endpoints were overall survival (OS) and Progression Free Survival (PFS). Side effects and complications were also investigated. RESULTS Forty eight patients were analyzed, 21 females and 27 males aged 21-70 with mean age of 48. Median PFS was 13 months (95%, CI 10.2-17.4) and Median Survival 43 months (95%, CI 34-57). Overall Survival Proportion after 1, 2, 3 and 5 years are 93.7%, 72.1%, 63.2 and 34.4% respectively. In the recurrent glioblastoma group, median PFS was 11 months and median OS was 22.11 months. In the recurrent IDH+ high grade gliomas, median PFS was 22 months and median OS was 75 months. Minimal side effects were noted. CONCLUSION There is an increased survival benefit in combining nimotuzumab with the current treatments available for malignant gliomas with minimal side effects.
P18.31.A NIRAPARIB EFFICACY IN PATIENTS WITH NEWLY-DIAGNOSED GLIOBLASTOMA: CLINICAL READOUT OF A PHASE 0/2 ‘TRIGGER’ TRIAL
Authors: N Sanai, Y Umemura, T Margaryan, J Molloy, H Zhang, W Knight, J Harmon, A Hong, J Wanebo, K Braun, W Kennedy, M Garcia, I Barani, W Yoo, A Tien, A Tovmasyan, S Mehta
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Poly (ADP-ribose) polymerase (PARP) mediates DNA damage response; niraparib is an investigational PARP1/2-selective inhibitor. This Phase 0 study evaluates newly-diagnosed glioblastoma (GBM) tumor pharmacokinetics (PK) and pharmacodynamics (PD), graduating patients with O6-methylguanine methyltransferase (MGMT) unmethylated tumors into a therapeutic regimen of niraparib plus fractionated radiotherapy when a PK threshold is met. METHODS Presumed newly-diagnosed GBM patients received 4 days of niraparib (300/200 mg QD) prior to planned resection 3-5 (cohort 1) or 8-10 hours (cohort2) following the last dose. Tumor tissue (Gadolinium enhancing and non-enhancing regions), cerebrospinal fluid (CSF), and plasma were collected. Total and unbound niraparib concentrations were measured using validated LC-MS/MS methods. PARP inhibition was assessed by quantification of PAR induction after ex vivo irradiation of surgical vs non-irradiated tissue. A PK ‘trigger’ determined eligibility for the Phase 2 component of the study and was defined as unbound [niraparib] &amp;gt; 5-fold biochemical IC50 (i.e., 19 nM) in non-enhancing tumor. Patients with MGMT unmethylated tumors in excess of the PK threshold were eligible for Phase 2 dosing of niraparib plus radiotherapy followed by a maintenance phase of niraparib monotherapy. RESULTS All patients in the Phase 0 analysis population (n=46) met the PK threshold. In non-enhancing tumor regions, the mean unbound concentration of niraparib was 335.1 nM (n=43) for cohort 1 and 331.9 nM (n=3) for cohort 2. PAR suppression after ex vivo radiation was observed in 73% of the patients (24/33). Twenty of 28 (71.4%) patients with unmethylated tumors were enrolled into Phase 2. Five patients in Phase 2 experienced Grade 4 thrombocytopenia related to niraparib. All adverse events resolved without sequelae. Median progression-free survival was 14.9 months and median overall survival was 20.3 months. CONCLUSIONS Niraparib achieves pharmacologically relevant concentrations in non-enhancing, newly-diagnosed GBM tissue in excess of any other studied PARP inhibitor. Accompanying PD effects were observed in patient tumor tissue and long-term clinical efficacy data is promising. A global Phase 3, open-label, randomized 2-arm study comparing niraparib versus temozolomide in adult patients with newly diagnosed, MGMT unmethylated glioblastoma is underway.
P27.26.B TUMOR GROWTH RATE IN RECURRENT GLIOBLASTOMA: WHEN TO PLAN THE BASELINE SCAN?
Authors: L Dobber, M Geurts, M van den Bent
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Little is known about the growth rate of glioblastoma once disease progression occurs. This is relevant for the timing of baseline imaging for second-line treatment in clinical trials and subsequent response monitoring. If a tumor grows rapidly in the period between imaging and therapy initiation, adequate response assessment may be hindered leading to false interpretations of progression to the experimental treatment. Recommendations on the interval duration between baseline scanning and treatment initiation are inconsistent between the RANO 2.0 criteria and various study protocols. We assessed whether the tumor area differs between the scan showing progressive disease (‘progression scan’) and the scan for study entry (‘baseline scan’) to determine the tumor growth rate. MATERIAL AND METHODS Patients who participated in a prospective clinical intervention for their first glioblastoma recurrence in the Erasmus MC and who had two available MRI scans with measurable disease made within ≤35-day interval between the progression scan and baseline scan were included. Main exclusion criterion was tumor re-resection. Tumor areas (2D) were assessed by three independent observers (per RANO). The percentage change in tumor area was calculated and compared to RANO’s ≥25% definition of disease progression. We chose a 17-day cut-off as landmark to evaluate the number of patients with tumor progression considering this is the maximum interval allowed by recent studies (e.g. NCT01986348, NCT04910022). RESULTS Fifty-three patients were included. Mean time between the progression scan and the baseline scan for study entry was 20 days. Mean tumor areas at progression and baseline scan were 1223mm2 (range, 128-4397) and 1405mm2 (range, 239-4493), respectively (mean difference in tumor area of 182mm2 (95% confidence interval (CI), 114-249mm2, p&amp;lt;0.001). This corresponds to a 15% tumor area growth (CI, 9-21%, p&amp;lt;0.001) between scans. Most tumor areas (47/53) increased in the short time interval between imaging. Eighteen out of 53 patients had formal disease progression (≥25%) within the 35-day interval. One third of the patients (7/19) who had two scans within 17 days had ≥20% tumor area increase and 5/19 patients had ≥25% tumor area increase. CONCLUSION We demonstrate the fast growth rate of recurrent glioblastoma. To properly assess the effect of second-line treatment, we emphasize the importance of baseline imaging as close as possible to starting with trial treatment: even a 17-day interval may result in misinterpretation at the first follow-up moment. Trial protocols must consider enrolling patients based on the scan demonstrating progression and perform baseline imaging 1-2 days prior to starting treatment.
P22.07.A END-OF-LIFE CHALLENGES IN NEURO-ONCOLOGICAL PATIENT CARE: A YOUNGNOA SURVEY
Authors: L Lazaridis, N Pepper, S Agkatsev, R Bodensohn, R Berg, C Seliger, P Hau, M Platten, S Combs, I Mildenberger, M Müther, S Kebir
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Despite advanced treatments, malignant brain tumors inevitably relapse, almost always causing significant functional and neurological impairments in patients. Thus, palliative care is crucial in managing individuals with malignant brain tumors. It is essential for neuro-oncologists to be well-prepared and supported to openly communicate about and meet the palliative needs of these patients. With this survey, we sought to evaluate palliative care practices in Germany and their impact on the treatment of neuro-oncological patients. MATERIAL AND METHODS We conducted an anonymous, interdisciplinary survey targeting palliative care practices among neuro-oncologists in Germany, all members of the Neuro-oncology Working Group “Neuroonkologische Arbeitsgemeinschaft” (NOA) of the German Cancer Society (Deutsche Krebsgesellschaft, DKG). The questionnaire, designed in close coordination with board-certified palliative care specialists, was distributed to 450 physicians. It collected personal information and assessed respondents’ knowledge of and access to palliative care structures. The survey was conducted online from March 31 to April 30, 2023. RESULTS Ninety-two physicians (39 female, 52 male, 1 unspecified) participated and completed the survey (response rate: 20%). Of these, 81 (88%) reported feeling comfortable with end-of-life conversations, while 11 (12%) did not. No significant differences were observed between the two subgroups regarding their level of medical education (p=0.7140), workplace (p=0.4966), sex (p=0.9999), medical specialty (p=0.5478), or region of practice (p=0.9999). However, those comfortable with end-of-life discussions had significantly more palliative care training either during specialty training (p=0.0475) or through active participation in palliative care courses (p=0.0254). Further detailed analysis is in progress. CONCLUSION The survey indicates that while the majority of participants are comfortable with end-of-life discussions, a clear correlation exists between their comfort level and the extent of palliative care training received. This highlights the critical need for enhanced and targeted palliative care education within neuro-oncology training programs to better prepare physicians for the complex communication and care challenges in neuro-oncological palliation. Further analysis will continue to explore additional educational and systemic factors that could increase the quality of palliative care in neuro-oncology.