HG-37SECOND RE-IRRADIATION FOR DIPG PROGRESSION, RE-CONSIDERING “OLD STRATEGIES” WITH NEW APPROACHES
Bibliographic record
Abstract
BACKGROUND: Diffuse intrinsic pontine gliomas (DIPG) are aggressive infiltrative gliomas for which there is no curative therapy. Radiation therapy (RT) delays tumor progression transiently. At progression, re-irradiation has shown to be effective and safe. At second progression, full palliative care is the rule. We report two patients who received tumor directed second re-irradiation. CASE 1: 6 year-old female with classic clinical and radiologic DIPG observed at diagnosed and then treated with focal RT(54 Gys/30 fractions) with dramatic clinical/radiologic improvement. No adjuvant therapy was administered and patient remained well for 8 months, when new clinical/imaging progression developed. Re-irradiation (30.6 Gys/17 fractions) accomplished clinical/ radiologic response. Afterwards, patient was kept on alternative therapy. Four months later new progression appeared. A second course of focal re-RT (21.6 Gys/12 fractions) obtained clinical/radiologic response. Three months later, symptoms reappeared and patient died of disease. CASE 2: 5 year-old male with classic clinical and radiologic DIPG received focal RT (39 Gys/13 fractions) with good clinical/radiologic response. Adjuvant oral metronomic regimen was administered. Eleven months later, clinical/radiologic tumor progression developed. Re-irradiation (20 Gys/10 fractions) accomplished good radiologic/clinical response. Afterwards, irinotecan and rapamycin were started. Eight months later, new clinical/radiologic progression established. A second re-irradiation course (20 Gys/10 fractions) with concomitant temozolomide was administered with good tolerance. Sustained clinical response remains 6 months after second re-RT. Most recent MRI shows tumor progression. CONCLUSION: Selected DIPG patients may benefit from a second focal re-irradiation course with good clinical and radiologic response and importantly with good quality of life.
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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 | 0.000 | 0.000 |
| 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 | 0.001 |
| 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".