Intracystic interferon-alpha in pediatric craniopharyngioma patients
Notice bibliographique
Résumé
I read with great interest the paper by John-Paul Kilday et al.1 I congratulate the authors for retrospectively studying 56 patients with craniopharyngiomas from different continents and aged <18 years, a study supported by 2 reputed medical societies in oncology and pediatric neurosurgery, SIOPE and ISPN. However, the results raise some questions and concerns. First, of the 56 enrolled patients treated with intracystic interferon-alpha, 43 had already received other therapies. In our opinion, this affects the overall assessment of these patients. These 43 patients had already failed the primary treatment of choice and were therefore being treated with a second therapeutic modality (interferon-alpha). This calls into question the combined analysis of this group with treatment-naïve patients. In addition, I question why the authors called this treatment modality the “Toronto Protocol,” as this treatment protocol is not substantially different from the protocol that was originally published by Cavalheiro et al2 in 2005 and used to treat patients in São Paulo, Brazil.2,3 The São Paulo team was the first to use and report this treatment, subjecting patients to this new therapeutic modality. They also analyzed and published the cellular changes occurring during and after treatment4 and performed the first multicenter study involving 60 patients.3 I also believe that the authors could have harnessed the collaborative nature of their study and analyzed differences in subgroups of patients with craniopharyngioma that respond differently to distinct treatment modalities. They could also have investigated why the craniopharyngiomas that were not cured with radical surgery, radiotherapy, and/or other intracystic chemotherapy agents also respond poorly to intracystic interferon, as these patients constituted 77% of the total number of patients analyzed. Because some lesions disappeared after only one treatment cycle, the genetic hallmarks of these tumors should have been evaluated. The authors also did not clarify the criteria for new treatment cycles. It was unclear whether they evaluated only the increase in volume or also considered changes in the radiological characteristics of the cystic component. Because previous studies have not determined when interferon treatment should be halted and patients switched to another therapeutic modality, switching hastily may cause false-negative findings of drug efficacy. Because this was a retrospective study involving 21 different centers, the criteria for switching therapy were likely non-uniform. Furthermore, craniopharyngioma surgery after treatment with interferon is no more difficult than after radiotherapy or even after treatment with bleomycin. Following treatment with interferon, the capsule of the craniopharyngioma becomes much more evident, allowing its complete exeresis. A prospective study in treatment-naïve patients, with genomic and proteomic analyses of the fluid removed during the injections, and analyses of radiological modifications before and after interferon treatment, would be very welcome.
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 distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,001 |
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 tête enseignante, 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 ».