Controversies in neuro-oncology: role of whole-brain radiation therapy in the treatment of newly diagnosed brain metastases
Bibliographic record
Abstract
As therapies for systemic cancers improve and patients survive longer, the incidence of brain metastases is increasing. Current therapies include varying combinations of surgery, stereotactic radiosurgery (SRS), whole-brain radiation therapy (WBRT), and in a small subset of patients, systemic therapy. The use of SRS to treat brain metastases has been one of the major successes in neuro-oncology, providing effective local control of even radioresistant brain metastases. Several studies have compared the outcomes of patients with a limited number of brain metastases treated with surgery or radiosurgery alone, with the addition of WBRT.1–4 These studies, which usually included heterogeneous tumor histologies and varying extent of systemic disease, have generally shown improved intracranial control with the addition of WBRT, but no significant improvement in overall survival, and an increased risk of neurocognitive impairment. Most recently, at the 2015 American Society of Clinical Oncology annual meeting, Brown et al presented the results of the North Central Cancer Treatment Group (NCCTG) (Alliance) N0574 study, a phase III trial comparing SRS+WBRT to SRS alone in patients with 1–3 brain metastases.5 This study for the first time used decline in cognitive function at 3 months as the primary endpoint. Cognitive deterioration at 3 months was significantly more frequent in the WBRT+SRS group than the SRS alone group, involving especially immediate recall, memory, and verbal fluency. As with prior studies, intracranial disease control was improved with WBRT but there was no improvement in overall survival.
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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 | 0.038 | 0.075 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.002 | 0.009 |
| Scholarly communication | 0.005 | 0.010 |
| Open science | 0.004 | 0.003 |
| Research integrity | 0.009 | 0.019 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
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".