A cross-sectional view of radiation fractionation schemes used for painful bone metastases (PBM) cases within the Veterans Health Administration Radiation Oncology Centers.
Bibliographic record
Abstract
177 Background: Though the use of single fraction (SF) radiotherapy in the treatment of PBM is an integral component of frontline palliative radiotherapy in Canada and Europe ((Popovic - Radiotherapy and Oncology 111 (2014) 11–17), its use in the United States is only now gaining clinical acceptance. Recently, VHA Radiation Oncologists reported that roughly 76% offer SF to patients with a limited life expectancy (J Palliat Med. 2014 Nov;17(11):1221-5). In this cross-sectional report, we examine the actual dose fractionation schemes used for PBM cases by VHA Radiation Oncologists. Methods: METHOD: An electronic request was sent to 38 of 39 active VHA RO centers asking them to provide the radiation dose fractionation scheme used in the last 10 of their cases of PBM - (International Classification of Diseases (ICD) 198.5 - secondary malignancy of bone and or bone marrow). The study period: 03/01/2015 to 03/16/2015; Response rate: 100%. Data was provided for 382 cases . The survey results were divided by regions, and the 18 Veterans Integrated Service Networks (VISN) w/ VHA RO Centers. Results: RESULTS: According to the 382 cases analyzed, the top 3 fractionation schemes used were: 1st 300cGy x 10 (169); 2nd 800cGy x 1 (69); 3rd 400cGy x5 (63). Overall, SFRT was used in 18% of cases reviewed. There was, however, substantial variation across Veterans Health Administration. While radiation oncology practices in four Veterans Integrated Service Networks (VISN) used SFRT in 50% or more of their reported cases, practices in seven VISNs used SFRT in only 10% or fewer cases. Single fractions and Hypofractionation (3-7) was more common, comprising 45% of the cases. Conclusions: Compared to prior published data, these results suggest that in addition to our previously reported wide availability of hypofractionation for Veterans receiving palliation, actual increased use of Single Fraction and Hypofractionated radiotherapy for PBM is now common within the VHA. VHA RO are using SFRT per the ASTRO 2013 Choosing Wisely Campaign. [Table: see text]
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
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".