SO-04 * INTERNATIONAL CONSENSUS GUIDELINES FOR POST-OPERATIVE STEREOTACTIC BODY RADIATION THERAPY (SBRT) FOR MALIGNANT SPINE TUMORS
Bibliographic record
Abstract
Emerging data suggests that post-operative SBRT for malignant spinal tumors may improve local control compared to conventional radiation therapy. However, few guidelines exist. The purpose of this study was to develop consensus guidelines to guide safe, effective treatment. Twenty spine specialists representing 19 centers in 4 countries with a collective experience of >1300 cases completed survey. Responses were defined as follows: 1) consensus: selected by ≥75%, 2) predominant: selected by ≥50%, 3) controversial: no single response selected by a majority of respondents. Consensus indications include: radio-resistant primary, 1-2 levels of adjacent disease and/or prior RT to same site. Contra-indications include: >3 contiguous vertebral bodies involved, ASIA score A (complete spinal cord injury without preservation of motor or sensory function), post-operative Bilsky grade 3 residual (cord compression without any CSF around the cord). For treatment planning, predominance of physicians co-register pre-operative MRI and post-operative T1 post-gadolinium MRI and delineate cord on T2 variant MRI or CT myelogram in cases of significant hardware artifact. Consensus GTV is post-operative residual tumor based on MRI. CTV is predominantly post-operative bed defined as entire extent of pre-operative tumor & anatomic compartment plus residual disease. Consensus is that hardware and scar do not need to be included. PTV expansion is controversial (range: 0-2 mm). Predominant prescription dose for initial treatment is 18 Gy x 1 with max point to cord <12-14 Gy (prescription range: 16-48.5 Gy in 1-10 fractions). For re-treatment, physicians predominantly account for repair and time interval between prior RT and spinal SBRT in calculating cord constraints. Acceptable PTV coverage is controversial, but physicians predominantly compromise coverage to meet cord constraint and/or fractionate to improve coverage while meeting cord constraint. Future investigation will be critical in better understanding areas of controversy including circumferential treatment of epidural space, margin for paraspinal extension and optimal dose/fractionation.
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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 | 0.012 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.004 |
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".