Citations

10043 Background: Tumor resection is a cornerstone of therapy for neuroblastoma (NB) and Wilms tumor (WT). Minimally invasive surgical approaches such as laparoscopic or robotic tumor resection hold promise to reduce surgical morbidity while maintaining excellent oncologic outcomes. This study aims to determine the utilization and outcomes of laparoscopic and robotic resection of NB and WT among children in a national cohort, hypothesizing that utilization is increasing over time and outcomes are not inferior to open resection. Methods: A retrospective cohort analysis of patients <18 years old in the 2020-2023 National Cancer Database who underwent resection of NB or WT was performed. Surgical approach trends were assessed via Cochran-Armitage tests. Conversions to open surgery, length of stay (LOS), and readmissions were compared between approaches using Kruskal-Wallis, Chi-square, and Fisher’s exact tests. Results: Among 1,262 children who underwent resection of NB (n=581) or WT (n=681), open procedures were most common (83.4%), followed by laparoscopic (13.9%), and robotic (2.7%). Utilization of each approach was stable over time aside from increased robotic resection of NB from 0% to 4% (p=.024). Approach did not vary by patient age (Table 1). Median WT size and lymph node yield were similar between approaches (both p>.05). In NB, laparoscopic procedures were performed on smaller tumors than open or robotic (p<.001). There were no robotic conversions to open; 11.4% of laparoscopic procedures were converted without change over time or difference between NB and WT (both p>.05). Median LOS was greater for open procedures than laparoscopic or robotic (p<.001). Readmission rates (p=.64) and margin status (p=.63) were similar between approaches. Outcomes did not vary by diagnosis. Conclusions: Utilization of minimally invasive approaches for NB or WT resection remains low despite noninferior or improved outcomes. Efforts to safely increase utilization are needed, especially for robotics, so that survivorship can be improved through reduced surgical morbidity. Differences in patient characteristics and outcomes by surgical approach. Characteristic or Outcome Open Laparoscopic Robotic p value Age in years (median, IQR) 3 (1, 4) 3 (1, 5) 3 (1, 7) 0.08 % female 53% 53% 44% 0.59 NB tumor size in mm (median, IQR) 72 (50, 101) 47 (35, 71) 70 (51, 86) <0.001 WT tumor size in mm (median, IQR) 110 (75, 140) 115 (93, 150) 93 (54, 125) 0.10 % metastatic disease 33% 30% 15% 0.07 % neoadjuvant therapy 35% 27% 22% 0.014 % conversion to open n/a 11% 0% 0.05 Negative margins 86% 83% 96% 0.63 # Lymph nodes assessed in WT (median, IQR) 5 (3, 8) 6 (3, 10) 4 (3, 9) 0.62 LOS in days (median, IQR) 5 (4, 7) 4 (2, 6) 4 (1, 5) <0.001 % readmission 15% 14% 9% 0.64

10030 Background: CABO is a multi-targeted kinase inhibitor of VEGFR2, c-MET, AXL and RET and has shown clinical evidence of activity in two prior studies of adult and pediatric patients with advanced OS. We report results of a feasibility cohort of CABO + MAP chemotherapy in patients with newly diagnosed high-risk OS. Methods: Patients <40 years, body surface area ≥ 0.8 m 2 and new diagnosis of high-grade OS with metastatic disease and resectable primary tumor were eligible. Patients were enrolled to two CABO dose levels (Dose Level 1 (DL1) 25 mg/m 2 /day, maximum 40 mg/day; Dose Level 2 (DL2) 35 mg/m 2 /day; maximum 60 mg/day) using a modified IQ 3+3 design. CABO was orally administered concomitantly with six 35-day cycles of MAP (cisplatin 60 mg/m 2 on days 1-2 (cycles 1-4), doxorubicin 37.5 mg/m 2 on days 1-2 (with dexrazoxane), methotrexate 12 g/m 2 on days 22, 29) and for 24 weeks as maintenance monotherapy. CABO was held after 7 weeks and resumed during 4 th MAP cycle to allow for primary tumor resection and metastatic surgeries. Dose-limiting toxicities (DLT) were assessed during weeks 1-6 of treatment; additional monitoring for post-surgical complications was conducted through completion of 4 th MAP cycle. The primary endpoint for this cohort was feasibility of combination therapy. Results: Ten patients (median age 11.5 years, 70% male) were enrolled and treated with CABO + MAP (DL1, n=4; DL2, n=6). Median cumulative doses of all MAP agents were maintained throughout treatment with no dose reductions. Concomitant dosing of CABO with MAP was tolerated with no protocol-specified DLTs occurring during the evaluation period. DL2 (35 mg/m 2 ) was established as the recommended dose for further study of combination therapy. Commonly reported adverse events included hematologic toxicities, febrile neutropenia, and alanine/aspartate aminotransferase (AST/ALT) elevation. Interruption of CABO was required in 6 patients for Grade 3+ AST/ALT elevation following methotrexate (n=3), wound complications (n=3), and Grade 3 pneumothorax (n=1). Wounds included two Grade 3 port site events and one Grade 1 primary tumor resection site; two patients later resumed CABO after healing without wound recurrence. Dose reduction of CABO was required in one patient for Grade 4 amylase elevation. Conclusions: The combination of CABO + MAP is feasible with no protocol-specified DLTs during the evaluation period. Generalizability is limited based on cohort size. Further evaluation of CABO + MAP is ongoing in a phase II/III randomized efficacy study in newly diagnosed standard and high-risk patients using CABO dose of 35 mg/m 2 /day (max 60 mg), with delayed initiation of CABO in patients with port placement and early safety monitoring for wound-related events, as well as full study monitoring of dose delivery, wound complications and systemic toxicity. Clinical trial information: NCT05691478 .

Telehealth may improve access to specialized oncology care for Medicaid beneficiaries with hematological malignancies who face geographic and financial barriers. During the COVID-19 public health emergency, telehealth use expanded rapidly, yet state policies governing telehealth coverage/payment parity varied. Evidence is limited on how these policy differences influenced oncology telehealth use for Medicaid patients. We conducted a cross-sectional analysis of 2020–2021 multistate Medicaid claims. Adult and pediatric oncology specialists were identified based on board certification data. Telehealth video visits were measured monthly at the extensive margin, defined as the proportion of specialists providing any telehealth, and the intensive margin, defined as average monthly telehealth visits among telehealth providing specialists. States were categorized by private insurance telehealth policy environment: coverage and payment parity, coverage parity only, or no or unspecified parity. Telehealth use increased sharply across all states in early 2020, rising from less than 1% of specialists before the pandemic to peak levels by April 2020. Specialists practicing in coverage and payment parity states demonstrated higher and more sustained telehealth use through 2021 compared with those in coverage only or no parity states. By December 2021, 15.1% of adult specialists in coverage and payment parity states provided telehealth, compared with 8.1% in coverage-only states and 7.8% in no-parity states. Pediatric specialists showed similar patterns, though overall telehealth use remained lower. Specialists in parity states also maintained higher monthly telehealth visit volumes over time. State-level coverage and payment parity policies may have been associated with greater and sustained telehealth provision by oncology specialists treating Medicaid beneficiaries with hematologic malignancies. Maintaining supportive telehealth policies may be essential for promoting equitable access to specialized cancer care and reducing disparities among underserved populations. These findings inform future telehealth policy decisions nationally statewide.

Estimates of fibromyalgia prevalence vary widely worldwide due to differences in diagnostic criteria, study methodology, and population characteristics. Accurate estimates are essential to inform population-level surveillance, guide resource allocation, and highlight disparities in disease recognition and access to care. The objective of this systematic review and meta-analysis was to determine the global prevalence of fibromyalgia in the general population, and secondarily to identify factors moderating prevalence variation and to assess prevalence in defined at-risk subpopulations. Pooled prevalence estimates with 95% confidence intervals (CIs) were calculated using the inverse variance heterogeneity model with Freeman–Tukey transformation. Subgroup analyses were performed by sex, diagnostic criteria, country, and other study characteristics, and meta-regression assessed moderators including publication year and Human Development Index (HDI). Of 21,645 records identified, 1,728 underwent full-text review and 882 studies were included in the final analysis. Across 38 countries and 30,070,032 individuals (188 studies), the pooled fibromyalgia prevalence in the general population was 1.40% (95% CI, 0.49–2.47), with substantial heterogeneity (I 2 = 100%) and very low certainty of evidence. Among at-risk subpopulations (9,771,123 participants; 768 studies), prevalence was markedly higher in autoimmune and inflammatory conditions, such as chronic urticaria (37.1%), interstitial cystitis (30.8%), systemic sclerosis (20.6%), celiac disease (20.5%), and inflammatory bowel disease (19.9%), and elevated in chronic pain, rheumatologic, and post-infection cohorts. Meta-regression identified publication year (β = 0.008, P < .001) and HDI (β = 0.725, P = .002) as significant moderators of prevalence. In conclusion, fibromyalgia affects 1% to 2% of the global population, with substantially higher rates in at-risk subpopulations. Temporal and socioeconomic trends emphasize diagnostic inconsistency and global disparities in care.

ABSTRACT The initiation and sustained expression of motivated behaviour is strongly regulated by mesolimbic dopamine (DA) release within the nucleus accumbens (NAc). Deep brain stimulation (DBS) has demonstrated efficacy in treating refractory psychiatric disorders characterised by dysfunctional motivated drive and related behaviours. However, the neurobiological mechanisms underlying DBS effects at the local and circuit levels remain unclear. This study aimed to investigate the effects of NAc DBS on effort‐based decision‐making and local phasic DA neurotransmission in male Wistar rats. Male Wistar rats ( N = 8) were trained on a concurrent fixed ratio 5/chow effort‐related choice task (ERCT) until stable baseline performance was reached. On the test day, animals underwent a 2‐h session of high‐frequency NAc DBS (130 Hz; 90 μs pulse width; 500 μA) immediately prior to behavioural testing, with additional testing conducted on subsequent days to assess prolonged effects. In a separate experiment, the effects of identical NAc DBS parameters (or sham) on ventral tegmental area (VTA)‐evoked (120 pulses; 60 Hz; 2 ms pulse width; 200–500 μA) DA release in the NAc core were quantified using fast‐scan cyclic voltammetry in urethane‐anesthetised rats ( N = 12). Acute bilateral NAc DBS transiently reduced overall food‐related motivation while maintaining effort‐based choice bias. In parallel, NAc DBS significantly suppressed VTA‐evoked NAc DA release compared to sham, although a moderate reduction was also observed in sham controls. DA reuptake kinetics remained unchanged across groups. NAc DBS transiently suppresses overall food‐related motivation while maintaining effort‐based decision‐making. Attenuated phasic DA neurotransmission with active DBS may contribute to this behavioural effect. image

Importance Ischemia-reperfusion injury contributes to graft dysfunction after liver transplant. Hypothermic oxygenated perfusion (HOPE) has been shown to improve liver function, but its benefit in extended criteria donors in a US population remains unclear. Objective To assess whether back-to-base portal-venous HOPE impacts outcomes after liver transplant in the US. Design, Setting, and Participants The Bridge to HOPE Trial is a multicenter, randomized, open-label trial with 1-year follow-up. The study took place at 15 US liver transplant centers and patients were enrolled between January 2021 and May 2023. Central assessment of complications and cholangiograms for nonanastomotic biliary strictures (NAS) was blinded to treatment arm. Participants included 219 recipients of extended-criteria donor livers after brain death (DBD) and after circulatory death (DCD) who were randomized 1:1 to HOPE after static cold storage (SCS) (n = 109) or SCS only (n = 110). Randomization was performed after liver inspection and acceptance for transplant. Data were analyzed from December 2024 to July 2025. Intervention After SCS and transport, livers underwent portal-venous HOPE until implant, using the VitaSmart HOPE System. Main Outcomes and Measures The primary efficacy end point was early allograft dysfunction (EAD). Other main outcomes included model for early allograft function (MEAF) score, hospital length of stay (LOS), patient and graft survival, and biliary complications. Additional post hoc analyses were performed. Results Overall, 219 patients (82 female [37.4%] and 137 male[62.6%]) were included (DCD, 57 of 219 [26%]) with 97% (212 of 219) completing 12-month follow-up. EAD incidence was 20.2% (22 of 109) with HOPE vs 37.3% (41 of 110) with SCS (rate difference, −17.1%; 95% CI, −27.2 to −7.0; noninferiority P &amp;lt; .001; superiority P = .005). HOPE treatment led to significantly lower MEAF mean (SD) scores (HOPE group, 4.28 [1.75]; control group, 4.82 [1.85]; mean difference, −0.54; 95% CI, −1.02 to −0.06; P = .03) and shorter median LOS (hazard ratio, 1.32; 95% CI, 1.01-1.73; P = .04). NAS on imaging and 1-year survivals were comparable between groups (patients: HOPE group, 106 of 109 [97.2%] vs SCS, 106 of 110 [96.4%]; graft: HOPE group, 104 of 109 [95.4%] vs SCS, 102 of 110 [92.7%]). Post hoc analyses showed numerically less graft loss due to NAS after HOPE (4 vs 1) and less major complications (Clavien-Dindo classification ≥IIIa) per patient, respectively. Conclusions and Relevance Back-to-base portal-venous HOPE was compared with SCS alone for extended risk DBD and DCD livers. The HOPE approach was safe and associated with reduced EAD, MEAF score, and LOS. These findings support the use of HOPE as a pragmatic strategy to improve early posttransplant outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT05045794 .