244: Hypofractionated Radiotherapy for Node Positive Cutaneous Melanoma
Bibliographic record
Abstract
Purpose: A variety of dose/fractionation schemes are used for adjuvant radiotherapy (RT) in node positive (Stage III) melanoma.A prospective randomized study of adjuvant nodal radiation for high-risk Stage III melanoma used 2.4 Gy x 20 fractions in four weeks.The largest retrospective series to date used a hypofractionated scheme of 6 Gy x 5 fractions over 2.5 weeks.No randomized comparison of these has been reported.At our institution, either fractionation is used based on physician and patient preference.We sought to compare clinical outcomes using hypofractionated and conventional radiotherapy for node positive melanoma.Methods and Materials: Patients who received adjuvant radiation for node positive melanoma between 2009 and 2014 were included.Kaplan-Meier estimates of overall survival (OS) and 95% confidence intervals (CI) were obtained.Logistic regression was used to explore the association between patient, tumour and treatment factors for the outcomes of these patients.Results: Forty-one patients were included in the final analysis.Median follow up was two years.Sixty-one percent of patients were treated with hypofractionated radiotherapy (6 Gy x 5 for 23 patients and 6 Gy x 6 for two patients) and the remainder received conventional fractionation 40-60 Gy in 15-30 fractions).Treatment sites included the axilla (39%), groin (29%) and head/neck (32%).No significant differences in stage, number of involved nodes, largest node, nodal location, or extracapsular extension were present between the two groups.Comparing the hypofractionated versus conventional groups, there was no significant difference in regional control (76 versus 84%), distant control (48 versus 44%) or overall survival (67 versus 62%).44% were referred to a specialty clinic for management of lymphedema in the hypofractionated group versus 19% in the conventional group (HR 2.56, 95% CI 0.85-7.68,p = 0.094).Conclusions: Hypofractionated and conventional radiotherapy results in similar rates of disease control at two years in node positive melanoma.A trend towards higher referrals for lymphedema management was observed in the hypofractionated group.Future work should prospectively compare outcomes and toxicity for giving patients best advice for hypofractionation compared with standard treatment.
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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 | 0.000 |
| Insufficient payload (model declined to judge) | 0.006 | 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".