Cognitive outcomes following proton vs. photon radiotherapy for CNS non-germinomatous germ cell tumors: A Children’s Oncology Group study.
Notice bibliographique
Résumé
10016 Background: The Children’s Oncology Group (COG) study ACNS1123 (stratum 1) treated children with localized non-germinomatous germ cell tumors (NGGCT) of the brain with chemotherapy followed by whole ventricular (WV) radiotherapy (RT, 30.6 Gy) followed by a focal tumor bed boost (54 Gy total dose). Previous work has shown that WVRT with proton therapy, compared to photon RT, resulted in lower RT doses to the brain. However, it was unclear whether this dosimetric difference led to superior cognitive outcomes. Methods: The ACNS1123 study was a prospective, phase II trial conducted by the COG that enrolled 107 patients. Evaluation of cognitive functioning of children was a co-primary objective of the study. Cognition was prospectively examined at 9, 30 and 60 months post-diagnosis, using the COG Standard Neuropsychological and Behavioral Battery. The primary endpoints were attention/concentration, estimated intelligence quotient (IQ), and processing speed. Linear mixed-effect models were created to model cognitive endpoints with treatment exposures, including RT modality (proton vs. photon RT) or RT dose to brain structures. Cognitive evaluations completed post-recurrence were excluded. Results: Seventy patients were evaluable and received WVRT followed by RT boost, of which 20 received proton therapy. Mean age of all patients was 11.8 ± 4.3 years old at the start WVRT, and were predominantly male (n = 52). Mean doses to the brain were significantly lower with proton vs. photon RT (mean 18.8 ± 1.8 [SD] vs. 24.7 ± 3.7 Gy, p < 0.0001), left hippocampus (41.1 ± 5.2 vs 46.2 ± 5.3 Gy, p = 0.0005), and right hippocampus (41.8 ± 5.1 vs 46.0 ± 5.3Gy, p = 0.0038). A total of 56, 60 and 61 patients were evaluable for attention/concentration, estimated IQ and processing speed, respectively, with 1 or more evaluation. Nine, 20 and 20 patients had data at all 3 time points for attention/concentration, estimated IQ and processing speed, respectively. Multivariable modelling demonstrated that photon therapy was associated with a decline in IQ over time (p = 0.0401), as compared with proton RT, adjusted for age at RT and gender. In a separate multivariable model, higher mean brain dose was also associated with poorer recovery of IQ over time (p = 0.0216), adjusted for gender. There were no identified associations between use of proton RT or hippocampal dose with processing speed or attention/concentration. Conclusions: Compared to proton therapy,WVRT delivered with photons was associated with a significant decline in IQ and adverse recovery of IQ over time. To our knowledge, this data is the first to demonstrate such an association for children with NGGCT.
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 | 0,002 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,000 | 0,001 |
| 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 | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 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 ».