Four Week Hypofractionated Accelerated Intensity Modulated Radiotherapy and Synchronous Carboplatin or Cetuximab in Biologically Staged Oropharyngeal Carcinoma
Bibliographic record
Abstract
Hypofractionated accelerated chemoradiotherapy in the conformal era achieved acceptable control rates for squamous cell carcinoma of the head and neck. This study reports outcomes for biologically staged oropharyngeal cancer treated using four-week intensity-modulated radiotherapy (IMRT) and synchronous chemotherapy. Between 2009–2012, patients with squamous cell carcinoma of the oropharynx treated with hypofractionated chemo-IMRT (55Gray in 20 fractions), with either carboplatin or cetuximab were prospectively identified. Outcome measures analysed were 2-year loco-regional recurrence-free survival (LR-RFS) and overall survival (OS). Eighty-five consecutive patients with oropharyngeal cancer (p16 positive never smoked n=17; p16 positive ever smoked n=42; p16 negative n=24; unknown n=2)) were treated with IMRT with carboplatin (n=69) or cetuximab (n=16), with median follow up in surviving patients of 26 months. Two year LR-RFS was 68% for the whole cohort (95% confidence intervals 58%-78%), 87% (58%–97%) for the p16 positive never-smokers, 75% (58%–86%) for the p16 positive ever-smokers and 45% (25%–63%) for the p16 negative patients. OS at 24 months for these groups respectively was 80% (69–87%), 100.0%, 90% (75%–96%) and 46.9% (25%–66%). Factors associated with a worse OS on multivariate analysis were p16 negativity (p<0.001), age>60 (p=0.048), increasing T stage (p=0.021) and contraindication to carboplatin (p<0.001). The acceptable efficacy obtained with this schedule questions the need for synchronous cisplatin in good prognosis groups of oropharyngeal carcinoma. These results may also prompt the examination of a 4 week schedule of chemoradiotherapy in future randomised trials.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 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 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".