Centre-specific treatment and outcomes of patients with brain metastases treated with whole brain or stereotactic radiation therapy: an Ontario-based retrospective cohort study
Notice bibliographique
Résumé
Abstract Background Whole brain radiation therapy (WBRT) and stereotactic radiation therapy (SRT) are the two most common treatments for patients with intracranial metastatic disease (IMD). In Ontario, Canada, 4 of the 18 (22%) regional cancer centres (RCC) are fitted with dedicated cranial SRT program, which we refer to as SRT-dedicated program centres, while the remaining RCCs deliver SRT but lack a dedicated cranial SRT program. We hypothesized that SRT usage would be higher and patient outcomes better in RCCs with vs. those without an SRT-dedicated program. Methods Using administrative data housed at the Institute for Clinical Evaluative Sciences (IC/ES), we identified patients who had a primary cancer diagnosis and received cranial RT between April 1, 2010, and August 31, 2023. Treatment centres were grouped based on the presence or absence of an SRT-dedicated program. Within these groupings, hazard ratios (HR) for overall survival (OS) were compared. Additional comparisons based on the movement of patients across centres were performed. Results The median OS of the cohort was 6.05 months. Significant differences in treatment and patient characteristics were observed according to RT modality used at RCCs with SRT-dedicated programs vs. those without, including the ratio of WBRT vs SRT (OR = 2.8, 95% CI 2.4-3.2, p < 0.0001), patient age ( X 2 = 38.2, df = 7, p < 0.0001), stage at diagnosis ( X 2 =50.1, df = 4, p < 0.0001), and number of brain metastases treated (OR = 29.9, 95% CI 14.5-76.9, p < 0.0001). The median OS for patients treated with intracranial RT (WBRT or SRT) at centres with vs. those without a dedicated SRT programs was 7.20 vs 5.03 months (HR = 0.81, p < 0.0001), respectively. OS for patients who were treated with SRT at centres with vs. without a dedicated SRT program was 10.15 vs 7.89 months (HR = 0.88, p = 0.0275), respectively. No significant difference in the median OS for patients treated with WBRT at centres with or without a dedicated SRT program was observed (2.96 vs 3.09 months, HR = 1.08, p = 1.0, respectively). Mean OS for patients who travelled to a centre with a dedicated SRT program for intracranial RT after initial systemic therapy at a non-SRT-dedicated centre was associated with an positive impact on OS, compared to OS for patients who received systemic therapy and RT at a non-SRT-dedicated centre (14.0 vs 7.3 months, t = -3.9, p < 0.001). Conclusion Our study found greater utilization of SRT and significantly longer OS for patients with IMD treated in Ontario RCCs with an SRT-dedicated program. OS was not negatively impacted for patients who travelled to a centre with a dedicated SRT program for radiation therapy.
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 | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 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 ».