NTOX-08. SAFETY OF INTRA-ARTERIAL CHEMOTHERAPY IN THE TREATMENT OF BRAIN TUMOURS
Bibliographic record
Abstract
The treatment of brain tumors is greatly limited the delivery impediment caused by the blood-brain barrier and blood-tumor barrier. To circumvent this limitation, different approaches have been studied, including intra-arterial delivery. Because of a significant local increase in plasma-peak concentration, this strategy increases the local area under the curve, and translates into a 3 to 5.5 fold increase in intra-tumoral chemotherapy concentration. However, intra-arterial chemotherapy in the treatment of brain tumors has a notoriously bad name, thanks to prior trials led in past decades showing significant neurotoxicities. This toxicity was related to the choice of therapeutics. Different agents are now available devoid of such toxicity, and we believe it is now time to revisit this approach. In this paper, we present our experience regarding the safety of this intra-arterial chemotherapy. For 15 uninterrupted years now, we have been using intra-arterial chemotherapy in the treatment glioma, lymphomas and metastatic disease, using a varied array of agents: carboplatin, etoposide phosphate, melphalan, methotrexate and doxil. As each patient enrolled in our trials undergo an MR scan prior to each cycle on monthly basis, and all these reports are archived in a centralized medical informatics system (Ariane) we used a database search of keywords associated to vascular complications: stroke, lacuna, lacunar stroke, bleeding, hematoma, dissection, ischemia, ischemic, etc. Once a keyword was identified in a report, the chart was reviewed and the MR scan was pulled and also reviewed by a radiologist (GG). On a total of 3583 intra-arterial treatments in 722 patients, we found a total of 55 vascular complications, 28 of which were symptomatic (20 lacuna, 5 strokes). Asymptomatic findings were mostly small lacuna (n=21) and 4 small hematomas. In this paper, we provide a full breakdown of the data. We conclude that intraarterial chemotherapy is reasonably safe.
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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 | 0.001 |
| 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 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
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".