A population-based study of glioblastoma multiforme (GBM) in the new stupp paradigm: Have we improved outcome?
Bibliographic record
Abstract
2012 Background: Current standard of care for newly diagnosed GBM includes trimodality treatment followed by six cycles of adjuvant temozolomide (TMZ). We analysed the uptake of standard of care in a real-world setting, and compared outcome to updated controlled clinical trial data. Methods: All GBM patients registered with Cancer Care Ontario between 2004-2008 were identified. Those who were >= 16 years age, newly diagnosed, treated at our institution, had confirmed pathology, complete records and imaging,were included. Demographics, planned and delivered treatments, total cycles of adjuvant TMZ, toxicity and outcome were captured. For survival analysis patients were stratified by age, ECOG, and treatment modalities, including total cycles of TMZ delivered. Descriptive statistics were used for early progressors and long term survivors. Kaplan-Meier curves, log-rank test and Cox proportional hazards model were used for survival analyses. To compare outcome from our population database to published data from controlled clinical trials, patients were stratified into radiotherapy (RT) only group or concurrent chemoradiation (CRT) followed by TMZ. At a median follow-up of 28 months, we compared our outcome data to updated EORTC 22981/26981 NCIC CE. 3 results. Results: 517 patients were identified and 433 included for analysis. Majority were male (63%), ECOG 0-1 (66%), and <=65 years(55%). 44% received CRT followed by TMZ, 13% had CRT only, 30% had RT only and 13% had best supportive care. 35% had >6 cycles of TMZ, 10% were early progressors (<3 months from completing CRT) and 9% survived beyond 2 years. In the entire cohort poor ECOG or older age demonstrated inferior survival (p<0.0001, p=0.0003 respectively). In a multivariate analysis CRT followed by TMZ predicted superior survival (p<0.0001). Comparison of our results to EORTC 22981/26981 NCIC CE. 3 data showed median survival was 15.8 months vs. 14.6 months, 2 year survival rate for CRT plus TMZ was 35% vs. 26%, and for RT alone 0% vs. 10%, respectively. Conclusions: Our results show that only < 50% of GBM patients complete standard of care in the real-world setting and prognosis remains dismal for patients who do not receive CRT.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".