Relapse Patterns and Subsequent Outcomes of Patients Treated on the NCIC CTG HD.6 (ECOG JHD06) Randomized Trial Evaluating ABVD Alone in Patients with Limited Stage Hodgkin Lymphoma (HL).
Notice bibliographique
Résumé
Abstract Background: We completed a randomized trial comparing ABVD alone with treatment that included extended field (EF) radiation therapy (RT) in 399 patients with limited stage HL. Patients allocated to EF RT received this as a single modality if categorized as favourable risk or preceded by 2 cycles of ABVD if unfavourable risk. The 5-year FFP was superior in patients receiving RT but no difference in overall survival was detected as the difference in FFP has been offset by deaths due to other causes (Meyer, J Clin Oncol2005; 23: 4634 42). Overall, 34 patients had progressive disease (PD) and 15 patients died (4 from HL, 2 from treatment-related toxicity and 9 from other causes). To better understand the implications of treatment with ABVD alone, we compared the patterns of PD and outcomes with secondary therapy of the two randomized groups. We were particularly interested in assessing how frequently sites of PD observed in patients assigned to ABVD alone occurred within the EF of RT that was prescribed in the HD.6 trial, or within a hypothetical involved field (IF) of RT that constitutes an accepted current practice. Methods: Two expert reviewers, blinded to treatment allocation, were provided a list of disease sites at diagnosis and at PD. Sites of PD were categorized as ’within field only’, ’out of field only’ and ’in + out of field’. Two analyses were performed by considering both EF and IF RT fields. A third blinded reviewer adjudicated disagreements. Results: Inter-observer agreement was excellent for both the EF (kappa 0.87) and IF (kappa = 1.0) analyses. More cases of PD were observed in patients allocated to ABVD alone (24 vs. 10). More within field only PD was observed in patients allocated to ABVD alone when assessed according to both the EF (88% vs 30%; P = 0.002) and IF (71% vs. 20%; P = 0.01) analyses. Individual investigators determined the actual choice of therapy for PD; among patients allocated to ABVD alone, secondary therapy included chemotherapy alone (2), RT alone (8), combined modality therapy (6) and autologous stem cell transplantation (8). No difference in the proportion of patients alive without second progression was detected between patients allocated to ABVD alone (18 /24; 75%) or treatment that included RT (8 /10; 80%) (P = 1.0). Conclusion: For patients with limited stage HL, treatment with ABVD alone is associated with a greater risk of PD at disease sites that would be included in an IF of RT. Secondary therapy is often successful and further testing is required to determine the optimum choice of therapy for these patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».