Radiotherapy for intubated patients with malignant airway obstruction: Futile, or facilitating extubation?
Bibliographic record
Abstract
e19120 Background: There is uncertainty as to the appropriate management of intubated patients with malignant airway obstruction (MAO). Radiotherapy (RT) may be delivered but requires substantial resources in this patient population. In the absence of evidence, it is unknown if radiotherapy facilitates extubation or prolongs ICU stays, resulting in a delay in the appropriate transition to end-of-life care. Methods: We performed a 10-year retrospective review of patients in the ICU treated with RT for MAO. Primary study endpoints were overall survival (OS) and extubation success (ES) defined as ≥48 hours without reintubation or death. Secondary endpoints included rates of discharge from the ICU and to home. Logistic regression and Cox regression analyses were performed to identify factors associated with ES and OS. Results: Twenty-six patients were eligible for analysis. Patients waited an average of 2.9 days (±4.5) from intubation and MV until receiving RT. Seven patients (27%) achieved ES, occurring between days 4 and 22 after RT initiation. All of these patients were discharged from the ICU, and most (n=6) were discharged home. There was a trend for a higher chance of ES in patients who received higher radiation doses (OR per 5 Gy increase: 0.63, p = 0.080). Median OS was only 0.36 months (range 0–113 months), and 6-months OS was 11%. On Cox regression analysis, increased radiation dose was predictive of improved OS (HR per 5 Gy increase: 0.74, p = 0.016). Conclusions: Although median survival is short, in a minority of intubated patients with MAO, RT is associated with ES. Survival beyond six months is uncommon, although improved OS is associated with higher delivered doses of RT.
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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 | 0.011 |
| 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 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".