124: Detection of Local Cancer Recurrence after Stereotactic Ablative Radiotherapy (SABR) for Lung Cancer: Physician Performance Versus Radiomic Assessment
Bibliographic record
Abstract
Purpose: The cognitive side effects of whole brain radiotherapy (WBRT) are well recognized, as is the importance of local disease control on neurocognitive function.We therefore set out to assess the neurocognitive impact of a central nervous system (CNS) event in patients that received volumetric radiosurgery (VRS) and WBRT to aid in defining a subgroup of patients receiving radiosurgery that may preserve cognition with WBRT.Methods and Materials: This multicentre Phase 2, single-arm study accrued 60 patients with one to ten brain metastases.Eligible patients received 47.5 Gy in 5 fractions VRS to their metastases concurrent with 20 Gy in 5 fractions to the whole brain.Cognitive assessment was a secondary endpoint in the trial.Neurocognitive function was assessed using the Mini-Mental State Examination (MMSE).It was analyzed at baseline and at three-month intervals, until the 12-month follow up point.An MMSE drop of 3 points, which is the minimal clinically significant difference, was defined as a cognitive event.A CNS event was defined as local recurrence, distant brain relapse or radionecrosis.Results: From July 2010 to May 2013, 60 patients, with a median age of 62 years, underwent treatment.Median survival was 10.1 months.Twenty-seven patients (45%) had a CNS event in the first 12 months after treatment.Sixteen patients (59%) developed distant brain relapse, five (19%) local relapse, and six (22%) radionecrosis.On univariate analysis, the risk of a CNS event (hazard ratio (HR = 5.4, p = 0.03).was significantly associated with the risk of first 3 point drop in MMSE.On multivariate analysis, both age (HR = 4.5, p = 0.03) and CNS event (HR =11.6, p = 0.03) were significantly associated with a cognitive event.The risk of a first 3-point drop in MMSE was found to be highest in patients above median age that experienced a CNS event.Conclusions: The results of this study showed that control of CNS events is the most import factor in maintaining neurocognitive function in patients with one to ten brain metastases.It determined that a clinically significant drop in MMSE was associated with local recurrence, distant brain relapse or radionecrosis, as well as older age.In patients treated with WBRT, it highlights the importance of age on neurocognitive function, as older patients with a CNS event were more at risk of a cognitive event.Using WBRT adjuvantly to preserve cognitive function, should be considered in younger patients with a highrisk of distant brain relapse.
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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 | 0.002 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 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".