Tumor Dimension Research Articles

Estimation of Fractal Dimension and Segmentation of Brain Tumor with Parallel Features Aggregation Network

The accurate recognition of a brain tumor (BT) is crucial for accurate diagnosis, intervention planning, and the evaluation of post-intervention outcomes. Conventional methods of manually identifying and delineating BTs are inefficient, prone to error, and time-consuming. Subjective methods for BT recognition are biased because of the diffuse and irregular nature of BTs, along with varying enhancement patterns and the coexistence of different tumor components. Hence, the development of an automated diagnostic system for BTs is vital for mitigating subjective bias and achieving speedy and effective BT segmentation. Recently developed deep learning (DL)-based methods have replaced subjective methods; however, these DL-based methods still have a low performance, showing room for improvement, and are limited to heterogeneous dataset analysis. Herein, we propose a DL-based parallel features aggregation network (PFA-Net) for the robust segmentation of three different regions in a BT scan, and we perform a heterogeneous dataset analysis to validate its generality. The parallel features aggregation (PFA) module exploits the local radiomic contextual spatial features of BTs at low, intermediate, and high levels for different types of tumors and aggregates them in a parallel fashion. To enhance the diagnostic capabilities of the proposed segmentation framework, we introduced the fractal dimension estimation into our system, seamlessly combined as an end-to-end task to gain insights into the complexity and irregularity of structures, thereby characterizing the intricate morphology of BTs. The proposed PFA-Net achieves the Dice scores (DSs) of 87.54%, 93.42%, and 91.02%, for the enhancing tumor region, whole tumor region, and tumor core region, respectively, with the multimodal brain tumor segmentation (BraTS)-2020 open database, surpassing the performance of existing state-of-the-art methods. Additionally, PFA-Net is validated with another open database of brain tumor progression and achieves a DS of 64.58% for heterogeneous dataset analysis, surpassing the performance of existing state-of-the-art methods.

Pituitary apoplexy in cushing's disease: a single center study and systematic literature review.

Pituitary apoplexy (PA) in Cushing's disease (CD) is rare with data limited to case reports/series. We retrospectively reviewed case records of PA in CD managed at our center from 1987 to 2023 and performed a systematic literature review. We identified 58 patients (44 females), including twelve from our center (12/315 CD, yielding a PA prevalence in CD of 3.8%) and forty six from systematic review. The median age at PA diagnosis was 35 years. The most common presentation was type A (79.3%) and symptom was headache (89.6%), with a median Pituitary Apoplexy Score (PAS) of 2. Median cortisol and ACTH levels were 24.9µg/dl and 94.1 pg/ml, respectively. Apoplexy was the first manifestation of underlying CD in 55.2% of cases, with 31.1% (14/45) presenting with hypocortisolemia (serum cortisol ≤ 5.0µg/dl), underscoring the importance of recognizing clinical signs/symptoms of hypercortisolism. The median largest tumor dimension was 1.7cm (53/58 were macroadenomas). PA was managed surgically in 57.8% of cases, with the remainder conservatively managed. All five PA cases in CD with microadenoma achieved remission through conservative management, though two later relapsed. Among treatment-naïve CD patients with macroadenoma, PA-related neuro-deficit improvement was comparable between surgical and conservative groups. However, a greater proportion of surgically managed patients remained in remission longer (70% vs. 38.5%; p = 0.07), for an average of 31 vs. 10.5 months. PA in CD is more commonly associated with macroadenomas, may present with hypocortisolemia, and surgical treatment tends towards higher and longer-lasting remission rates.

A multi-institutional machine learning algorithm for prognosticating facial nerve injury following microsurgical resection of vestibular schwannoma

Vestibular schwannomas (VS) are the most common tumor of the skull base with available treatment options that carry a risk of iatrogenic injury to the facial nerve, which can significantly impact patients’ quality of life. As facial nerve outcomes remain challenging to prognosticate, we endeavored to utilize machine learning to decipher predictive factors relevant to facial nerve outcomes following microsurgical resection of VS. A database of patient-, tumor- and surgery-specific features was constructed via retrospective chart review of 242 consecutive patients who underwent microsurgical resection of VS over a 7-year study period. This database was then used to train non-linear supervised machine learning classifiers to predict facial nerve preservation, defined as House-Brackmann (HB) I vs. facial nerve injury, defined as HB II–VI, as determined at 6-month outpatient follow-up. A random forest algorithm demonstrated 90.5% accuracy, 90% sensitivity and 90% specificity in facial nerve injury prognostication. A random variable (rv) was generated by randomly sampling a Gaussian distribution and used as a benchmark to compare the predictiveness of other features. This analysis revealed age, body mass index (BMI), case length and the tumor dimension representing tumor growth towards the brainstem as prognosticators of facial nerve injury. When validated via prospective assessment of facial nerve injury risk, this model demonstrated 84% accuracy. Here, we describe the development of a machine learning algorithm to predict the likelihood of facial nerve injury following microsurgical resection of VS. In addition to serving as a clinically applicable tool, this highlights the potential of machine learning to reveal non-linear relationships between variables which may have clinical value in prognostication of outcomes for high-risk surgical procedures.

Predictive value of ultrasound doppler parameters in neoadjuvant chemotherapy response of breast cancer: Prospective comparison with magnetic resonance and mammography.

Neoadjuvant chemotherapy (NACT) is a treatment option for breast cancer patients that allows for the assessment of tumor response during treatment. This information can be used to adjust treatment and improve outcomes. However, the optimal imaging modalities and parameters for assessing tumor response to NACT are not well established. This study included 173 breast cancer patients who underwent NACT. Patients were imaged with ultrasound (US), mammography (MMG), and magnetic resonance imaging (MRI) at baseline, after two cycles of NACT, and before breast surgery. US parameters included lesion morphology, Doppler variables, and elastography measurements. MMG and MRI were evaluated for the presence of nodules and tumor dimensions. The pathological response to NACT was determined using the residual cancer burden (RCB) classification. The US parameter with the highest power for predicting pathological complete response (pCR) was shear wave elastography (SWE) maximum speed inside the tumor at baseline. For nonluminal tumors, the end diastolic velocity measured by US after two cycles of NACT showed the highest predictive value for pCR. Similarly, SWE maximum speed after two cycles of NACT had the highest discriminating power for predicting RCB-III in luminal tumors, while the same parameter measured at baseline was most predictive for nonluminal tumors. This study provides evidence that mid-treatment Doppler US and other imaging modalities can be used to predict the response to NACT in breast cancer patients. Functional parameters, such as blood flow velocities and SWE measurements, demonstrated superior predictive value for pCR, while morphological parameters had limited value. These findings have implications for personalized treatment strategies and may contribute to improved outcomes in the management of breast cancer.

18F-AlF-NOTA-octreotide PET/CT in the localization of tumor-induced osteomalacia: case series and literature review.

This study explores tumor-induced osteomalacia (TIO) through a case series and literature review, assessing the diagnostic potential of 18F-AlF-NOTA-octreotide (18F-OC) positron emission tomography/computed tomography (PET/CT). We analyzed TIO patients who underwent 18F-OC PET/CT. Parameters such as tumor dimension, the maximum standardized uptake value (SUVmax), the mean standardized uptake value (SUVmean) and metabolic tumor volume (MTV) were meticulously assessed. Clinical features and imaging characteristics pertinent to TIO were reviewed. 6 patients with clinical suspicion of TIO exhibited hypophosphatemia (0.25 to 0.64 mmol/L), elevated alkaline phosphatase (ALP) levels (142 to 506 U/L), and increased parathyroid hormone (PTH) levels (92.9 to 281.7 pg/mL). Of these patients, two underwent FGF-23 testing, with results of 3185.00 pg/ml and 17.56 pg/ml, respectively. Conventional imaging modalities depicted widespread osteoporosis, with several cases demonstrating fractures indicative of osteomalacic and associated pathological fractures. Subsequent 18F-OC PET/CT facilitated the accurate localization of causative tumors, with histopathological examination confirming the diagnosis of phosphaturic mesenchymal tumor (PMT). The interval from initial clinical presentation to definitive TIO diagnosis spanned approximately 2.5 years (range: 1 - 4 years), with tumors varying in size (maximum diameter: 7.8 to 40.0mm), SUVmax (5.47 to 25.69), SUVmean (3.43 to 7.26), and MTV (1.27 to 18.59 cm3). The implementation of whole-body 18F-OC PET/CT imaging emerges as a critical tool in the identification of occult tumors causing TIO. Future investigations incorporating a broader cohort are imperative to further delineate the diagnostic and therapeutic implications of 18F-OC PET/CT in managing TIO.

Intravesical local administration of pembrolizumab for treatment of bladder cancer: A novel strategy to minimize toxicity.

e14687 Background: A major hallmark of bladder cancer (BCa) is a higher treatment success rate than prostate cancer following stimulation of innate anti-tumor immune response either by intravesical BCG or to FDA approved intravenous anti-PD1 checkpoint antibody (pembrolizumab) approved for BCG resistant BCa since 2021. However, injected pembrolizumab is characterized by a markedly higher incidence (66%) of serious adverse events than the median duration of complete response of ~40% for non-muscle invasive BCa (NMIBC) and 15-20% for invasive BCa. Since the toxicity (fatigue, Pneumonitis and diarrhea) of injected pembrolizumab is linked to systemic breakdown of T-cell mediated immune surveillance we enquired whether analogous to BCG, pembrolizumab can be administered intravesically to safely induce a localized anti-tumor response in mouse model of BCa. Methods: Six weeks old female mice of B6D2F1 strain (n=10) were ad libitum fed carcinogen, N-butyl-N-4-hydroxybutyl nitrosamine (BBN) in drinking water (0.05% w/v) for 12 weeks. The presence of BBN evoked tumor was ascertained by unenhanced T2 weighted MRI at week 11 prior to single intravesical dosing by 24G transurethral catheter under isoflurane anesthesia of 0.1mL vehicle (sterile water) with or without 0.3mg of Pembrolizumab (Lipella Pharmaceuticals). 6 weeks later, T2 weighted MRI was repeated together with T1 mapping by ICE-MRI prior to organ harvest. Results: BBN feeding evoked multiclonal tumors (red*) of comparable size on T2 weighted MRI at week 11 but repeat MRI 7 weeks after treatment revealed that tumor progression and perivesical invasion noted in vehicle group was arrested in pembrolizumab group. Longest dimension of BBN tumor in vehicle treated mice was ≥ 1mm longer (p<0.05) than in pembrolizumab treated mice. T1 mapping revealed thickened bladder wall missed by T2 MRI. Conclusions: These findings on single intravesical dose of pembrolizumab (10mg/kg) in mice are consistent with human study on multiple intravesical dosing of BCG plus pembrolizumab (1-2mg/kg) in BCG resistant NMIBC patients. Intravesical pembrolizumab mirrors the limited systemic uptake of radiolabelled antibodies together with substantially higher ingress into tumor foci. The tumor selective ingress for BCa immunotherapy without any toxicity will be enhanced with Lipella Pharmaceutical’s liposomal delivery of Pembrolizumab.

Use of an AI-powered visualization platform to support precision clinical decision-making in patients with breast cancer undergoing neoadjuvant chemotherapy.

e12618 Background: Chemotherapy to reduce cancer burden and tumor size ("downstaging") is widely used in neoadjuvant treatment of early-stage breast cancer (ESBC) and can have a dramatic impact on selection of further treatment courses, including surgery. The resulting decision-making process between physicians and cancer patients requires detailed and effective communication of the patient's disease status, and clear presentation of this information in Tumor Board settings. Artificial intelligence (AI) -powered visualization platforms offer the potential to aid in evaluating breast tumor location and morphology, and accordingly optimize treatment. Additionally, these tools offer enhanced communication with patients regarding future treatment options, particularly serving as clinical decision support (CDS) tools. Methods: We assessed the performance of an AI platform that employs dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to render three-dimensional (3D) visualizations of breast tumors and 5 additional chest tissues on an independent validation dataset comprise of 100 ESBC cases with ground-truth tumor labels vetted by 2 breast-specialized radiologists. The platform provides 3D depictions of the tumor and its multi-tissue context, as well as functionalities for quantifying tumor morphology, tumor-to-landmark structure distances, excision volumes, and approximate surgical margins. We subsequently evaluated the tool's utility in a real-world setting to understand how the tool impacts clinical decision-making and patient communication, specifically around surgical planning in the context of neoadjuvant chemotherapy (NACT). Results: The platform generated accurate 3D tumor maps, as evidenced by a median Dice score of 75.6% and a median Hausdorff distances of 15.1 mm relative to the radiologist validation set. The automatic longest tumor dimension calculations were linearly correlated with radiologist direct measurements (Pearson correlation coefficient = 0.78) and had a median absolute difference of 6.3 mm. We found strong overlap between the platform’s ground-truth convex hulls, as shown by a median Dice score of 81.5%. When used by a skilled breast-specialized surgeon, the tool enabled rapid and intuitive patient-physician communication of the location and extent of disease, and potential degrees of downstaging to breast-conserving surgery. Conclusions: Detailed 3D tumor and surrounding multi-tissue depictions offer both qualitative and quantitative comprehension of cancer topology and may aid in formulating an optimal treatment approach for breast cancer treatment. We show that detailed depictions enhance communication between physicians and patients and may aid in streamlining decision-making.

Neoadjuvant pazopanib with radiation therapy in patients with localized sarcoma: Experience from a sarcoma center.

e23555 Background: Tissue oxygenation is critical to the success of radiation therapy (RT) in any tumor type. However, tumor vasculature is abnormally structured and dysfunctional. Anti-angiogenic molecules have been shown to stabilize the intratumoral vascular structures and improve tissue oxygenation, which may aid in the success of RT. Pazopanib (PAZO) is a multi-kinase inhibitor targeting the Vascular Endothelial Growth Factor Receptor. Here, we report the pathologic outcome and clinical correlates of concurrent use of neoadjuvant PAZO and RT in our cohort of patients with localized soft-tissue sarcoma (STS). Methods: This is a retrospective, single institution study of patients diagnosed with localized STS between January 2019 and October 2023. Patients who received concurrent PAZO and pre-operative external beam RT (50 Gy in 25 fractions) were included. Patients with metastatic disease, unplanned resections, and those requiring excisional biopsy/curettage for diagnosis were excluded. The primary endpoint was the rate of major pathologic response (mPR) defined by > 90% necrosis on surgical pathology specimen. The secondary endpoint was local relapse-free survival (RFS), distant metastasis-free survival (DMFS), and local and distant relapse rate (RR) at 6 months. All-grade toxicities from PAZO were recorded. Results: Ten patients with a median age of 51 years (Interquartile range (IQR): 34-76) were included. Undifferentiated pleomorphic sarcoma was the most common histologic subtype (50% patients). Median follow up was 24.2 months (IQR: 11-36). Six patients tolerated the maximum dose of PAZO until RT completion (800mg PO daily). The dose of PAZO was reduced in 4 patients due to grade 3 GI toxicity and HTN. Nine patients stayed on PAZO until RT completion. The median time to surgery after RT was 42 days (IQR: 37-77). The median largest tumor dimension prior to RT was 11.65 cm (IQR: 3.8 to 18), and 10.6 cm (IQR: 5.4 to 19.7) after RT completion. Nine of 10 patients had R0 resection, and 7 (70%) had mPR. Three of 7 (43%) patients had complete necrosis. All patients with R0 resection have no local recurrence after a median follow-up of 23 months (IQR: 11-36). Median local RFS was 20 months (IQR: 5-32), and DMFS was 6 months (IQR: 1-32). The local RR at 6 months was 10%, and the distant RR at 6 months was 30%. No correlation was observed between mPR and DMFS. Conclusions: Historically, neoadjuvant RT alone induces a mPR in ~30% of patients with localized STS. In our cohort, neoadjuvant PAZO with RT achieved an mPR in 70% of patients. Although dose reduction and grade 3 toxicity were noted in the majority of patients, these were reversible after stopping PAZO. There was no correlation between mPR and DMFS. However, a short course of PAZO with RT may help achieve R0 margins, which is the strongest predictor of better local RFS. A randomized trial is warranted to help understand the true impact of neoadjuvant PAZO with RT.

SURGICAL TREATMENT FOR ADVANCED COLORECTAL CANCER WITH ABDOMINAL WALL INVASION AND IMPLANTATION

Abstract Aim The prognosis of abdominal wall invasion and implantation from colorectal cancer (CRC) is not good. With radical resection and abdominal wall reconstruction (AWR) technique, locally advanced CRC patients with resectable abdominal wall invasion and implantation may achieve longer tumor-free survival time and an improved quality of life. Methods 15 patients were retrospectively analyzed. All patients underwent preoperative three-dimensional visualization reconstruction of the abdominal wall and evaluation with a multidisciplinary team (MDT). Patient information, including tumor size, defect size, operation time, intraoperative bleeding, length of hospital stays, and other factors, was collected. Results All 15 locally advanced CRC patients with abdominal wall invasion and implantation underwent radical abdominal wall tumor resection followed by AWR. The average tumor dimension and abdominal wall defects after resection were 98.13 ± 71.70 and 270.07 ± 101.95 cm2 respectively; and accurate abdominal wall classification and zoning were obtained for all patients. The average operation time was 431.7 ± 189.2 min, and the average blood loss was 513.3 ± 244.6 ml. The incidence of incisional hernia and CRC recurrence were 6.0% and 13.3%, respectively. Conclusions With comprehensive preoperative evaluation, results of radical resection of abdominal wall invasion and implantation in locally advanced CRC patients is satisfactory and safe.

Stereotactic central/core ablative radiation therapy: results of a phase I study of a novel strategy to treat bulky tumor

PurposeBulky tumor remains as a challenge to surgery, chemotherapy and conventional radiation therapy. Hence, in efforts to overcome this challenge, we designed a novel therapeutic paradigm via strategy of Stereotactic Central/Core Ablative Radiation Therapy (SCART).), which is based on the principles of SBRT (stereotactic body radiation therapy and spatially fractionated radiation therapy (SFRT). We intend to safely deliver an ablative dose to the core of the tumor and with a low dose at tumor edge. The purpose of the phase 1 study was to determine dose-limiting toxicities (DLT)s and the Maximum Tolerated Dose (MTD) of SCART.Methods and materialsWe defined a SCART-plan volume inside the tumor, which is proportional to the dimension of tumor. VMAT/Cyberknife technique was adopted. In the current clinical trial; Patients with biopsy proven recurrent or metastatic bulky cancers were enrolled. The five dose levels were 15 Gy X1, 15Gy X3, 18GyX3, 21GyX3 and 24GyX3, while keeping the whole tumor GTV’s border dose at 5Gy each fraction. There was no restriction on concurrent systemic chemotherapy agents.Results21 patients were enrolled and underwent SCART. All 21 patients have eligible data for study follow-up. Radiotherapy was well tolerated with all treatment completed as scheduled. The dose was escalated for two patients to 24GyX3. No grade 3 or higher toxicity was observed in any of the enrolled patients. The average age of patients was 66 years (range: 14–85) and 13 (62%) patients were male. The median SCART dose was 18Gy (range: 15 - 24). Six out of the 18 patients with data for overall survival (OS) died, and the median time to death was 16.3 months (range: 1 - 25.6). The mean percent change for tumor shrinkage between first visit volumes and post-SCART volumes was 49.5% (SD: 40.89, p-value:0.009).ConclusionSCART was safely escalated to 24 GyX 3 fractions, which is the maximum Tolerated Dose (MTD) for SCART. This regimen will be used in future phase II trials.

Ruthenium-106 Plaque Brachytherapy for Circumscribed Choroidal Hemangioma: A Case Series and Review of Literature

Introduction: We aim to report the anatomical and functional outcomes of ruthenium-106 brachytherapy in the management of circumscribed choroidal hemangiomas (CCH). Methods: This is a single-center, retrospective case series including patients with unilateral symptomatic CCH treated with ruthenium-106 brachytherapy at the Cairo University Ocular Oncology Service. Patient records were analyzed for patients’ demographics, best corrected visual acuity (BCVA), tumor dimensions (thickness and largest base diameter), foveal subretinal fluid, radiation-related complications, and recurrence. Results: Seven patients were included in the study (including 6 males) with a mean age of 39.3 ± 15.4 years; ruthenium-106 plaque was used to deliver 50 Gray to the tumor apex. After a mean follow-up duration of 12.5 months, all patients had significant improvement in BCVA after treatment, mean tumor height decreased significantly from 4.76 ± 1.76 mm to 1.70 ± 1.2 mm (p value 0.01). The largest tumor base diameter also decreased significantly from 9.13 ± 2.68 mm to 4.65 ± 3.75 mm (p value 0.05). Subretinal fluid and exudative retinal detachment resolved in all patients, and no significant radiation-related complications were observed in any patient. None of the patients needed any further treatment or experienced recurrence within the follow-up period. Conclusion: Ruthenium-106 brachytherapy is an effective tool in the management of symptomatic CCH with a good visual prognosis and safety profile.

Beyond histology: A tissue algorithm predictive of post-surgical recurrence in hepatocellular carcinomas, including TERT promoter mutation.

Surgical resection for hepatocellular carcinoma (HCC) is burdened with a high recurrence rate and a lack of reliable prognostic factors. The aim of this study was to integrate the HCC pathological features with gene mutations to improve the prognostic role of pathological analysis.This is a monocentric prospective study, including 67 patients resected for HCC. All clinical data and histological features were collected, including tumor grade, architecture, margins, microvascular invasion, and microscopic portal vascular invasion (MPVI). Next-generation sequencing (NGS) was performed using a laboratory-developed multi-gene panel, allowing to amplify 330 amplicons (21.77kb), covering the relevant targets for solid tumor analysis. The most represented mutations were TERT promoter (n = 41, 61.2%), TP53 (n = 18, 26.9%) and CTNNB1 (n = 17, 25.4%). At follow-up, 13 (19.4%) patients experienced HCC recurrence: at multivariate analysis, tumor dimensions (p = 0.040), MPVI (p = 0.010), and TERT mutation (p = 0.034) correlated with recurrence. Dimensions ≥ 4.5cm (very close to AJCC stage pT3; 9 recurrences, p = 0.041, odd-ratio = 3.7), MPVI (9 recurrences, p = 0.062, OR = 3.3), and TERT (11 recurrences, p = 0.049, OR = 4.4) correlated with disease-free survival also at univariate analysis. The concomitant occurrence of these three variables was present in 7 cases, among which 5 recurred (p = 0.002, OR = 15.94).In conclusion, NGS analysis in resected HCC could not only be used for future therapies but should be integrated with histopathology to predict the risk of tumor recurrence after surgical resection: TERT mutation is among the strongest predictors of tumor recurrence, together with tumor stage (dimensions) and the occurrence of MPVI, which should always be reported separately from the classic MVI.

Detection and identification of circulating tumor cells in parathyroid tumors and correlation analysis with clinicopathological features.

The differential diagnosis of parathyroid carcinoma (PC)/parathyroid adenoma (PA) in parathyroid tumors is critical for their management and prognosis. Circulating tumor cells (CTCs) identification in the peripheral blood of parathyroid tumors remains unknown. In this study, we proposed to investigate the differences of CTCs in PC/PA and the relationship with clinicopathologic features to assess its relevance to PC and value in identifying PC/PA. Peripheral blood was collected from 27 patients with PC and 37 patients with PA treated in our hospital, and the number of chromosome 8 aberrant CTCs was detected by negative magnetic bead sorting fluorescence in situ hybridization (NE-FISH). The differences of CTCs in PC/PA peripheral blood were compared and their diagnostic efficacy was evaluated, and the correlation between CTCs and clinicopathological features of PC was further explored. CTCs differed significantly in PC/PA (p = 0.0008) and were up-regulated in PC, with good diagnostic efficacy. CTCs combined with alkaline phosphatase (ALP) assay improved the diagnostic efficacy in identifying PC/PA (AUC = 0.7838, p = 0.0001). The number of CTCs was correlated with tumor dimensions, but not significantly correlated with clinical markers such as calcium and PTH and pathological features such as vascular invasion, lymph node metastasis and distant metastasis. As a non-invasive liquid biopsy method, CTCs test combined with ALP test can be used as an important reference basis for timely and accurate identification and treatment of PC. It is of great significance to improve the current situation of PC diagnosis, treatment and prognosis.

Comprehensive assessment of atypical and anaplastic pediatric meningiomas utilizing national cancer database: a retrospective cohort study.

To examine demographic and clinical characteristics and their association with survival in grade 2 and 3 pediatric meningiomas in a large cohort using the National Cancer Database (NCDB). We conducted a comprehensive analysis using data from NCDB between 2004 to 2018. Tumor-specific data included tumor grade and size. Treatment details, including surgical resection, extent of resection, and radiotherapy, were gathered. Our analytic approach incorporated logistic and Poisson regression, Kaplan-Meier survival estimates, and Cox proportional hazards models. Among the included 239 patients aged 0-21years, age category distribution was significantly different between grade 2 and grade 3 tumors (p = 0.018). For grade 2 meningiomas, 51.5% of patients were female, and 76.7% were white. 85.3% of patients with grade 2 meningiomas underwent surgical resection, of which 67% underwent gross total resection. Overall survival (OS) was significantly different between resected and non-resected patients (p = 0.048). Uninsured patients were over seven times as likely to have prolonged length of stay (LOS) versus those with private insurance (OR = 7.663, p = 0.014). For grade 3 meningiomas, 51.4% of patients were male, and 82.9% were white. 91.4% of patients with grade 3 meningiomas underwent surgical resection, of which 53.3% underwent subtotal resection. OS was not significantly different between resected and non-resected patients (p = 0.659). In summary, there were significant differences in age, maximum tumor dimension, unplanned readmission, radiotherapy, and treatment combinations between grade 2 and 3 meningiomas. These findings highlight the intricacies of managing pediatric meningiomas and emphasize the necessity for tailored therapeutic approaches to enhance outcomes in the future.

Abstract PS05-08: Restriction Spectrum Imaging MRI for automated evaluation of response to neoadjuvant therapy in breast cancer

Abstract Introduction: Dynamic contrast-enhanced MRI (DCE) is currently used to evaluate neoadjuvant therapy response of breast cancer (1). However, DCE requires expert radiologist readers to assess the change in longest tumor dimension during therapy, as well as administration of Gadolinium contrast agents. One MRI modality that does not require contrast agents is diffusion-weighted MRI (DWI), a method that detects the microscopic diffusion of water molecules. However, the commonly used DWI method apparent diffusion coefficient (ADC) is not fully optimised in the breast (2). The purpose of the current study was to evaluate the recent DWI method Restriction Spectrum Imaging (RSI) (2) to automatically monitor breast tumor size during neoadjuvant therapy. Methods: Twenty-seven women underwent 3T MRI at four time points during therapy at University of California San Diego; 17 received all four scans (see Table 1 for patient details). Inclusion criteria included biopsy-proven unilateral invasive breast cancer ≥2.5 cm (defined on clinical examination/imaging) with indication for neoadjuvant therapy. The therapy used was primarily paclitaxel (+/-experimental agent) followed by anthracycline. The MRI protocol included Gadolinium DCE and DWI (b-values 0, 500, 1500, 4000 s/mm2); TE/TR = 82/9000 ms. ADC was calculated using b-values < 1000 s/mm2 while signal from all available b-values were fitted to the previously-developed three-component RSI model (2). The tumor size by RSI was assessed against manual DCE tumor size and mean ADC values. Prediction of therapy response during therapy and residual tumor post-therapy were assessed using non-pathological complete response (non-pCR) as endpoint. pCR was defined as ypT0/is or ypN0. Results: Ten patients experienced pCR. Prediction of non-pCR by ROC AUC at the early-therapy time point was 0.65 for RSI, 0.64 for DCE and 0.45 for ADC (Table 2). Prediction of post-therapy residual tumor is given in Table 3. Discussion: The novel RSI cancer tissue classifier predicted response to neoadjuvant therapy after only 19 days. RSI could also identify 71% of cases with residual tumor at surgery with 90% specificity post-therapy. RSI performance was similar to performance by standard MRI by manual tumor measurement on DCE. In contrast to standard-of-care MRI by using DCE and ADC that requires manual user input, the RSI classifier is automatic. This suggests that RSI may aid to cost-efficiently evaluate neoadjuvant therapy of breast cancer, with the aim to help guide clinical decision-making and enable tailored therapy regimens.

Prognostic Role of Basal Serum Alpha-Fetoprotein in Patients with Hepatocellular Carcinoma Suitable for Curative Treatment.

Background and Objectives: Serum alpha-fetoprotein (AFP) is a recognized affordable oncological marker in patients with hepatocellular carcinoma (HCC). However, AFP's prognostic role has been assessed mainly after specific treatments, and no unanimously recognized cut-offs have been identified. The aim of this study is to investigate the prognostic role of different basal AFP cut-offs on survival and HCC course. Materials and Methods: In this single-center, retrospective study, all patients newly diagnosed with HCC between January 2009 and December 2021 were prospectively enrolled. Only patients suitable for curative HCC treatments were included in the analyses. Patients were stratified according to AFP cut-offs of 20, 200, 400, and 1000 ng/mL, which were correlated with survival outcomes and clinical parameters. Results: A total of 266 patients were analyzed, with a median follow-up time of 41.5 months. Median overall survival (OS) of all cohort was 43 months. At the multivariate Cox-regression analysis, AFP value ≥ 1000 ng/mL correlated with impaired OS (1-year OS: 67% vs. 88%, 5-year OS: 1% vs. 43%; p = 0.005); other risk factors were tumor dimension ≥ 5 cm (HR 1.73; p = 0.002), Child-Pugh class B-C (HR 1.72; p = 0.002), BCLC stage A (vs. 0) (HR 2.4; p = 0.011), and malignant portal vein thrombosis (HR 2.57; p = 0.007). AFP ≥ 1000 ng/mL was also associated with a reduced recurrence-free survival (HR 2.0; p = 0.038), while starting from AFP ≥ 20 ng/mL, a correlation with development of HCC metastases over time (HR 3.5; p = 0.002) was seen. AFP values ≥ 20 ng/mL significantly correlated with tumor size and higher histological grading; starting from AFP values ≥ 400 ng/mL, a significant correlation with Child-Pugh class B-C and female gender was also observed. Conclusions: Basal AFP correlates with relevant outcomes in patients with HCC. It could help identify patients at a higher risk of worse prognosis who might benefit from personalized surveillance and treatment programs. Prospective studies are needed to confirm these results.

Phase I trial of dose escalation for preoperative stereotactic radiosurgery for patients with large brain metastases.

Single-session stereotactic radiosurgery (SRS) or surgical resection alone for brain metastases larger than 2 cm results in unsatisfactory local control. We conducted a phase I trial for brain metastases(>2 cm) to determine the safety of preoperative SRS at escalating doses. Radiosurgery dose was escalated at 3 Gy increments for 3 cohorts based on maximum tumor dimension starting at: 18 Gy for >2-3 cm, 15 Gy for >3-4 cm, and 12 Gy for >4-6 cm. Dose-limiting toxicity was defined as grade III or greater acute toxicity. A total of 35 patients/36 lesions were enrolled. For tumor size >2-3 cm, patients were enrolled up to the second dose level (21 Gy); for >3-4 cm and >4-6 cm cohorts the third dose level (21 and 18 Gy, respectively) was reached. There were 2 DLTs in the >3-4 cm arm at 21 Gy. The maximum tolerated dose of SRS for >2-3 cm was not reached; and was 18 Gy for both >3-4 cm arm and >4-6 cm arm. With a median follow-up of 64.0 months, the 6- and 12-month local control rates were 85.9% and 76.6%, respectively. One patient developed grade 3 radiation necrosis at 5 months. The 2-year rate of leptomeningeal disease (LMD) was 0%. Preoperative SRS with dose escalation followed by surgical resection for brain metastases greater than 2 cm in size demonstrates acceptable acute toxicity. The phase II portion of the trial will be conducted at the maximum tolerated SRS doses.

Radio-anatomical evaluation of clinical and radiomic profile of multi-parametric magnetic resonance imaging of de novo glioblastoma multiforme

BackgroundGlioblastoma (GBM) is a fatal, fast-growing, and aggressive brain tumor arising from glial cells or their progenitors. It is a primary malignancy with a poor prognosis. The current study aims at evaluating the neuroradiological parameters of de novo GBM by analyzing the brain multi-parametric magnetic resonance imaging (mpMRI) scans acquired from a publicly available database analysis of the scans.MethodsThe dataset used was the mpMRI scans for de novo glioblastoma (GBM) patients from the University of Pennsylvania Health System, called the UPENN-GBM dataset. This was a collection from The Cancer Imaging Archive (TCIA), a part of the National Cancer Institute. The MRIs were reviewed by a single diagnostic radiologist, and the tumor parameters were recorded, wherein all recorded data was corroborated with the clinical findings.ResultsThe study included a total of 58 subjects who were predominantly male (male:female ratio of 1.07:1). The mean age with SD was 58.49 (11.39) years. Mean survival days with SD were 347 (416.21) days. The left parietal lobe was the most commonly found tumor location with 11 (18.96%) patients. The mean intensity for T1, T2, and FLAIR with SD was 1.45E + 02 (20.42), 1.11E + 02 (17.61), and 141.64 (30.67), respectively (p = < 0.001). The tumor dimensions of anteroposterior, transverse, and craniocaudal gave a z-score (significance level = 0.05) of − 2.53 (p = 0.01), − 3.89 (p < 0.001), and 1.53 (p = 0.12), respectively.ConclusionThe current study takes a third-party database and reduces physician bias from interfering with study findings. Further prospective and retrospective studies are needed to provide conclusive data.

Morphological and Histological Features of Nephrectomy Materials: A Single-Center Experience and Short Review of the Literature

Objective: To determine the demographic characteristics of patients undergoing nephrectomy at a tertiary care hospital and to analyze the spectrum of renal tumors based on histopathological findings of nephrectomy specimens by current literature. Material and Method: The results of nephrectomy materials admitted to the pathology clinic between January 2019 and December 2023 were included in the study. The demographic characteristics of the included patients, presenting complaints, reasons for nephrectomy, surgical method, nephrectomy area, tumor dimension, and histopathological reports were recorded in a standard data form. Results: A total of 325 nephrectomy materials were included in the study. 61.5% of the patients were male. The mean age of the patients was 54.5±20.2 years (min:3 max:91). The most common presenting complaints were flank pain (28.3%). The most commonly observed pathological malignancy was clear cell carcinoma (32%), and it was found to be significantly higher in male patients (38.5%) (p=0.001). The most frequently detected pathological TNM grade of the patients was grade 1, and the histological WHO/ISUP grade was 2. 28.9% of the patients (n:94) received a diagnosis incidentally. Among those incidentally diagnosed patients, 87.2% (n:82) were histopathologically malignant. When benign pathological diagnoses were examined, the most common diagnosis was pyelonephritis, followed by oncocytoma, benign cystic disease, and angiomyolipoma, respectively. Conclusion: According to our study results, malignant tumors are more commonly observed than benign neoplasms. Despite advancements in imaging technologies, the histopathological diagnosis of renal masses cannot be determined preoperatively, and surgical intervention is required for diagnosis

Comparison of Ultrasonographic Images of Glioblastoma Tumor with Magnetic Resonance Images: Rat Animal Model

Purpose: Magnetic Resonance Imaging (MRI) can guide the surgical strategy to identify brain tumors and monitor treatment response. It is possible to use transcranial Ultrasound (US) for periodical follow-ups. Ultrasound waves pass through the delicate areas of the skull called acoustic windows. In this study, the efficiency of ultrasound imaging was performed to diagnose glioblastoma brain tumors and the results were compared with MR images.&#x0D; Materials and Methods: Male Wistar rats were anesthetized by intraperitoneal injection of Ketamine and Xylazine. A stereotaxic device was used to determine the injection coordinates. C6 GBM cell lines were injected into the brains of rats. After two weeks, the formation of a glioblastoma tumor was confirmed histopathologically. The brain of animals was imaged by B-mode ultrasound and MRI. The section with the largest tumor dimensions was selected and the dimensions of the skull and tumor were measured based on the pixel size of each of the imaging methods. Pearson coefficient of correlation and Limits Of Agreement (LOA) were calculated for comparisons of the skull and tumor dimensions.&#x0D; Results: The skull and the tumor dimensions showed a significant correlation between the B-mode ultrasound and the MRI measurements (R = 0.99 and p &lt; 0.05). According to the Bland-Altman analysis, the mean difference was 0.31 mm (SD = 0.20) for skull and tumor dimensions. The exact shape of the tumor is not completely clear in the ultrasound images, but it can be useful to detect the presence of the tumor and its approximate dimensions.&#x0D; Conclusion: In conclusion, a glioblastoma tumor was produced in the male Wistar rat. The tumor dimensions were properly assessed by B-mode ultrasound image processing and compared with MR imaging.