Radiomic features define risk and are linked to DNA methylation attributes in primary CNS lymphoma

Background

The prognostic roles of clinical and laboratory markers have been exploited to model risk in patients with primary CNS lymphoma, but these approaches do not fully explain the observed variation in outcome. To date, neuroimaging or molecular information is not used. The aim of this study was to determine the utility of radiomic features to capture clinically relevant phenotypes, and to link those to molecular profiles for enhanced risk stratification.

Methods

In this retrospective study, we investigated 133 patients across 9 sites in Austria (2005-2018) and an external validation site in South Korea (44 patients, 2013-2016). We used T1-weighted contrast-enhanced MRI and an L1-norm regularized Cox proportional hazard model to derive a radiomic risk score. We integrated radiomic features with DNA methylation profiles using machine learning-based prediction, and validated the most relevant biological associations in tissues and cell lines.

Results

The radiomic risk score, consisting of 20 mostly textural features, was a strong and independent predictor of survival (multivariate hazard ratio = 6.56 [3.64-11.81]) that remained valid in the external validation cohort. Radiomic features captured gene regulatory differences such as in BCL6 binding activity, which was put forth as testable treatment target for a subset of patients.

Conclusions

The radiomic risk score was a robust and complementary predictor of survival and reflected characteristics in underlying DNA methylation patterns. Leveraging imaging phenotypes to assess risk and inform epigenetic treatment targets provides a concept on which to advance prognostic modeling and precision therapy for this aggressive cancer.

OS06.6.A Real-World Pattern of Care Study on Glioblastoma in the Austrian Population. Final results from 2014-2020

Background

The Austrian ABTR-SANO Glioblastoma Registry is the first population-based assessment of patterns of care for patients with Glioblastoma across Austrian healthcare institutions. The primary aim is to assess the real world effectiveness of administered therapies.

Material and Methods

Clinical data are collected via a common web-based IT platform “ABTR-SANO Net” since 2014. The database and the ongoing evaluation of clinical parameters, as well as interims analysis are provided in cooperation with a review board. First Outcome analysis, including patients from 2014-2020, was performed at the end of 2021.

Results

Eleven centers across Austria are involved, and the data of 1416 patients (m/f ratio: 1,35, median age: 66 years) were recently analyzed in detail. Age, extent of resection, as well as ECOG was associated with improved survival. Methylated MGMT Status also showed a moderate survival benefit. Patients with re-resection and re-radiation also exhibited improved survival, which however may be attributed to a selection bias.Second line treatment manly comprised of antiangiogenic treatment, followed by alkylated agents, re-radiation and re-surgery. Median overall survival of all patients was 344 days and clearly age dependent (best for <50 years, worse for>80 years).

Conclusion

This is the first population based outcome analysis of Glioblastoma in Austria. Results regarding prognostic markers and outcome are mostly comparable with international data. Robust population based data are important in order to monitor quality of health care, and to match the data with results from clinical studies.

Concomitant Treatment of Malignant Brain Tumours With CBD - A Case Series and Review of the Literature

Grade IV glioblastoma multiforme is a deadly disease, with a median survival of around 14 to 16 months. Maximal resection followed by adjuvant radiochemotherapy has been the mainstay of treatment since many years, although survival is only extended by a few months. In recent years, an increasing number of data from in vitro and in vivo research with cannabinoids, particularly with the non-intoxicating cannabidiol (CBD), point to their potential role as tumour-inhibiting agents. Herein, a total of nine consecutive patients with brain tumours are described as case series; all patients received CBD in a daily dose of 400 mg concomitantly to the standard therapeutic procedure of maximal resection followed by radiochemotherapy. By the time of the submission of this article, all but one patient are still alive with a mean survival time of 22.3 months (range=7-47 months). This is longer than what would have been expected.

Increasing use of immunotherapy and prolonged survival among younger patients with primary CNS lymphoma: a population-based study

Background: Primary CNS lymphoma is a highly aggressive and rare type of extranodal non-Hodgkin lymphoma. Although, new therapeutic approaches have led to improved survival, the management of the disease poses a challenge, practice patterns vary across institutions and countries, and remain ill-defined for vulnerable patient subgroups. Material and Methods: Using information from the Austrian Brain Tumor Registry we followed a population-based cohort of 189 patients newly diagnosed from 2005 to 2010 through various lines of treatment until death or last follow-up (12-31-2016). Prognostic factors and treatment-related data were integrated in a comprehensive survival analysis including conditional survival estimates. Results: We find variable patterns of first-line treatment with increasing use of rituximab and high-dose methotrexate (HDMTX)-based poly-chemotherapy after 2007, paralleled by an increase in median overall survival restricted to patients aged below 70 years. In the entire cohort, 5-year overall survival was 24.4% while 5-year conditional survival increased with every year postdiagnosis. Conclusion: In conclusion, we show that the use of poly-chemotherapy and immunotherapy has disseminated to community practice to a fair extent and survival has increased over time at least in younger patients. Annually increasing conditional survival rates provide clinicians with an adequate and encouraging prognostic measure.

Photometric evaluation of lipid peroxidation products in human plasma and copper oxidized low density lipoproteins: correlation of different oxidation parameters

Despite considerable methodological advances, ideal parameters relating to the in vitro assessment of lipoprotein oxidizability are lacking. In this study, some of the more common parameters of lipid peroxidation were measured in 30 plasma samples. The following parameters were determined: conjugated dienes (method 1), reaction of lipid hydroperoxides with a methylene blue derivative (method 2), oxidation of iodide to triiodide (method 3) and an iodometric assay based on the same chemistry but modified to correct for unspecific interferences (method 4). Alpha-Tocopherol in plasma was assayed by high-pressure liquid chromatography. In addition, LDL was isolated from plasma and the susceptibility of individual LDL preparations towards copper-initiated oxidation was characterized. The amount of lipid hydroperoxides found in fresh plasma samples obtained from apparently healthy humans was dependent on the method used for the assessment. Lipid hydroperoxides measured by method 2 were: 8.6 +/- 5.8 mu M, by method 3: 5.8 +/- 1.9 mu M and by method 4: 4.2 +/- 2.7 mu M. Mean values of conjugated dienes (method 1) were 84.6 +/- 20.9 mu M; The content of alpha-tocopherol in plasma was 23.6 +/- 3.9 mu M. Despite the differences in absolute values, a statistically significant correlation was found between values obtained by methods 1, 2 and 3, but not by method 4. An inverse relationship has been observed between the lipid hydroperoxide content in plasma obtained with method 4 and two parameters of LDL oxidation (diene concentration, rate of diene formation) but not with the lag time. Our data suggest that--among the photometric methods evaluated--method 4 might be the most specific for the measurement of plasma (and lipoprotein associated) lipid hydroperoxides.