Optimal management of leptomeningeal carcinomatosis in breast cancer patients - a systematic review.
Bibliographic record
Abstract
e13526 Background: The incidence of leptomeningeal carcinomatosis (LC) in breast cancer patients (LC-BC) is rising. Despite significantly impacting patient survival and quality of life (QoL), little is known about its optimal management. A systematic review of treatment strategies for LC-BC was performed. Methods: EMBASE, Ovid Medline(R), Pubmed, and the Cochrane Central Register of Controlled Trials were searched from 1946 to September 2015 for trials reporting on treatments for LC-BC. All treatment modalities were considered. Outcome measures of interest included: overall survival (OS), time to neurologic progression (TTNP), QoL and treatment toxicity. Results: Of 724 unique citations, 181 studies met the pre-specified eligibility criteria. Most studies were not specific to LC-BC patients. Of four identified randomized controlled trials, one was specific to LC-BC patients and compared standard systemic therapy and involved field radiotherapy +/- intrathecal (IT) methotrexate (35 patients), while the remaining three compared different IT chemotherapy regimens (157 total patients, 58 with LC-BC). Of the remaining studies, 19 were non-randomized, interventional studies (225 LC-BC patients); 156 were observational studies (3438 LC-BC patients); and 2 were systematic reviews (17 LC-BC patients). There was minimal prospective data available on OS, TTNP, QoL, or toxicity. Due to study heterogeneity, a meta-analysis was not performed. Conclusions: Minimal high-quality evidence exists regarding optimal treatment of LC-BC. Identified studies were heterogeneous in nature and often methodologically poor. With no established standard of care, a wide variety of treatment strategies are employed worldwide, with no data to support any one therapeutic approach over another. The only RCT that specifically assessed IT chemotherapy in the presence of standard systemic and radiation therapy showed no benefit and, if anything, harm. If the management of these patients is to be improved, further prospective, tumour-specific trials are urgently needed with improved inter-study methodological consistency and appropriately reported data on OS, TTNP, QoL and toxicity.
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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 | 0.005 | 0.018 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.007 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 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".