Good long term results of multidrug resistance-reversal chemotherapy for advanced intraocular retinoblastoma without upfront elective consolidation radiation
Bibliographic record
Abstract
Proc Amer Assoc Cancer Res, Volume 46, 2005 4732 PURPOSE: Radiation increases secondary cancer risk, and cosmetic complications in heritable retinoblastoma patients. In 2 multidrug resistance-reversal chemotherapy trials without upfront radiation, we treated consecutively, 66 Groups A-D eyes in 43 newly diagnosed patients (Trial 1), and 30 such eyes in 19 patients (Trial 2). We report mature results for advanced Groups C/D eyes. METHODS: In Trial 1 since 1991, we treated 13 D eyes (11 patients) and 18 C eyes (16 patients), with carboplatin (22 mg/kg), etoposide (9 mg/kg) and vincristine (0.05 mg/kg), with cyclosporine (33 mg/kg/day for 2 days as 3-hour infusions), no Neupogen support, and only focal therapy consolidation. In Trial 2 since 2000, we treated 14 Group D eyes (10 patients) and 7 Group C eyes (7 patients), with higher dose carboplatin (28 mg/kg) and etoposide (12 mg/kg), the same vincristine and cyclosporine dosages, with Neupogen support, and again only focal therapy consolidation. For both trials, radiation or enucleation for recurrent disease was considered treatment failure. RESULTS: For Trial 1, eye event-free rates (median followup 8.5 years) were 23% for Group D (3/13) and 78% for Group C (14/18). Ten Group D eyes (9 patients) failed: 6 had one eye enucleated and retained the other eye, 1 had remaining eye enucleated, and 1 had both while 1 had remaining eye radiated. Four Group C eyes (4 patients) failed: 2 had one eye enucleated and retained the other eye, and 2 had remaining eye radiated but second enucleation when this failed. For Trial 2, eye event-free rates (median followup 3 years) were 57% for Group D (8/14) and 71% for Group C (5/7). Six Group D eyes (5 patients) failed: 3 had one eye enucleated and retained the other eye, 1 had radiation to one eye and enucleation of the other eye, and 1 had radiation to remaining eye. Two Group C eyes (2 patients) failed: both had one eye enucleated and retained the other eye. Hematopoietic toxicity rates (fever/neutropenia admission 16.7%, sepsis 0%, blood transfusion 15.6%, platelet transfusion 18.6%) for the Neupogen-supported higher-dose Trial 2 were not significantly different (P = 0.88; 2-sided t-test of myelotoxicity) from toxicity rates (16.3%, 1.5%, 5%, 8%) for standard-dose Trial 1. CONCLUSIONS: With higher dose cyclosporine-modulated chemotherapy in Trial 2, no child lost both eyes, while 100% with Group C eyes and 86% with Group D eyes avoided radiation. Although followup is shorter with Trial 2, the outcomes indicate that most children can avoid radiation while retaining vision in one or both eyes. Higher dosages of carboplatin and etoposide with cyclosporine have acceptable and reversible hematopoietic toxicity, and appear to improve success rates for the highest risk Group D eyes. By reserving radiation only for relapses in their one remaining eye, children with Groups C/D eyes avoided serious long term tumorigenic and cosmetic morbidity.
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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) | 0.001 | 0.001 |
| 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) | 0.001 | 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".