Neuro-oncology Research Articles

DO NEURO ONCOLOGY PATIENTS FEEL SUffiCIENTLY SUPPORTED TO MANAGE THEIR SURGICAL WOUNDS AFTER SURGERY?

Abstract AIMS Establish if neuro oncology patients feel they are sufficiently well supported to manage their wounds post operatively. Is there any correlation to patient wound care management and developing wound infections. METHOD There was an anecdotal rise in wound infections in the neuro oncology department, which led to the team investigation a cause. This project was looking to see if patients felt they were sufficiently supported to manage their wounds post operatively. A survey was sent via email to 94 patient’s who had undergone neurosurgery under the neuro oncology team at a London teaching Hospital in December 2023, January 2024, and February 2024. RESULTS There was a response rate of 23.5%. Overall 96% of patients felt able to manage their wound post operatively. 76% of people wished to have the information on wound care at discharge from hospital. 68% advised that they would like to receive information about wound care via printed material and 76% would like verbal instruction with questions. Patients commented that ‘there was a conflict of information’, and ‘the information at discharge could have been better’. They would like information on’ how to clean it [the wound]. 3 patients had a suspect infection but did not have treatment, and 1 had a confirmed infection with treatment. CONCLUSION Neuro oncology patients are able to manage their wounds post operatively, but they feel that they would benefit from extra support via written material, and verbal instructions. Future projects may include developing an evidence based post operative wound care information leaflet and instructions for wound care. Although in this cohort there was only 1 confirmed infection, further investigation is needed to establish the cause for the apparent increase.

IMPROVING THE EffiCIENCY OF THE NEURO-ONCOLOGY NEW PATIENT CLINIC AT THE ROYAL MARSDEN HOSPITAL

Abstract AIMS Patients seen for the first time in the neuro oncology outpatient unit are typically reviewed by a registrar, then a consultant and a clinical nurse specialist (CNS). This can lead to repetition in history taking and prolonged appointment times. We aimed to improve this by introducing a clerking proforma. METHOD Prospective audit of all new patients seen in clinic over a four month period. The total clinic appointment time was recorded for each patient. A proforma was designed to cover the main domains of presenting symptoms, especially focussing on tumour related symptoms, medications including dexamethasone and antiepileptic use, and ensured the appropriate information was given to the patient about the treatment proposed and driving restrictions. The proforma was introduced in to the clinic after 2 months and results analysed to see if a difference was made in terms of overall patient time in the clinic. Qualitative feedback gathered from the team members involved. RESULTS 10 patients were included prior to the use of the proforma and 9 patients afterwards. Patients presented with a mixture of high and low grade gliomas. Treatment options discussed included chemotherapy, radiotherapy, surveillance and best supportive care. The average time of patient stay in the department prior to the proforma was 107 minutes (range 65 to 165) and after the introduction of the proforma was 91 (range 40 to 110). The proforma was well received by the clinical team, it was felt useful to have a template to structure the new patient consultation, especially for more junior registrars, and the consultants were more confident that the appropriate information had been given. CONCLUSION Within the confines of a small sample size, the introduction of a proforma reduced the average new patient consultation time and standardised the clinical information collected.

NURS-10. DEVELOPMENT OF A NATIONAL PAEDIATRIC NEURO-ONCOLOGY NURSES GROUP (UNITED KINGDOM)

Abstract BACKGROUND The purpose of developing this group is to provide neuro-oncology patients with a high standard of care from diagnosis, treatment and beyond that is research based and reflects individual needs. This forum allows nurses working within paediatric neuro-oncology to share knowledge, experience, collaborate on projects, benchmarking and research opportunities. This will allow paediatric neuro-oncology nurses to increase their expertise and to foster relationships and collaborate with the wider neuro-oncology field and multi-disciplinary team. METHODS Develop an affiliation with a national association or organization Develop links to ensure all neuro-oncology nurses within CCLG centres are aware of the group, have the opportunity to join, fostering collaboration and support. Develop awareness of the neuro-oncology nursing speciality Develop a mission statement, terms of reference, and rolling agenda Literature reviews to ensure group has similar operation in line with other national nurses’ groups. Developing accountability. RESULTS Developed database of national neuro oncology nurses with all CCLG UK and Ireland centres represented. Set frequency of meetings and agendas. Ensure it operates to the same standard as other nurses’ groups. Organised working groups for projects. Agreed role of chair. CONCLUSION These activities have continued the development of the group since it’s conception in 2015 providing more structure, continued support to its members and wider recognition of its work. A robust mission statement, terms of reference, organisation and structure will ensure continued provision of education and support to neuro-oncology nurses, recognition of the group to the wider neuro-oncology community and improve overall patient experience.

NURS-16. CREATING A STANDARDISED DOCUMENT FOR EDUCATION SETTINGS ACROSS THE UNITED KINGDOM FOR CHILDREN WITH CENTRAL NERVOUS SYSTEM TUMOURS

Abstract There are currently nineteen Principle Treatment Centres (PTC) in the UK delivering care to children, aged 0-19, following diagnosis of a Central Nervous System (CNS) tumour. Every centre promotes inclusivity and the safe and successful return to education, however reintegration can be a challenging process for this complex group of patients and there is a vast amount of information available. At present each PTC provides their own personalised document, including a list of resources, to signpost the education setting to appropriate information. With the collaboration of participating PTC’s, our aim was to create a standardised document for education settings to utilise following a child’s CNS diagnosis. Each of the nineteen PTC’s were approached, requesting representation from a neuro oncology nurse specialist and the sharing of their bespoke information. Following this, benchmarking criteria were created and each document reviewed and evaluated. The review and evaluation process also included websites and information leaflets that centres currently signpost to, from charities and other relevant organisations. By working closely together as a national group of neuro oncology nurses, we have created a standardised document and list of suitable resources for education settings. The finalised document will be shared with each PTC, with the intention of promoting a smooth transition back into education and quality and equity of information for all children, irrespective of where they live in the UK. Auditing of the document will be part of the ongoing work of the group.

LMIC-21. SERIES OF 9 CASES OF SPINAL CORD COMPRESSION IN CHILDREN: A SINGLE EXPERIENCE FROM THE PEDIATRIC NEURO-ONCOLOGY GROUP, IN A MIDDLE INCOME COUNTRIES

Abstract BACKGROUND Spinal cord compression secondary to pediatric neoplasms is a rare but serious event that can result in irreversible neurological sequelae, with paralysis, sensory losses and sphincter dysfunction. This retrospective study aims to describe the main causes, treatments and outcomes of a series of cases of spinal cord compression in patients admitted to the Childhood Cancer Treatment Institute- ITACI, University of São Paulo, Brazil. METHODS Based on data collected from the pediatric neuro oncology group, we analyzed nine cases of spinal cord compression in patients under 18 years, admitted from 2020 to 2023. RESULTS In our case series, 7 of the 9 children were female, with an average age of 104 months, the youngest being 3 months. Of the cases described, 77.7% had extradural spinal cord compression. Ewing’s sarcoma was the main neoplasm associated with extradural compression, representing 44.4%. Neuroblastoma, giant cell tumor and B acute lymphoblastic leukemia accounted for 11.1% of cases each. Cases of intradural compression were represented by low-grade glioma with cervical compression and germ cell tumor from with thoracolumbar lesion. Spinal cord compression was the first manifestation of malignancy in 8 of the 9 patients, who presented loss of motricity and sensitivity. All patients were treated with corticosteroid, therapy due to its benefits in reducing vasogenic edema caused by spinal cord compression. Additionally, 8 patients underwent surgical spinal decompression. A patient with Ewing sarcoma received cytoreductive chemotherapy and achieved complete motor recovery. CONCLUSIONS Spinal cord compression is associated with serious neurological sequelae when not treated appropriately. However, neurological recovery is possible with early diagnosis and adequate decompression treatment. We increased the importance of specialized services with a pediatric neuro-oncology group, in which several professionals work together to provide individualized care, even in developing countries, as demonstrated by the patients treated at our institution.

A qualitative evaluation of factors influencing Tumor Treating fields (TTFields) therapy decision making among brain tumor patients and physicians

BackgroundTumor Treating Fields (TTFields) Therapy is an FDA-approved therapy in the first line and recurrent setting for glioblastoma. Despite Phase 3 evidence showing improved survival with TTFields, it is not uniformly utilized. We aimed to examine patient and clinician views of TTFields and factors shaping utilization of TTFields through a unique research partnership with medical neuro oncology and medical social sciences.MethodsAdult glioblastoma patients who were offered TTFields at a tertiary care academic hospital were invited to participate in a semi-structured interview about their decision to use or not use TTFields. Clinicians who prescribe TTFields were invited to participate in a semi-structured interview about TTFields.ResultsInterviews were completed with 40 patients with a mean age of 53 years; 92.5% were white and 60% were male. Participants who decided against TTFields stated that head shaving, appearing sick, and inconvenience of wearing/carrying the device most influenced their decision. The most influential factors for use of TTFields were the efficacy of the device and their clinician’s opinion. Clinicians (N = 9) stated that TTFields was a good option for glioblastoma patients, but some noted that their patients should consider the burdens and benefits of TTFields as it may not be the desired choice for all patients.ConclusionsThis is the first study to examine patient decision making for TTFields. Findings suggest that clinician support and efficacy data are among the key decision-making factors. Properly understanding the path to patients’ decision making is crucial in optimizing the use of TTFields and other therapeutic decisions for glioblastoma patients.

1239 Trends in Geospatial Availability of Neuro-oncology Clinical Trials in the United States Over Two Decades

INTRODUCTION: Advances in brain tumors treatments rely on successful neuro-oncology (NO) clinical trials. To date, data on NO trials completion in the US is scarce. Understanding these factors could help improve access to and the design of future clinical trials. METHODS: NO clinical trials registered in the US were analyzed (2000-2019). Univariate and multivariate analysis were used to compare success rates among trials. Geospatial analysis was performed to determine the trial density and failure rates across different states. Trial density was estimated by the number of trials/state population. RESULTS: A total of 2,610 neuro-oncology clinical trials were registered in the US during the study period, of which 1,257 met a primary endpoint – completion or trial failure. North Dakota had the highest trial density (6.03 trials/100,000 residents), followed by South Dakota (5.83) and several Northeastern states (3.90-5.60). The change in trial failure rates did not correlate with trial density by state (p = 0.777). The states with the greatest increase in trial failure rates were Nevada (23.1%), West Virginia, Alaska, and Idaho (all three at 20.0%). Florida showed a trend towards a statistically significant increase in failure rates to 10.9% (p = 0.09). CONCLUSIONS: The results of this study highlight the variations in success rates and geographic distribution of neuro-oncology clinical trials in the United States. Factors beyond trial density may be critical to trial success. The significant geographic variations in trial density and failure rates across states emphasize the need for targeted efforts to improve access participation to trials in certain regions. Further studies aimed at identifying the factors contributing to the increase in trial failure rates are needed to develop strategies to improve trial enrollment.

A Clinical Audit: Assessing the Diagnostic Delay of Primary Brain Tumors, Glioblastoma IDH-Wild Type and Primary CNS Lymphoma; Exploring the Use of CSF Liquid Biopsy

Background: Diagnostic delay is a critical issue in healthcare, often leading to delayed treatment and poor patient outcomes. Diagnostic errors contribute to about 10% of patient deaths annually. Delays are very prevalent in Glioblastoma and Primary CNS Lymphoma. Both have an aggressive nature and a short survival rate, which urges for early diagnosis to ensue treatment as quick as possible. The delayed diagnosis can be attributed to tumor-specific factors such as challenging differential diagnoses, inadequate methods in achieving optimal outcomes, and the presence of confounding factors like steroid usage. Aims and Objectives: The objective of this clinical audit is to analyse patient records within an oncology unit. The primary goal is to assess the quality of practice by evaluating the standards of diagnosis and treatment. Additionally, the audit aims to pinpoint areas that require improvement at every stage of patient management, encompassing administration, symptom evaluation, and post-therapeutic measures. Based on these findings, a comprehensive plan of action will be proposed to address the identified issues effectively. Standards and Methods: In this Clinical Audit, we assessed the adherence of 10 Glioblastoma and PCNSL patients in a neuro oncology unit, to standards and guidelines set by professional medical associations. Which include World Health Organisation (WHO), National Health Service England (NHS), and European Association of Neuro-oncology (EANO). Results: Our cohort showed long diagnostic delays, minimum and maximum values of 30 and 1825 days. The sample did not show significantly longer delays compared to other PCNSL or HGG patients, all collected from the literature, with p values of 0.174 and 0.637, respectively. Conclusions: In Conclusion, Diagnostic Delay attributed to PCNSL and Glioblastoma can be pinpointed to the inadequacy of existing standards in relying solely on stereotactic biopsies for definite diagnosis when it may not be ideal for all patients at all tumor stages. A plan of action encouraging large clinical trials of CSF Liquid Biopsy is recommended with an employment of recent advances and focusing on detecting circular tumor DNA for the diagnostic insight it provides. As well as exploring its use during or post therapy to monitor the lesion and pathology. To also adhere strictly to the discouragement of steroid use for the negative prognostic factors it causes.

EOLP-07. A REAL-WORLD INTEGRATED OUTPATIENT PALLIATIVE AND SUPPORTIVE CARE CLINIC IN A REGIONAL COMMUNITY NEURO-ONCOLOGY PRACTICE

Abstract BACKGROUND Palliative care (PC), a specialty focused on alleviating suffering, is appropriate at any stage of serious illness and can improve quality of life, survival and reduce care partner distress. Integration within the care of neuro-oncology (NOC) patients remains difficult. At our center, patients who might benefit from specialty palliative care have been seen by a dual fellowship trained NOC and PC specialist (A.S.) since February 2021. We present our experience here. METHODS This was a retrospective chart review including records from the electronic medical record system from February 2021 to May 2023. RESULTS/ CONCLUSION A total of 58 patients received integrated PC from 651 seen in the general NOC practice. The most common diagnosis was glioma (59%), with the rest being a mixture of lymphoma or systemic cancer with brain involvement. Majority of patients were male (53%) and identified as White/Caucasian (86%). The average age of patients at referral was 58. The most common focus was symptom management (40%), followed by guidance around decision-making (14%), care partner support (11%), advance care planning (10%), and support with coping (9%). The most common symptoms discussed included fatigue (36%), seizures (22%), and pain (21%). By the submission of this abstract, 28 (48%) patients had passed away, 22 of whom (79%) had formally enrolled on hospice with an average of 24 days prior to death. The primary cause of death was respiratory failure towards end of life (71%). Three patients (11%) had chosen to employ the California End of Life Act. Advanced directives were discussed and completed in 82% and a proxy had been identified in 100%. This model of integrated PC for NOC clinics appears to be feasible, meaningful and is welcomed for it allows focused, dedicated attention to symptom management, distress alleviation, advance care planning and hospice transition.

QLTI-13. RETROSPECTIVE REVIEW OF THE DIAGNOSTIC YIELD OF CEREBROSPINAL FLUID (CSF) ANALYSIS IN DIAGNOSIS OF CENTRAL NERVOUS SYSTEM (CNS) LYMPHOMA IN A COMMUNITY NEURO ONCOLOGY CENTER

Abstract Central nervous system (CNS) lymphoma can be a challenging disease to diagnose. Both primary and secondary CNS lymphoma often result in poor outcomes rendering early diagnosis and treatment essential. Traditionally, diagnostic modalities include surgery, cerebral spinal fluid (CSF) cytologic analysis, vitrectomy, and chorioretinal biopsy. Radiographic and clinical presentation can widely vary between patients, further enhancing diagnostic dilemma. We present a retrospective study from a community neuro oncology center analyzing the utility of CSF analysis in the diagnosis of CNS lymphoma. Between 2018-2022, 26 CNS lymphoma patients were identified of which 22 (85%) were primary CNS lymphoma patients. Median age of diagnosis was 68.5 years, and 21 (81%) of the patients were immunocompetent. 13 (50%) of the patients underwent CSF analysis, including cytology and flow cytometry), prior to biopsy and none (0%) yielded a positive diagnosis of CNS lymphoma. While mean CSF volume for cytology was slightly more than 3 cc of fluid, patients who had 5-10 cc of fluid sent for cytology also yielded a negative result for CNS lymphoma. For all patients, median duration from presentation of symptoms to surgery was 10.5 days. However, when divided between patients who proceeded straight to biopsy (CSFsecond) versus those who underwent CSF analysis prior to biopsy (CSFfirst), the duration from presentation of symptoms to surgery was 6 days versus 11 days, respectively. 10 patients in the CSFfirst group were not on steroids at the time of lumbar puncture whereas only 4 patients in the CSFsecond group were not on steroids at time of biopsy suggesting that steroid use did not seem to influence the yield of either diagnostic modalities. Our experience suggests that CSF analysis in community settings should be reserved only for staging and that surgical biopsy should be pursued as soon as the diagnosis of CNS lymphoma is considered.

PATIENT ADVOCACY-01 WHY IS NEURO- ONCOLOGY MISSING FROM CIVIL SOCIETY CANCER ADVOCACY AGENDA?

Abstract BACKGROUND Cancer civil society and patient groups across Africa play a major role in pressuring governments to develop, fund, and implement national cancer control plans and to keep their commitments to international declarations. Additionally, community cancer awareness is mainly driven by lay cancer advocates and cancer survivors. The cancer policy and legislation landscape in Kenya has largely been shaped by the civil society through consistent advocacy OBJECTIVE Explore barriers and enablers to meaningful engagement of cancer civil society advocates in advancing neuro-oncology in Africa. METHODOLOGY This is a desk review of current developments and literature in advocacy for neuro-oncology with insights and perspectives of practicing oncology nurses and civil society cancer advocates in Kenya. FINDINGS Cancer advocacy in Kenya has traditionally focused on creating awareness on the more common cancers, breast, cervical prostate and Gastro-intestinal cancers. Over the last 10 years’ attention has gradually shifted to access and cost of care. Cancers of the central nervous system such as gliomas, neuroblastomas and meningiomas, though not uncommon do not feature prominently in advocacy discourses. This is due the fact that they are perceived as ‘rare’, complex, difficult to explain and with poor outcomes. DISCUSSION AND IMPLICATIONS There is a growing appreciation of the need to develop a framework through which civil society can contribute to the development of quality neuro oncology services. Cancer civil society organizations, neurosurgeons, neurologists, oncologists, academicians, and other healthcare professionals must work together to overcome structural barriers so that neuro oncology is not left behind in the national cancer plans. Stakeholders will need to establish guidelines with well defined mechanism for engaging, involving and acknowledging the contribution of cancer advocates in advancing neuro-oncology. This will require a cultural shift from neuro-oncology professionals to accommodate the input of lay civil society advocates.

JS01.4.A CENTRALIZED CRANIOSPINAL PROTON THERAPY FOR MEDULLOBLASTOMA PATIENTS; AN EVALUATION OF THE CARE INFRASTRUCTURE IN THE NETHERLANDS

Abstract BACKGROUND The introduction of proton radiotherapy in the Netherlands resulted in the centralization of proton craniospinal irradiation (pCSI) for patients with medulloblastoma (MB) to a single center. For optimal outcome of MB patients, timely start of pCSI and treatment without interruptions is important. However, national-scale referrals and the complexity of delivering pCSI pose a risk for treatment delays in these patients. Therefore, to aid in high quality care, integration of pCSI within the national pediatric oncology center and collaboration within the Dutch neuro oncology society - rare cancer working group was established. In this study, we evaluated the care infrastructure for pCSI for a nationwide defined MB patient cohort in the Netherlands. MATERIAL AND METHODS All Dutch MB patients referred for pCSI to our center were included in this analysis. The interval between surgery and start of pCSI was calculated, excluding patients who received neo-adjuvant chemotherapy. Overall treatment time, use of (back-up) photon fractions and plan adaptations were evaluated. Data regarding planned and additional multidisciplinary care during pCSI were extracted from the medical records. RESULTS Between February 2018 and December 2022, 79 MB patients, including 25 (32%) adult (>18 years) patients, were treated with pCSI. The median interval between surgery and start of pCSI for pediatric and adult patients was 32 days (IQR 30, 35) and 41 days (IQR 35, 55) respectively, and 91% and 47% started within 40 days from surgery. The median overall treatment time for all patients was 41 days (range 11). The longest treatment interruption was 3 days in one adult patient. Eight patients received a median of 9 photon fractions (IQR 2, 11); most often because of the need to start treatment quickly. In 30% of all patients a plan adaptation was needed, mostly because of changes in patient weight during treatment. In our center, it is considered standard of care to involve the (pediatric) medical oncologist and neurologist during pCSI. Clinical care (hospitalization) was required in 42% of the patients for a median of 10 days. Anesthesia was necessary predominantly for patients aged 8 years and younger. Other (para)medical disciplines involved during pCSI were neurosurgery (6%), neuropsychology (22%), speech therapy (25%), rehabilitation therapy (46%) and nutritional specialist (73%). CONCLUSION The Dutch pCSI infrastructure for MB patients facilitated a timely start of treatment in over 90% of pediatric patients and in nearly half of the adult patients. During pCSI treatment, a well-orchestrated interplay between several (para)medical disciplines is required to provide all potential necessary care. More disciplines were involved and more clinical care was required for pediatric patients. We were able to deliver pCSI treatment with less than 3 days interruption in 98% of patients.

Auto-Segmentation and Classification of Glioma Tumors with the Goals of Treatment Response Assessment Using Deep Learning Based on Magnetic Resonance Imaging.

Glioma is the most common primary intracranial neoplasm in adults. Radiotherapy is a treatment approach in glioma patients, and Magnetic Resonance Imaging (MRI) is a beneficial diagnostic tool in treatment planning. Treatment response assessment in glioma patients is usually based on the Response Assessment in Neuro Oncology (RANO) criteria. The limitation of assessment based on RANO is two-dimensional (2D) manual measurements. Deep learning (DL) has great potential in neuro-oncology to improve the accuracy of response assessment. In the current research, firstly, the BraTS 2018 Challenge dataset included 210 HGG and 75 LGGwere applied to train a designed U-Net network for automatic tumor and intra-tumoral segmentation, followed by training of the designed classifier with transfer learning for determining grading HGG and LGG. Then, designed networks were employed for the segmentation and classification of local MRI images of 49 glioma patients preand post-radiotherapy. The results of tumor segmentation and its intra-tumoral regions were utilized to determine the volume of different regions and treatment response assessment. Treatment response assessment demonstrated that radiotherapy is effective on the whole tumor and enhancing region with p-value ≤ 0.05 with a 95% confidence level, while it did not affect necrosis and peri-tumoral edema regions. This work demonstrated the potential of using deep learning in MRI images to provide a beneficial tool in the automated treatment response assessment so that the patient can obtain the best treatment.

Semi-solid MT and APTw CEST-MRI predict clinical outcome of patients with glioma early after radiotherapy.

The purpose of this study was to compare the potential of asymmetry-based (APTwasym ), Lorentzian-fit-based (PeakAreaAPT and MTconst ), and relaxation-compensated (MTRRex APT and MTRRex MT) CEST contrasts of the amide proton transfer (APT) and semi-solid magnetization transfer (ssMT) for early response assessment and prediction of progression-free survival (PFS) in patients with glioma. Seventy-two study participants underwent CEST-MRI at 3T from July 2018 to December 2021 in a prospective clinical trial four to 6 wk after the completion of radiotherapy for diffuse glioma. Tumor segmentations were performed on T2w -FLAIR and contrast-enhanced T1w images. Therapy response assessment and determination of PFS were performed according to response assessment in neuro oncology (RANO) criteria using clinical follow-up data with a median observation time of 9.2 mo (range, 1.6-40.8) and compared to CEST MRI metrics. Statistical testing included receiver operating characteristic analyses, Mann-Whitney-U-test, Kaplan-Meier analyses, and logrank-test. MTconst (AUC = 0.79, p < 0.01) showed a stronger association with RANO response assessment compared to PeakAreaAPT (AUC = 0.71, p = 0.02) and MTRRex MT (AUC = 0.71, p = 0.02), and enabled differentiation of participants with pseudoprogression (n = 8) from those with true progression (AUC = 0.79, p = 0.02). Furthermore, MTconst (HR = 3.04, p = 0.01), PeakAreaAPT (HR = 0.39, p = 0.03), and APTwasym (HR = 2.63, p = 0.02) were associated with PFS. MTRRex APT was not associated with any outcome. MTconst , PeakAreaAPT, and APTwasym imaging predict clinical outcome by means of progression-free survival. Furthermore, MTconst enables differentiation of radiation-induced pseudoprogression from disease progression. Therefore, the assessed metrics may have synergistic potential for supporting clinical decision making during follow-up of patients with glioma.

Abstract 54: Influence of Neuro Oncology Capacity Development on Diagnosis of Pediatric Primary CNS Tumors in Northern Tanzania

Abstract Purpose: The diagnosis of CNS tumors requires a multidisciplinary team including oncologists, neurosurgeons, radiologists and pathologists. We review the impact of expanding diagnostic capacity on the identification and diagnosis of primary pediatric CNS tumors at Bugando Medical Centre (BMC), the regional cancer referral hospital in the lake zone region of Mwanza Tanzania. Methods: Patients who presented to BMC from 2016-2022 and received a radiographic or pathologic diagnosis of primary brain or spinal cord tumor were included a CNS tumor registry. Collected data included basic demographics, most specific diagnosis, and diagnostic method. Data was measured and compared before and after initiating key capacity development milestones: 2018 – installation of CT scan, 2020 – arrival of neurosurgical specialist, 2021 – initiation of multidisciplinary tumor board and WhatsApp chat. Results: A total of 7 spinal and 71 brain tumors were diagnosed among patients aged &amp;lt; 18yo, with (46%) female (n=31) and average age of 7 years. The number of cases per year increased from 3 in 2016, to 17 in 2022. Prior to availability of CT scan (2016-2017), there were an average of 2.5 cases/year, compared to 14.6/year in 2018-2022. With the arrival of the neurosurgeon in 2020, the number of diagnoses/year increased from 11 to 20 from the year prior, but only 50% of patients had a confirmed radiologic or histologic diagnosis. Following initiation of Multidisciplinary Tumor Board Discussion and WhatsApp group, 88% of patients registered in 2022 had a radiographic or histologic diagnosis. Conclusion: This retrospective study demonstrated the step wise influence of key development milestones on the diagnostic capacity for CNS tumors in a LMIC. While introduction of CNS imaging allowed the identification of more tumors, the multidisciplinary team discussion of the imaging, clinical presentation and pathology results had the greatest overall impact on diagnostic capacity in our setting and should be a key component in future program development. Citation Format: Kristin Schroeder, Taryn Kerley, James Lubuulwa, Margreth Magambo, Jacqueline Kamanga, Heronima Joas. Influence of Neuro Oncology Capacity Development on Diagnosis of Pediatric Primary CNS Tumors in Northern Tanzania [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 54.

Editorial: Frontiers in Neuro Oncology and Neurosurgery

Despite advances in our knowledge and treatments, Central Nervous System (CNS) Tumors remain the most difficult clinical challenge for the worldwide medical community [...].

NIMG-36. MR PERFUSION IS A BETTER PREDICTOR OF TUMOR RECURRENCE AND TREATMENT RESPONSE THAN STANDARD MRI IN SOME OLIGODENDROGLIOMA PATIENTS

Abstract Dynamic susceptibility contrast (DSC) perfusion MRI (pMRI) has proven efficacy in the evaluation of glioma grade, progression and response to therapy. While not currently integrated within RANO (Response Assessment in Neuro Oncology) criteria, pMRI is often assessed alongside standard imaging of astrocytic glioma. In contrast, evaluation of pMRI in oligodendroglioma, has been less well-studied despite its potential to evaluate the comparatively greater vascularity of its “chicken-wire” capillary networks. Moreover, standard imaging to evaluate oligodendroglioma course can be confounded by slow-growing enhancement that does not meet RANO threshold for progression, or disease control despite low or absent radiographic response, and radiation-induced leukoencephalopathy resembling hyperintense changes on T2w and FLAIR imaging. Consequently, there is a clinical need to understand the potential role of pMRI in the evaluation of oligodendroglioma. As an initial step, we present here a case study of a patient with oligodendroglioma for which pMRI bested standard imaging in evaluation throughout radiographic disease surveillance. A 32 y/o gentleman with oligodendroglioma WHO grade 2 (IDH mutant, 1p19q codeletion) completed standard treatment, including surgical resection, irradiation, and chemotherapy. During surveillance imaging, a region of hyperperfusion on pMRI developed. However, since standard imaging was stable, RANO criteria was not met and observation was continued without intervention. Subsequent standard imaging demonstrated clear radiographic progression, reflecting the radiographic findings of pMRI but with delayed manifestation. Systemic chemotherapy was resumed with successively stable standard MR imaging. In contrast, the previous region of hyperperfusion improved over serial pMRI, and more consistently mirrored the patient’s clinical course. This case illustrates the timely radiographic importance of pMRI in assessing stability of tumor as well as treatment response. Considerations for the inclusion of pMRI within RANO criteria should be explored further.

P11.06.A benefits of carbohydrate loading drinks pre-operatively for patients with a presumed high-grade glioma planned for an awake craniotomy

Abstract Background As part of enhanced recovery after surgery in neuro oncology, carbohydrate loading drinks were reviewed to see if there were any benefits in administering this pre operatively, in particularly for patients for awake craniotomy electively. This method is currently used in colorectal and spinal teams within the trust. Carbohydrate loading drinks are clear, and can be consumed up to 2 hours before induction of anaesthesia. Currently reviewed for patients for awake craniotomy with the vision to implement for all patients planned for craniotomy, both asleep and awake. The concept of this drink, is that it helps with post-operative nausea and vomiting , insulin resistance, helps with energy boost which is helpful during awake craniotomies and potentially during their engagement with therapists post operatively and wound healing (Hausel J et al, 2005). This could essentially lead to safer discharge, reduced risk of wound infection and reduced length of stay. Material and Methods In a single centre, data for patients who have undergone awake craniotomies this year were abstracted. Patients planned for an awake surgery were prescribed carb-loading drinks. Due to the start date of this study, there were already a number of patients who have had their awake craniotomies without having carb-loading drinks prescribed. The data for both cohorts enabled comparison on engagement during and after awake craniotomies with therapists and length of stay. Results The current data collected has found that the average length of stay in the group who were not prescribed carbohydrate loading drinks pre operatively, had an average length of stay 7.2 days in total, 50% had experienced nausea and vomiting post operatively, which led therapists unable to perform assessments. 66% of patients in this group were found to have some form of difficulties engaging with the therapists during the awake phase of their craniotomies. Compared with patients who were prescribed the carbohydrate loading drink, the average length of stay was 4.6 days, with no post operative nausea and vomiting, no difficulties engaging with therapists post operatively. Conclusion Though the current data is of a small volume, carbohydrate loading pre-operatively can help patients for elective awake craniotomies and reduce length of stay in hospital, optimising their recovery in a fast yet safe manner to ensure they are in the best performance status prior to commencing oncology treatment. With further analysis into the use of carb-loading drinks pre-operatively, this can be used widely within neuro-oncology surgeries. Hausel J, Nygren J, Thorell A et al Randomized clinical trial of the effects of oral preoperative carbohydrates on postoperative nausea and vomiting after laparoscopic cholecystectomy. Br J Surg 2005; : 415-421. [PubMed] [Google Scholar]

The role of stereotactic radiosurgery in the management of petroclival meningioma: a systematic review.

Petroclival meningioma (PM) is a challenging neuro oncology case and stereotactic radiosurgery (SRS) is proposed as one treatment option. This systematic review aimed to examine the role of SRS in treating PM cases. We constructed a systematic review using the PRISMA guidelines using peer-reviewed English literature until 16 February 2022 from EuroPMC and PubMed. We used the terms petroclival meningioma, clival meningioma, apex petrous meningioma, spheno petroclival meningioma, stereotactic radiosurgery, radiosurgery, CyberKnife, Gamma Knife, linear accelerator, LINAC, and radiotherapy. 10 out of 266 studies were chosen for this systematic review, two of which are case reports. The study comprised 719 patients, 73.7% of whom were female (n = 530) and had a median age of 56.99years (18-90years). At the time of diagnosis, the median tumor volume was 6.07 cm3 (0.13-64.9 cm3). The tumors were frequently located near the petroclival junction (83.6%, n = 598). Following SRS, the median follow-up was 64.52months (3-252months). 46.5% of 719 PMs exhibited a decrease in tumor size. 46% and 7.5% showed no change and increase in tumor volume, respectively. At the last radiographic follow-up (7-21.2years), tumor control with a median of 98.8% (85-100%). Complications occurred in 6% of patients, with hydrocephalus (2.2%) as the prevalent complication.The use of SRS as a primary treatment for petroclival cases was not associated with increased complication rate RR 0.62 (95% CI [0.11, 3.59], p = 0.59) but statistically correlated with clinical failure clinical failure RR 0.56 (95% CI [0.32, 0.98], p = 0.04). We found a low number of complications following SRS intervention and has been effectively controlling tumor progression.

A New Frontier in Fighting Brain Cancer: Cutting Edge Magnetic Resonance Imaging Techniques

Of the currently available brain imaging techniques for diagnosing tumors, diffusion-weighted MRI and perfusion MRI are cutting-edge techniques and may provide improved diagnostic capacity compared to traditional techniques such as positron emission tomography. Moreover, they are fully non-invasive and avoid the exposure to radiation. While MRI in general has been used in research and medicine for decades, the more recent development of multi-modal and multiparametric imaging in neuro oncology holds much promise for the enhancement of diagnosis, prognosis, and patient-tailored treatments in this field. This review will evaluate how these various imaging techniques provide clinical value above and beyond previous techniques.