tbuckley/cabot-search huggingface dataset:
P21.03.B PSYCHOLOGICAL FACTORS AND LONG-TERM TINNITUS HANDICAP IN VESTIBULAR SCHWANNOMA PATIENTS AFTER RETROSIGMOID MICROSURGERY - A CROSS-SECTIONAL STUDY
Authors: M Rutenkröger, M Scheer, S Rampp, C Strauss, R Schönfeld, B Leplow
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND This study aimed to investigate the connection between psychological factors and postoperative tinnitus in vestibular schwannoma (VS) patients following retrosigmoid microsurgery. MATERIAL AND METHODS Ninety-three VS patients participated, completing questionnaires on demographics, tinnitus severity (THI-12), personality traits (TIPI-G), dizziness impact (DHI), perceived health benefits (GBI),somatisation tendencies (SOMS-2), and psychological distress (HADS-D). Our analysis involved Mann-Whitney U-tests, Spearman’s rank-order correlations, and false discovery rate correction. RESULTS Most participants reported postoperative tinnitus (77/93), with 41 experiencing it preoperatively. Emotional stability correlated negatively with tinnitus presence, while tinnitus severity was associatedwith emotional distress. Preoperative somatisation tendencies were also positively linked to tinnitus severity. Postoperative Tinnitus was further linked to reduced perceived health benefits and increased anxiety and depression levels. Notably, age and gender showed no significant associations. CONCLUSION This study uncovers the interplay between postoperative tinnitus and psychological factors in VS patients, highlighting emotional and cognitive dimensions. Tailored psychological interventions addressing tinnitus‘s psychosomatic impact may enhance patients quality of life.
P22.03.A ASSESSING PALLIATIVE CARE APPROACHES IN NEUROONCOLOGY: INSIGHTS FROM GERMANY
Authors: A Lawson McLean, A Lawson McLean, T Ernst, M Forster, C Freyschlag, J Gempt, R Goldbrunner, S Grau, C Jungk, B von Oorschot, S Rosahl, U Wedding, A Neumeister, C Senft, M Kamp
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND This study aims to assess the palliative care practices across neurooncology centres in Germany, focusing on the variations in integration, timing, and involvement in tumour board discussions. By pinpointing gaps in care, it seeks to contribute to discussions on refining optimal palliative care strategies. MATERIAL AND METHODS Surveys were distributed to both DKG-certified neurooncology centres and non-certified university neurooncology centres in Germany to investigate their palliative care frameworks and practices. The survey examined department availability, participation in tumour boards, timing of integration, and the use of standardised screening tools for assessing palliative burden and psycho-oncological distress. RESULTS Out of 57 centres contacted, 46 responded (81% response rate). The findings indicate that 76.1% of centres have dedicated palliative care departments, but only 34.8% include specialists in tumour board discussions. There is notable variability in the initiation of palliative care, with early integration occurring in only 30.4% of centres at the diagnosis stage. The survey also reveals a lack of standardised spiritual care assessments and minimal use of advanced care planning. Discrepancies in documenting and treating palliative care symptoms and social complaints highlight the need for comprehensive care approaches. CONCLUSION This study underscores the diverse landscape of palliative care provision within German neurooncology centres and stresses the importance of standardised practices and early integration. It suggests the imperative need for developing standard protocols and guidelines to enhance the quality and uniformity of palliative care, ultimately improving patient-centred care in neurooncology.
P23.04.A DIZZY, DODDERY AND DISCOMBOBULATED: EXPLORING SYMPTOMS OF DIZZINESS AND IMBALANCE IN VESTIBULAR SCHWANNOMA TREATABLE WITH SRS AT A TERTIARY CANCER CENTRE
Authors: J Jethwa, L Williams, S Davenport, A Adonis
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Vestibular schwannoma (VS), a brain tumour of the vestibulocochlear nerve, causing auditory and vestibular symptoms. Dizziness and associated fatigue, cognitive changes and anxiety are shown to have the biggest impact on quality of life and ability to work. The National Institute for Health and Care Excellence (2021) and Tessa Jowel Brain Cancer Mission (2024) recommend patients with brain tumour have early and ongoing access to specialist therapy assessment and rehabilitation. However, assessment of vestibular symptoms is not included in VS guidelines, nor is it included in routine assessment for those with VS at The Royal Marsden Hospital (RMH). Consequently, symptom burden for those with VS is unclear at RMH. Without a defined rehabilitation pathways, this affects equity of access to vestibular rehabilitation locally. The aim of this study was therefore to understand vestibular symptoms in VS, describe the patient profile, and identify improvements to local VS services. MATERIAL AND METHODS An observational study assessed vestibular function in VS using a symptom questionnaire, Dizziness Handicap Inventory, oculomotor examination and MiniBESTest. Case-note audits identified demographics, frequency of rehabilitation referral, and rehabilitation waiting times. RESULTS Vestibular symptoms (dizziness, oculomotor impairment, and imbalance) and secondary symptoms (anxiety, fatigue and cognitive changes) were frequent. The majority caused mild or moderate functional impact on work or recreation. Rehabilitation need correlated significantly with a DHI score &amp;gt;20 combined with moderate-severe functional impact. Rehabilitation waiting times significantly improved with early physiotherapy assessment. Patients reported many benefits of physiotherapy as part an MDT clinic. RMH VS population was older than the catchment population. There was no gender or race difference. CONCLUSION Vestibular symptoms are common and impactful in VS. Prevalence of secondary symptoms appear common and warrant formal investigation. Vestibular symptoms, secondary symptoms, and the functional impact of these should be assessed as standard practice and included in future guidelines. A DHI score &amp;gt;20 combined with moderate/severe functional impact identified rehabilitation need, but should not replace physiotherapy as part of MDT clinic. Demographic findings showing no difference in VS incidence according to race are contrary to previous findings of increase incidence in Caucasian populations.
P18.20.B GENETIC AND EPIGENETIC ALTERATIONS OF EPITHELIOID GLIOBLASTOMA
Authors: J Adachi, M Shirahata, T Suzuki, K Mishima, R Nishikawa
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Epithelioid Glioblastoma (E-GBM) has been identified as a rare subtype of Glioblastoma. It is mainly known as in case reports. The details of its genetic, much less epigenetic profiles are not clear. Here, we retrospecivly studied the results of genetic and epigenetic features of E-GBM. MATERIAL AND METHODS Four patients who underwent surgery at our institution and were diagnosed with E-GBM, were included in this study. Histological diagnosis was obtained by surgical excision in all cases. We extracted DNA from the resected tissues and analyzed glioma-related genes using various methods such as high resolution melting (HRM), MGMT methylation-specific HRM, digital PCR, and Multiple ligation-dependent probe amplification (MLPA) analysis. Furthermore, comprehensive methylation array analysis was performed using Infinium Methylation EPIC ver2.0. RESULTS E-GBM tended to develop at a slightly younger age than other general glioblastoma. Genetic analysis revealed both TERT promoter mutations and BRAFV600E mutation in all cases. In addition, IDH mutation was not found, and MGMT promoter methylation was unmethylated in all cases. EGFR amplification, CDKN2A/2B homozygous deletion and 1p/19q co-deletion were not found in any cases. Classifier prediction from methylation array analysis tended to match Pleomorphic Xanthoastrocytoma, and E-GBM was not listed as a candidate tumor. CONCLUSION The simultaneous mutations of TERT promoter with BRAFV600E could serve as diagnostic molecular markers for the diagnosis of E-GBM. It has been difficult to predict E-GBM using current methylation array analysis alone.
JS06.6.A COPENHAGEN GRADING FOR MENINGIOMA
Authors: J L Haslund-Vinding, J Skjoth-Rasmussen, I Law, K B Fugleholm, T R Meling, L Poulsgaard, A D Maier, V A Larsen, A Forsse, O M Henriksen, K Madsen, C Mirian, F R Poulsen, P Förrander, T Santarius, J J Bartek, D Scheie, M Ziebell, B W Kristensen, T Mathiesen
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND The extent of meningioma resection is the most fundamental risk factor for recurrence and exact knowledge of extent of resection is necessary for prognostication and for planning of adjuvant treatment. Currently used classifications are the EANO-grading and the Simpson grading. The former comprises radiological imaging with contrast-enhanced MRI and differentiation between “gross total removal” and “subtotal removal”, while the latter comprises a five-tiered differentiation of the surgeon’s impression of the extent of resection. The extent of resection of tumors is usually defined via analyses of resection margins but has until now not been implemented for meningiomas. PET/MRI imaging with 68Ga-DOTATOC allows more sensitive and specific imaging than MRI following surgery of meningiomas. OBJECTIVE To develop an objective grading system based on microscopic analyses of resection margins and sensitive radiological analyses to improve management of follow-up, adjuvant therapy and prognostication of meningiomas. Based on the rationale of resection-margin analyses as gold standard and superior imaging performance of 68Ga DOTATOC PET, we propose “Copenhagen Grading” for meningiomas. PRELIMINARY RESULTS Since April 2021, Copenhagen Grading has been implemented prospectively as a clinical standard at Rigshospitalet, Copenhagen, with 264 patients enrolled thus far. DOTATOC PET was used for follow-up in 212 subjects, while resection margin biopsies were obtained from 90 subjects. DOTATOC-PET revealed residual tumor in 33% (55/168) of cases where MRI results were inconclusive and in 28% (47/168) of cases where MRI showed no residual tumor. CONCLUSION Copenhagen Grading offers a comprehensive, logical, and reproducible means of defining resection extent, showing potential as the most sensitive and specific grading. Further long term evaluation of the clinical implication of biopsies and the cost-effectiveness of DOTATOC PET is necessary during the prospective implementation.
P17.16.B POTENTIAL BARRIERS TO STEREOTACTIC RADIOSURGERY (SRS) REFERRAL AT THE BEATSON, WEST OF SCOTLAND CANCER CENTRE (BWOSCC): AN ONCOLOGY REGISTRAR’S POINT OF VIEW
Authors: S Walker, S Nowicki, A James, A Williamson
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND At BWOSCC, we are constantly striving to optimise our SRS service. To better understand potential barriers to SRS referral, we surveyed our registrars to assess their understanding of suitability criteria for SRS and the current service at BWOSCC. Registrars were targeted as, with their frequent rotation through different tumour sites, or whilst on-call, they are often the first point of contact for patients in the West of Scotland with newly diagnosed brain metastases. MATERIAL AND METHODS 28 oncology registrars currently working at BWOSCC were invited to complete a survey using an online survey tool (Google form™). The survey was developed by a SABR clinical research fellow, two neuro-oncology consultants and a consultant Neuro-oncology radiographer. The survey compromised 21 items: 15 close-ended questions; 3 multiple choice questions; 2 demographic questions and 1 open-ended question. RESULTS 17/28 registrars responded. 70.6% were aware there is an SRS service at BWOSCC; only 1 knew where to find the electronic referral form. 41.2% would consider referring a patient with brain metastasis &amp;gt;3cm. Although 88.2% would refer if &amp;gt;1 brain metastasis, only 35.3% would if &amp;gt;3 brain metastases present. 70.6% would not refer if systemic disease was uncontrolled. 82.4% would refer if previous neurosurgery had been performed. Only 41.2% felt previous whole brain radiotherapy (WBRT) was not a barrier to referral. 82.4% were comfortable to refer if previous PB (partial brain) RT was delivered; 76.5% if previous SRS. 94.1% said if prognosis was ≤3 months they would not refer. 100% would refer if PS 0 or 1; 82.4% if PS2; 94.1% would not refer if PS3. 88.2% stated CT and MRI are optimal pre-treatment imaging. 11.8% stated the duration of planning and treatment appointments would discourage them from referring; 17.6% said the mask and set-up position would, and 11.8% declared the geographical location of the patient would. 88.2 % feel they don’t receive enough teaching on SRS; most would prefer SRS teaching in specialty trainee year 4. CONCLUSION Survey results demonstrated a positive awareness of the SRS service, but responses suggest a lack of understanding about suitability criteria for SRS. Improved education of SRS is required at registrar-level to help better inform clinicians practicing at BWOSCC. Moving forward, we will: update the SRS referral form, highlighting where it can be accessed; survey the consultants; provide registrar SRS teaching; discuss SRS education with the training programme director and re-survey.
P18.45.A THE INCONSISTENT TERMINOLOGY FOR EXTENT OF RESECTION IN GLIOBLASTOMA: A SYSTEMATIC REVIEW ON SIX DECADES OF NEURO-ONCOLOGICAL STUDIES
Authors: N C Teske, L B Jung, N Teske, N Thon, J Tonn, P Karschnia
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND More extensive resection translates into improved outcome in patients with newly diagnosed glioblastoma. Insufficient acknowledgment of extent of resection may therefore introduce substantial bias in clinical trials. We herein aimed to systemically characterize the terminology used to describe resection in the context of neuro-oncological studies. MATERIAL AND METHODS A thorough review of the PubMed database was conducted to identify neuro-oncological trials between January 1966, and January 2024. Only studies which included information on extent of resection for newly diagnosed glioblastoma in adult patients were selected for our analysis. A standardized set of semantic and clinical variables was extracted for each study. RESULTS A total of 1862 neuro-oncological studies were screened, and 117 studies including 44 prospective interventional trials and 73 retrospective studies met our inclusion criteria. While a favorable association between outcome and more extensive resection was virtually uniformly reported, a broad range of 15 different semantic terms were used to describe the extent of resection (e.g., “complete/incomplete”, “gross-total/subtotal”, or “total/partial” resection). In line with this inconsistent terminology, only 60 studies (60/117, 51%) provided explicit definitions on how much tumor needed to be removed in order for a patient to match into a category corresponding to more extensive resection. Of these 60 studies, 17 (17/60, 28%) relied on subjective measurements including intraoperative estimations for extent of resection, while 43 studies (43/60, 72%) required objective measurements of volumetrics on pre- and post-operative imaging. There was no difference in the number of objective definitions between prospective and retrospective studies. However, the number of studies with objective definitions were significantly higher in surgical studies compared to medical neuro-oncological studies and increased over the last years (before 2010: 21%; after 2010: 41%). CONCLUSION The terminology used to describe the extent of resection is highly inconsistent across different clinical studies in neuro-oncology. To reduce potential imbalances between study arms and enable comparisons across different institutions, adaption of a standardized surgical nomenclature appears crucial. The recent RANO resect classification for extent of resection might form the basis for such a standardized terminology.
P09.11.A IMPACT OF FET-PET IMAGING IN SURVEILLANCE OF THERANOSTIC TREATMENT WITH 4-L-[131I]IODO-PHENYLALANINE ([131I]IPA) IN RELAPSED GLIOBLASTOMA PATIENTS
Authors: J Pichler, A Leibetseder, I Höllmüller, J Feichtinger, J Dierneder, O Osipova, R Pichler
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Theranostic is an evolving field in oncology. IPAX1 and IPAX-Linz studies used the radioligand Iodine-131[131I] IPA in combination with external re-irradiation in glioblastoma (GBM) patients. Modality of choice for assessment after therapy is contrast-enhanced magnetic resonance imaging (CE-MRI). Further, O-(2-[18F]fluoroethyl-)-L-tyrosine (18F-FET) positron emission tomography (PET) has become a valuable tool for brain tumor surveillance by adding metabolic information. However, no real-world data exist in the joint application of RANO 2.0 and PET RANO 1.0 criteria in response assessment of GBM, especially in patients treated with a theranostic approach. MATERIAL AND METHODS 12 patients with histological diagnosis of recurrent GBM treated in our center within study protocols IPAX 1 and IPAX Linz were evaluated to compare MRI with FET-PET in follow up after treatment with theranostic therapy. PET RANO 1.0 criteria were used to evaluate the validity and predictive value of additional FET-PET imaging in treatment surveillance. Primary aim of the study was the response assessment and comparison of progression-free survival following RANO 2.0 criteria and PET RANO 1.0 criteria. RESULTS Mean PFS according to MRI criteria was 20.5 weeks (4.7 months). Mean OS was 48.5 weeks (11.2 months). No partial or complete responses were seen in MRI follow up. 7/12 (58.3 %) patients show progression at first FU MRI two months after baseline. In 2nd FU 11/12 (91.7 %) patients progressed. Evaluation based on PET RANO 1.0 criteria at first FET-PET FU investigation resulted in different outcomes depending on which PET parameter was used (volume, TBRmax, TBRmean). Mean PFS calculated by PET volume is 77 days (11 weeks/2.5 mo). Mean PFS based on TBRmax or TBRmean is not assessable because in the 2 follow up investigations most patients were stable or had a partial response in these two PET parameters. CONCLUSION This pilot study demonstrated different outcome in respect of PFS depending on whether MRI or PET RANO criteria have been used for analysis. Further, application of PET RANO criteria showed varying results in terms of response for each individual parameter (TBRmax, TBRmean and PETvolume). Based on our data, the value of an additional PET scan for a valid prediction of response in recurrent GBM patients must be discussed. Disclosure: IPAX-1 was sponsored by Telix Pharmaceuticals. IPAX Linz is an investigator-initiated trial; IMP was provided by Telix Pharmaceuticals.
P24.03.B PATIENT AND CAREGIVER VIEWS ON AN INNOVATIVE SURGICALLY IMPLANTABLE MEDICAL DEVICE TO DELIVER ELECTRIC FIELD THERAPY IN GLIOBLASTOMA
Authors: R Purdy, A Thomson, H Bulbeck, N Munir, D Venters, K Koh, Q Akhtar, C Bullock, S Price, R Fu
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Glioblastoma (GBM) is the most common primary brain cancer in adults and carries a poor prognosis, with just 3% of those diagnosed surviving to 5 years. The standard of care (SOC) for glioblastoma has remained the same for the last 20 years: debulking brain surgery, chemotherapy, and radiotherapy. Electric field therapy (EFT), or Tumour Treating Fields (TTFields), is a promising novel treatment option for glioblastoma but there is just one commercially available device, applied to the head externally. It is currently unavailable to GBM patients in the UK through the National Health Service (NHS). QV Bioelectronics is developing an implantable medical device to deliver EFT, called GRACE, and has recently undertaken several patient and public involvement (PPI) studies alongside charity and clinical partners to understand the views of patients and caregivers on glioblastoma treatment and emerging EFT research. MATERIAL AND METHODS 19 patients living with high grade glioma, of which glioblastoma is a subtype, and 6 caregivers were recruited to the PPI sessions. Four live workshops were conducted virtually in focus groups, each session lasting between 60 and 120 minutes. During the workshops, information was presented to participants with regular intervals for open-ended discussion. Material explored as part of the workshops included current treatment options for GBM, the design of GRACE, its eligibility criteria, and clinical trial design. A survey comprising 10 questions was also sent to a sample of participants prior to the workshops to understand views independent of technology developed by QV Bioelectronics. RESULTS The questionnaire was sent to 17 participants prior to the workshops, of whom 14 (82%) responded (8 patients and 6 caregivers). 100% strongly agreed that better treatment options for glioblastoma were needed, and only 21% were aware of TTFields as an approved therapy. 93% would consider an implanted medical device to deliver EFT as part of their or their close person’s treatment plan. During the workshops, the main concern expressed by participants was the impact of current treatment options on activities of daily living (ADLs) and quality of life. Participants felt that GRACE and its components were appropriate and would not hinder ADLs or negatively impact quality of life, and provided advice on patient-facing material. Participants expressed support for clinical trials and associated dissemination methods. CONCLUSION UK patients living with high grade glioma and their caregivers clearly outlined the current treatment gap in glioblastoma and the opportunities for improved therapy options.