99: Prognostic Value of Pre-Treatment Serum Lactate Dehydrogenase in HPV-Related and HPV-Unrelated Oropharyngeal Cancer
Bibliographic record
Abstract
Purpose: To compare the combined intracavitary/interstitial brachytherapy (IC/IS) with intracavitary brachytherapy alone (IC) in cervical cancer treated with definitive radiochemotherapy and MRI guided adaptive brachytherapy (BT) within the EMBRACE study and the impact on target dose, OAR dose and late morbidity. Methods and Materials:The EMBRACE database containing 1129 cervix cancer patients enrolled in the study with treatment completed before 09/2014 was used for this study.Patients having a MRI based parametrial infiltration status (PI) at time of BT (n = 999) were divided according to their PI status at first BT: no PI (456 patients), proximal PI (412 patients) and distal + pelvic wall PI (122 patients).Patients in each group were compared according to the use of IC or IC/IS during the course of their treatment, to dose in the HRCTV, OARs, and to late morbidity.T-test was performed on target and OAR doses (all EQD2 with α/β of 10 and 3 Gy) and Chi-square test was performed on patients' characteristics variables.Univariate analysis of morbidity Grade 2 and more (G2≤) (rectum, bladder, bowel, vagina, overall morbidity) was performed with actuarial probabilities based on Kaplan-Meier statistics.Results: The median follow up was 23 and 26 months for the IC/IS and IC group, respectively.IC/IS patients with proximal PI had significantly less G2≥ bladder (19% versus 28%, p = 0.014), bowel (10% versus 22%, p = 0.002) and overall morbidity (51% versus 68%, p = 0.003) at three years, but no difference in G2 ≥ rectal and vaginal morbidity.A significant dose decrease was found for bowel D2cm 3 in the IC/IS group in comparison to the IC group (61 ± 8 Gy versus 63 ± 10Gy) while the same mean dose (D90) to the HRCTV was given.Rectal and bladder D2cm 3 was not significantly different.Patients with distal or pelvic wall PI experienced less rectal (13% versus 46%, p = 0.001) and bowel (13% versus 40%, p = 0.054) morbidity G2≥ at three years in the IC/IS group in comparison to the IC group while bladder and vaginal toxicities were not significantly different.Patients in the IS/IC group received a significantly higher HR CTV D90 (87 ± 9 Gy versus 80 ± 13 Gy, p < 0.001).Conclusions: These results demonstrate that regardless of the extent of PI, the dosimetric and clinical advantages of combined intracavitary/interstitial brachytherapy compared to intracavitary brachytherapy alone are substantial.IC/IS brachytherapy allows for a significantly higher HRCTV D90 (7Gy) in patients with distal and pelvic wall PI than IC brachytherapy while leading to less rectal and bowel morbidity.For patients with proximal PI, the use of IC/IS brachytherapy was associated with less bladder, bowel and overall morbidity while allowing for the same target dose.Potential biases induced by treatment related factors still have to be addressed in a multivariate analysis.A more systematic use of IC/IS brachytherapy in cervix cancer patients with PI is therefore recommended, especially for OAR sparing and for increase of dose to the HRCTV.98
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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 | 0.004 |
| 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 | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 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".