Predictive value of restaging after induction concurrent chemoradiotherapy for locoregionally advanced adenocarcinoma of the esophagus and gastroesophageal junction
Bibliographic record
Abstract
Background: Current treatment protocols for locoregionally advanced esophageal cancer add concurrent chemoradiotherapy to surgical resection in an effort to improve curative potential. These approaches are intensive and toxic. This retrospective review was undertaken to identify clinical features after concurrent chemoradiotherapy that might predict for treatment failure. Methods: 155 patients with locoregionally advanced adenocarcinoma of the esophagus/gastroesophageal junction were treated with concurrent chemoradiation with 96 hour infusions of cisplatin (20mg/m 2 /day) and fluorouracil (1,000mg/m 2 /day) beginning on day 1 of radiation (30 Gy @ 1.5 Gy bid). Surgery followed in 4-6 weeks with identical concurrent chemotherapy planned post-operatively. 75 patients also received 2 years of oral gefitinib Pretreatment staging evaluation was obtained in all patients which included a medical history, physical examination, complete blood count, serum chemistries, chest radiograph, computed tomographic scans of the chest and abdomen, pulmonary function studies, esophagogastroduodenoscopy (EGD) with biopsy, endoscopic ultrasound (EUS), and bronchoscopy if indicated by symptomatology, or by the extent or location of the primary lesion. This also included assessment of symptomatic dysphagia. Approximately 3 weeks after completing induction chemoradiation, all patients underwent restaging evaluation. Using this pretreatment and posttreatment staging information, prognostic factors for freedom from recurrence and overall survival were identified. Results: The 36 months freedom from recurrence was 31% and overall survival 32%. Post-induction change in EGD tumor length and EUS TNM stage did not correlate with outcome. Resolution of symptomatic dysphagia, which occurred in 86%, was the strongest predictor for freedom from recurrence ( p <0.001) and overall survival ( p <0.001). Conclusions: EGD and EUS restaging of locoregional disease after induction concurrent chemoradiotherapy did not help to predict recurrence. The persistence symptomatic dysphagia, when coupled with advanced pretreatment stage, is ominous and predicts for incurable disease. Subsequent therapy should be considered palliative.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".