PURPOSE:To evaluate the efficacy of CanCommunicate for improving perceived communication disability and quality of life in people with brain tumour, compared to usual care. MATERIALS & METHODS:A randomised trial with a waitlist control was used. Participants were randomised to CanCommunicate (immediate intervention) or a wait list (control). CanCommunicate involved a 7-week communication intervention guided by Goal Attainment Scaling with group and individualised sessions. Participants completed the Comprehensive Aphasia Test Disability Questionnaire (CAT DQ), Functional Assessment of Cancer Therapy - General (FACT-G), La Trobe Communication questionnaire (LCQ) and semi-structured interviews at baseline and post-intervention. RESULTS:39 people participated (Immediate intervention n = 24, waitlist n = 15). There was a significant between-group difference on the CAT DQ over time (p = 0.04) in favour of the intervention group, but not for the LCQ (p = 0.58) or FACT-G (p = 0.80). When data were combined for all participants who completed CanCommunicate (n = 23), ratings were significantly improved on the CAT-DQ (p < 0.001) and LCQ (p = 0.04) at 6-week follow-up. Participants perceived CanCommunicate favourably and made suggestions for further optimisation. CONCLUSION:The current study supports the benefits of communication intervention for people with brain tumour and reinforces the need for tailored, goal-based interventions.

People with primary brain tumor (PBT) and their families experience high distress and face challenges navigating their disease and treatment, healthcare systems, and/or survivorship. Quality brain tumor care coordination (BTCC) enables continuous, timely care according to the individual care needs of patients. We aimed to explore healthcare professionals’ (HCPs) practices and perceptions of BTCC. We conducted semi-structured interviews with 12 HCPs (92

Background and purpose Accurate delineation of intracranial tumours is crucial for stereotactic radiosurgery (SRS), where target definition directly influences treatment outcome. We developed and clinically integrated an automated multi-tumour segmentation pipeline using three-dimensional nnU-Net models for brain metastases, pituitary adenomas, vestibular schwannomas, and meningiomas. Materials and methods Four independent, tumour-specific models were trained on T1-weighted Magnetisation-Prepared RApid Gradient Echo Magnetic Resonance Imaging data using the nnU‑Net architecture. For model development, 100 cases per tumour-type (n = 400) were used, and to evaluate the clinical workflow, 25 additional cases per tumour-type (n = 100) were processed prospectively. The performance was assessed using the Dice Similarity Coefficient (DSC), the 95th-percentile Hausdorff Distance (HD95), and the Average Symmetric Surface Distance (ASSD). The pipeline continuously monitored incoming Digital Imaging and Communications in Medicine (DICOM) images using a listener and applied the appropriate tumour-specific segmentation model. It, then, automatically exported the DICOM images and the inferred Radiotherapy Structure-Set to the treatment planning system. Results Among all the tumour-types, vestibular schwannomas achieved the highest performance (DSC: 0.90 ± 0.03; HD95: 0.93 ± 0.34 mm; ASSD: 0.31 ± 0.09 mm) followed by brain metastases (DSC: 0.83 ± 0.08; HD95: 1.33 ± 0.55 mm; ASSD: 0.47 ± 0.19 mm), pituitary adenomas (DSC: 0.81 ± 0.09; HD95: 2.39 ± 1.14 mm; ASSD: 0.78 ± 0.32 mm) and meningiomas (DSC: 0.80 ± 0.11; HD95: 4.46 ± 3.64 mm; ASSD: 1.19 ± 0.80 mm). All tumour-types were segmented with consistent performance (SDDSC < 0.11), and segmentation was completed within two to four minutes per case. Conclusions The auto-segmentation pipeline enabled consistent and rapid delineation of multiple intracranial tumours, achieving clinically acceptable performance metrics and efficiency suitable for SRS.

The uptake of stereotactic radiosurgery (SRS) for the treatment of brain metastases (BM) has been rapid. SRS differs from other forms of radiation therapy in that large radiation doses are typically delivered with small margins for error and high dose heterogeneity. Geometric accuracy relies on the integrity of the entire treatment chain including patient immobilisation, imaging, treatment equipment and verification. Given this requirement for high fidelity geometric and dosimetric accuracy, credentialing for SRS within clinical trials requires special considerations. This process is further complicated by the range of treatment equipment that may be used to deliver SRS. The Trans-Tasman Radiation Oncology Group (TROG) SRS Technical Working Group was established to develop technical guidelines for SRS to BM in clinical trials in Australia, New Zealand and any other countries contributing to TROG recruitment. The panel comprised experts from Radiation Oncology, Medical Physics, Radiation Therapy and the TROG Quality Assurance (QA) team. These guidelines were developed collaboratively to assist trial management committees to formulate SRS credentialing and QA requirements appropriate for the clinical questions addressed by their trial.

Second primary invasive cutaneous melanomas (SPICMs) are common and pose an increased risk of death compared with single invasive melanoma only. Using data from the Queensland Oncology Repository, we investigated changes in the cumulative incidence of SPICMs for people diagnosed with a first primary invasive cutaneous melanoma between 1982 and 2022, with follow-up until December 31, 2023. Death due to any cause was treated as a competing risk. Among the 101,035 people in the study cohort, 9% (n = 9224) were diagnosed with a metachronous SPICM. Estimated 40-year cumulative incidence of SPICMs was 16.3% (95% confidence interval = 15.8-16.8%). Ten-year cumulative incidence was 4.9% between 1982 and 1991, 7.0% for 1992-2001, 7.9% for 2002-2011, and 7.3% between 2012 and 2022. After multivariable analysis, people first diagnosed between 2012 and 2022 were 23% more likely to subsequently be diagnosed with a SPICM within 10 years than those first diagnosed in 1982-1991 (subhazard ratio = 1.23, 95% confidence interval = 1.11-1.35), whereas the subhazard ratio was 1.38 (95% confidence interval = 1.26-1.52) for 2002-2011. These results provide evidence that the cumulative incidence of SPICM may have plateaued within a population having the highest rates of melanoma in the world, possibly owing to the impact of long-running sun safety campaigns in Australia combined with increased surveillance.

Isocitrate dehydrogenase (IDH)-mutant low-grade and high-grade gliomas are primary brain cancers with slower growth rates and longer survival than IDH-wildtype counterparts. However, these tumors are fatal and because of the younger age of patients, result in significant morbidity and loss of productivity. Several management options are available at initial diagnosis for IDH-mutant gliomas (including close surveillance, surgery, radiation therapy, chemotherapy and/or targeted therapies either alone or in combination), however, there is limited data about optimal timing and sequencing. When considering treatment, the risks associated with uncontrolled disease should be weighed against potential treatment-associated toxicities given the expected long overall survival times for many patients. Preservation of cognition, neurological function and quality of life remain a priority. Treatment decisions should therefore be made in the context of a neuro-oncology multidisciplinary team, and incorporating the patient's wishes and expectations. The management of recurrent IDH-mutant glioma is not well defined. This expert position statement aims to provide an Australian perspective on the evidence base and available treatments for contemporaneous management of IDH-mutant glioma in adults.

BACKGROUND:Brain metastases (BM) occur in at least 20% of people with an advanced solid malignancy and can lead to morbidity or mortality if not controlled. Hypofractionated stereotactic radiotherapy (HF-SRT) may be preferred to single fraction stereotactic radiosurgery (SRS) in certain clinical situations to improve the therapeutic ratio. Certain dose-volume metrics can predict the risk of symptomatic radionecrosis or other toxicities after HF-SRT but dosimetric predictors of more complex outcomes such as cognitive function are less well described. For this reason, clinicians aim to limit the dose to uninvolved brain so that it is as low as reasonably achievable rather than simply aiming for a threshold goal. The number of treatment arcs and arc length, floor angles and volumetric modulated arc therapy (VMAT) optimization strategies impact low dose distribution outside the target volume, and various combinations can be trialed and modified during the plan optimization process. On the other hand, variation in patient-specific factors such as target size and location cannot be changed. This combination of modifiable and fixed factors is expected to influence dose to uninvolved brain, but their relative impacts are not well understood. PURPOSE:This study aims to investigate both modifiable and fixed factors influencing low dose distribution to the normal brain and to develop predictive models for multiple normal brain dose metrics used for developing single BM VMAT HF-SRT plans. METHODS:Consecutive patients receiving HF-SRT for a single BM or cavity at a single institution between July 2017 and December 2019 were reviewed. Patient-specific, dosimetric and treatment technique data was collected retrospectively and used to develop statistical models to predict planned dose to the normal brain. Exploratory analyses and relevant parametric and non-parametric bivariate testing were performed to identify significant variables for inclusion in model development. A manual backward stepwise approach of multiple linear regression (MLR) was used to model achievable low dose in normal brain tissue for three outcomes. The three model outcomes produced in this study include predicting normal brain mean in Gray (Gy), the volume of normal brain receiving 50% of the prescribed dose and the volume of normal brain receiving 25% of the prescribed dose. RESULTS:Planning data from a total of 90 patients was included in the analysis. Over 60 patient-specific, dosimetric and treatment technique variables were examined from each patient, with several variables showing significance for all three outcomes through bivariate testing. The nine most significant variables were included in the model development. MLR modeling produced three or four statistically significant variables of planning target volume (PTV) location, PTV shape, PTV volume and arc combinations. Each model explained between 68.6% and 78.3% of the variation in normal brain dose, and the overall significance of each model is p < 0.001. CONCLUSIONS:This study has produced three predictive models which estimate an achievable amount of low dose to normal brain for use in the development of single BM VMAT HF-SRT 6MV plans. This is one of the first studies to investigate the impact of a comprehensive range of variables on achievable low dose distribution.

INTRODUCTION:Clinical guidelines recommend upfront osimertinib monotherapy for asymptomatic brain metastases (BM) in EGFR-mutant NSCLC, despite a lack of randomized trial evidence. We conducted two randomized phase II trials, OUTRUN and LUOSICNS, to evaluate the efficacy and safety of upfront stereotactic radiosurgery (SRS) plus osimertinib versus osimertinib in this patient population. METHODS:Participants with up to ten BM amenable to SRS were randomized 1:1 to SRS followed by osimertinib (80 mg daily) or osimertinib monotherapy. SRS was delivered as a single or multi-fraction regimen. The primary end point was 12-month intracranial progression-free survival (ic-PFS). Key secondary end points include overall survival (OS), patterns of intracranial progression, and safety. Data from both trials were prospectively pooled for a joint analysis. RESULTS:Overall, 79 participants were randomized. At a median follow-up of 39.0 months, 12-month ic-PFS was not significantly different between SRS plus osimertinib (n = 39) than osimertinib monotherapy (n = 40) (11%, 95% CI: -10% to 32%, p = 0.31; median ic-PFS 21.9 mo versus 17.2 mo). Median OS was 46.1 versus 29.1 months. Among those with intracranial progression, 35% in the SRS plus osimertinib group and 57% in the osimertinib monotherapy group underwent SRS at progression. Grade 3/4 radionecrosis occurred in 5% of participants treated with SRS plus osimertinib. CONCLUSIONS:Adding upfront SRS to osimertinib did not significantly improve 12-month ic-PFS in EGFR-mutant NSCLC with BM. This represents the first randomized evidence supporting the use of osimertinib monotherapy as upfront therapy in minimally symptomatic patients with low-burden BM. CLINICALTRIALS: GOV IDENTIFIER:OUTRUN: NCT03497767; LUOSICNS: NCT03769103.

Background:The Telehealth Making Sense of Brain Tumour program (Tele-MAST) was adapted for caregivers (cTele-MAST) to address the lack of caregiver-specific psychological support interventions in the context of high-grade glioma. This study aimed to explore current and bereaved caregivers' reasons for seeking psychological support, experiences of participating in cTele-MAST, and impacts on mental health and quality of life. Methods:A longitudinal multi-methods design was employed, capturing qualitative and quantitative data prior to cTele-MAST (Time 1), 1-week (Time 2), and 3-month post-intervention (Time 3). Qualitative data were analyzed using reflexive thematic analysis and quantitative data using repeated measures ANOVA. Participants were offered individual cTele-MAST sessions via videoconferencing and completed semi-structured interviews and measures of mental health and quality of life (QoL). Eighteen caregivers (15 female, M age = 47.27, SD = 9.37) of people with high-grade glioma were recruited, and 15 completed cTele-MAST (M = 9.5 sessions). Results:Three themes were identified. "Caregiver expectations of the self" reflected a desire to become stronger, more resilient, and quickly adapt their lives around caregiving. "Enabling, connecting and reframing" represented perceived benefits of cTele-MAST in terms of accessibility, brain tumor-specific expertise, and support to reset self-expectations. "Finding one's self" reflected caregivers better acknowledging their own needs and understanding themselves in grief. Significant post-intervention reductions in distress and stress were evident, but not for depression, anxiety or QoL. Conclusions:Caregivers found participating in a psychological support program tailored to their needs beneficial. Early referral to cTele-MAST and flexible ongoing access to psychological support is recommended.

Use of theory to conceptualise interprofessional practice and inform interprofessional education is growing. This paper draws on two emerging theories in education and the sociology of emotions – epistemic cognition and emotional climates – to analyse an important interprofessional setting: weekly case conferences in one radiation oncology department. Drawing on detailed transcription of video data, ethnographic fieldnotes, and reflexive interviews with four participant/co-analysts, we analysed the knowledge aims, ideals, and processes for evaluating knowledge claims across 9 case conferences (3 meetings x 3 groups), as well as their associated emotional climates. Findings indicate that recency, and relational or disciplinary expertise are key values against which knowledge claims are judged. Epistemic styles and emotional climates vary; when meeting leaders encourage others to ask questions and promote a relaxed emotional climate, this may invite more diversified epistemic contributions. More broadly, our study brings together epistemic cognition and emotional climate as situated phenomena, providing empirical, conceptual and potential pedagogical advances.

For people with primary brain tumors (PBT) and their carers, care coordination (CC) offers comprehensive, timely, person-centered care. This review aimed to systematically scope the breadth of literature relevant to approaches to CC for PBT. Four databases were searched (PubMed, PsycINFO, EMBASE, and CINAHL) for empirical research, and gray literature was searched for doctoral theses, clinical guidelines, and education resources for healthcare professionals (HCPs) related to the concept/model of CC in neuro-oncology. Data were systematically evaluated and synthesized following PRISMA-SCR guidelines. From 1163 screened abstracts, 30 eligible reports were reviewed (13 addressed CC interventions, 9 narrative reports, 5 describing CC/navigator positions, and 3 clinical guidelines). Most reports described nurse-led models of care within single tertiary care centers in metropolitan settings: a single HCP acting as primary contact, educator, and liaison, screening patient/carer distress and providing referrals as key components of CC. Clinical guidelines emphasize healthcare system navigation and access to medical care in CC. A CC approach overseeing the whole PBT trajectory was lacking. Facilitators of CC included availability of HCP dedicated to CC; HCPs' competency in relationship-based and communication skills; and improved access to resources. System-level and resource barriers to CC were identified. Knowledge about CC is largely based on descriptions of nurse-led models of PBT care. Further research is required to refine the framework of CC reflecting factors of known importance in PBT care, and identify training and support needs of HCPs who may play a pivotal role in current models of neuro-oncology CC.

Background: Despite advances in systemic therapy, survival in metastatic colorectal cancer (mCRC) remains poor. The utility of stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS), allowing dose escalation to achieve improved local control has risen in the treatment of mCRC. However, local control (LC) and overall survival (OS) varies widely between studies, and prognostic factors are not well defined. Methods: We retrospectively assessed LC and OS in patients with mCRC treated with SBRT/SRS between 2014 and 2022. Results: 124 Patients were treated during the study period. Median follow up was 16.4 months (0.2-93.1 months). There were 310 lesions treated with 53% located in the brain, 22% lung, 16% liver, 4% bone, 4% nodal and 1% other. Biologically effective dose (BED10) ranged from 33.6 to 151.2 Gy. LC was 75% (95% CI 67-81%) at 1 year and 65% (95%CI 56-73%) 2 years. On multivariable analysis (MVA), older age (HR 1.04, p = 0.001) and tumour volume >2.5 cc (HR 3.13, p < 0.001) were associated with worse LC. OS from first course of SBRT/SRS was 68% at 1 year (95%CI 58-76%), and 48% at 2 years (95%CI 38-58%). On MVA, >= 2 or more lines of systemic therapy (HR 3.04, p < 0.001) and brain metastases (HR 4.24, p = 0.001) were associated with shorter OS. Living long enough to receive >= 2 courses of SBRT/SRS (HR 0.20, p = 0.004) was associated with longer OS. Conclusion: This study demonstrates that SBRT and SRS offer effective local control, and LC is associated with tumour volume.

The Making Sense of Brain Tumour programme delivered via videoconferencing (Tele-MAST) demonstrated efficacy for improving mental health and quality of life in people with primary brain tumour (PBT). This study explored the perceived need for and benefits of the Tele-MAST programme, from the perspectives of individuals with PBT and family members. Individuals with PBT completed semi-structured interviews prior to Tele-MAST, after Tele-MAST, and at 3-months follow-up. Twenty-four participants (M age = 46.26, SD = 11.45; 63% high-grade glioma) commenced Tele-MAST (including 6 couples) and 16 completed the programme (67% retention). Reflexive thematic analysis identified PBT as a unique and complex illness with multiple unknowns and emotional impacts. Individuals often felt lost and cast aside in the healthcare system as they searched for understanding and hope regarding the illness. Unmet psychological support needs were typically addressed by experiencing Tele-MAST, a person-centred intervention in which the complexities of PBT were understood from the outset and individuals felt supported to cope with and find meaning in their illness. Providing early and ongoing access with longer-term support options was considered key to improving Tele-MAST. These findings underscore the value of early access to tailored psychological support delivered flexibly according to individuals' ongoing support needs and preferences.

Advanced melanoma is an aggressive cancer with a high metastatic potential often resulting in melanoma brain metastases (MBM). The complexity of the MBM tumor microenvironment (TME) impacts tumor progression and therapy response, leading to poor outcomes. Our study integrates spatial transcriptomics profiles with tissue morphology annotations of MBM and clinical data to investigate the TME landscape in relation to treatment and patient outcomes. We performed spatial transcriptomics on 21 MBM samples collected after various treatment strategies. All samples were preserved in formalin-fixed paraffin-embedded (FFPE) blocks and profiled using the Visium Spatial Gene Expression kit (10X Genomics) with a 6.5x6.5mm Visium Capture slide. All sequencing was performed on a NovaSeq6000 platform (Illumina) with an average of 71,391 reads per spots. H&E slides were annotated by our study pathologist (DL) to enable pathology-guided cluster analysis. Spatial transcriptomics data analysis was conducted using Seurat R pipeline which involved data quality check, normalization, integration, cell type annotation and deconvolution, and clustering. Further differential gene expression analyses were performed between different identified tumor clusters or between clinical groups, leading to the identification of enriched pathways and cell-cell interaction patterns. Our phenotyping of 25,208 spots revealed the presence of diverse cell populations, including neurons, melanoma, plasma, endothelial, stromal, and myeloid cells. We identified 8 distinct functional clusters characterized by specific gene expression and activated pathways. These include 5 tumor clusters with different immune infiltration or expression profiles, identifying differences in cell metabolism and heterogeneity in the TME. Importantly, we found MBM from patients exposed to radiation were significantly enriched for epithelial-to-mesenchymal transition pathway and genes related to cell adhesion. We further showed a reduced immune response in patients received radiation compared those who did not, and we noted that an active immune response was generally positively correlated with survival. Our study is the largest spatial analysis of MBM reported to date. Advances in spatial technologies provide novel insights into the structure and composition of MBM TME. Our findings highlight the importance of spatial context in understanding MBM biology and the potential of spatial transcriptomics in advancing precision oncology. Clemence J. Belle, Sandra Brosda, Vanessa F. Bonazzi, Victor Bulteau, Thomas Stuart, Zherui Xiong, Duncan Lambie, Peter A. Johansson, Lauren G. Aoude, Kalpana Patel, Samantha J. Stehbens, Mitchell S. Stark, Nikolas K. Haass, Wen Xu, Mark B. Pinkham, Matthew C. Foote, Sarah Olson, Victoria Atkinson, Arutha Kulasinghe, Quan H. Nguyen, Andrew Barbour. Unravelling melanoma brain metastasis tumor microenvironment characteristics using spatial transcriptomics [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 5076.

Aims: The study aims to develop a modified Pix2Pix convolutional neural network framework to enhance the quality of cone-beam computed tomography (CBCT) images. It also seeks to reduce the Hounsfield unit (HU) variations, making CBCT images closely resemble the internal anatomy as depicted in computed tomography (CT) images. Materials and Methods: We used datasets from 50 patients who underwent Gamma Knife treatment to develop a deep learning model that translates CBCT images into high-quality synthetic CT (sCT) images. Paired CBCT and ground truth CT images from 40 patients were used for training and 10 for testing on 7484 slices of 512 × 512 pixels with the Pix2Pix model. The sCT images were evaluated against ground truth CT scans using image quality assessment metrics, including the structural similarity index (SSIM), mean absolute error (MAE), root mean square error (RMSE), peak signal-to-noise ratio (PSNR), normalized cross-correlation, and dice similarity coefficient. Results: The results demonstrate significant improvements in image quality when comparing sCT images to CBCT, with SSIM increasing from 0.85 ± 0.05 to 0.95 ± 0.03 and MAE dropping from 77.37 ± 20.05 to 18.81 ± 7.22 (p < 0.0001 for both). PSNR and RMSE also improved, from 26.50 ± 1.72 to 30.76 ± 2.23 and 228.52 ± 53.76 to 82.30 ± 23.81, respectively (p < 0.0001). Conclusion: The sCT images show reduced noise and artifacts, closely matching CT in HU values, and demonstrate a high degree of similarity to CT images, highlighting the potential of deep learning to significantly improve CBCT image quality for radiosurgery applications.

INTRODUCTION:Glioblastoma management in elderly patients is challenging. The aim of this study was to review oncological treatment strategies at a single institution from 2011 to 2020. METHODS:Patients aged ≥ 70 years who received radiotherapy and/or chemotherapy for radiological or histological glioblastoma were identified from a centralised database. Patients receiving supportive care only were excluded, whether or not they had surgery at diagnosis. Clinicopathologic data and treatment modalities were collected. Median survival from diagnosis was calculated by the Kaplan-Meier method. RESULTS:Seventy-eight people were identified during the study period, median age 74.5 years (range 70-88). Seventy-five people had surgery (24 biopsy only, and 51 resection) and three people had radiological diagnosis only. The most common first-line treatment was concurrent chemoradiation (33/78, 42%). Only 18/33 (55%) went on to receive adjuvant temozolomide, median of five cycles (interquartile range [IQR] 2-6). The most common radiotherapy dose was 40 Gy in 15 fractions (52/73, 71%) and 60 Gy in 30 fractions was less frequently prescribed over time. Second-line therapy for recurrent or progressive disease was received in 23% overall, and varied in modality. Median survival was 7.0 months (IQR 4.4-12.5), and 6.4% (CI 4.3%-9.1%) at 2 years. CONCLUSION:Survival is poor for elderly patients with glioblastoma despite treatment. Concurrent chemoradiation was the most common treatment strategy, and 40 Gy in 15 fractions was the most common radiotherapy schedule. A small proportion of people received treatment for recurrent disease, and modality varied greatly.

Background:Cognitive changes are common following primary brain tumor (PBT), impacting employment, independence, relationships, and quality of life (QoL). Despite this, tailored cognitive interventions are unavailable within Australia. The La Trobe and Caulfield Hospital (LaTCH) group cognitive rehabilitation program has demonstrated efficacy for older adults without PBT. Efficacy for people with PBT was examined using a telehealth adaption of LaTCH. Methods:A Type 1 hybrid-implementation design randomized controlled trial (RCT) with waitlist control (WLC) was used. Adults > 3-months post-PBT diagnosis, and > 1-month post-radiation were randomized to (1) Intervention [6-week group sessions; 2 hours/week], delivered over Zoom (n = 3-7/group) or (2) WLC (intervention offered at 16 weeks). Primary outcomes were self-perceived memory (ability, strategy knowledge and use, satisfaction) and general cognitive function; secondary outcomes included QoL, fatigue, mood, and objective cognition (attention, working memory, processing speed, memory, executive function). Linear mixed models analyzed between-group differences post-intervention and 6 weeks later (maintenance). Results:Sixty participants (M(SD) age = 49.0 (10.4) years, 57% female, 55% high-grade glioma) were randomized (29 intervention, 31 WLC). The intervention group reported significantly improved perceived memory ability, satisfaction, strategy use, and strategy knowledge. Effect sizes were moderate-large (ηp2 0.06-0.21), and maintained for memory ability (t = 4.26, P < .001, ηp2 = 0.18), satisfaction (t = 2.23, P = .028, ηp2 = 0.18), and strategy knowledge (t = 2.92, P = .004, ηp2 = 0.09). Secondary outcomes exhibited no intervention effect. Conclusions:Telehealth-delivered LaTCH-BRAINS improved subjective memory-related outcomes for people with PBT, demonstrating promise as a cognitive rehabilitation approach for people with PBT reporting memory decline. Trial Registration:Australian New Zealand Clinical Trials Registry (ACTRN 12622000189729p), registered on 03/02/2022 (Appendix A).

The prospective multi-site trial evaluating O-(2-[18F]-fluoroethyl)-L-tyrosine Positron Emission Tomography (FET-PET) in Glioblastoma (FIG) study is currently recruiting. This abstract aims to evaluate the impact of full central Nuclear Medicine physician (NMP) review of prospective FET-PET1 delineation of the biological target volume (BTV) for radiotherapy (RT) planning. Adult GBM participants across 11 Australian sites undergo up to 3 FET-PET studies post-surgery/pre-chemo-RT [CRT] (FET-PET1), one month post CRT (FET-PET2) and at suspected progression evaluation timepoint (FET-PET3). Group 1 participants enter at timepoint 1 (FET-PET1 with MRI1), with Group 2 at timepoint 2. Adjuvant RT target volumes are derived per standard contrast MRI. These are compared to hybrid post-hoc RT volumes incorporating the FET-PET1 NM-derived BTV utilising MiM version 7.0 to evaluate the impact of FET PET on potential treatment planning. All trial sites and NMP have passed credentialling which included three benchmarking cases involving FET1-BTV delineation. Recruitment commenced in January 2021, with 253 (n=156 Group 1 and n=97 Group 2) participants enrolled to date, n=144 with evaluable FET-PET1 data. Trial credentialling demonstrated variations in FET-PET1-derived BTV in 25/72 (34.7%) -13 minor and 12 major. All n=144 prospective participant FET-PET1 with BTV delineation cases across 11 sites have undergone central NMP review, with 20/144 (13.9%) requiring resubmission. Reasons for resubmission/protocol deviation included incorrect imaging sequence selection within MiM workflow (n=3/20), static GTV overcontouring (n=12/20), dynamic volume of interest change in size/position during workflow (n=1/20) and static FET interpretation issues (n=3/20). Central radiation oncology review of hybrid BTV-derived RT volumes is underway. The importance of credentialling and full central review of all prospective FET-PET-derived BTV delineation in FIG trial participants is demonstrated. The FIG study remains the largest prospective multi-site study of its kind addressing the impact of FET-PET on radiation planning, management of pseudoprogression and prognostication.