Shifting Practice in Definitive Chemoradiation for Localized Esophageal Cancer
Bibliographic record
Abstract
Background: The efficacy of carboplatin–paclitaxel in the trimodality setting was demonstrated in the cross trial. Because of better tolerance, that regimen has been adopted as an alternative for patients receiving definitive chemoradiation (dCRT). The purpose of our study was to compare outcomes in patients with localized esophageal and gastroesophageal junction (GEJ) cancer who received dCRT using either platinum–5-fluorouracil (5FU) or carboplatin–paclitaxel. Methods: Medical records and outcomes for all patients diagnosed with localized carcinoma of the esophagus and GEJ at our centre between 2008 and 2015 were reviewed. All patients who underwent dCRT using cisplatin–5FU, carboplatin–5FU, or carboplatin–paclitaxel were included. Results: The 73 identified patients (34 cisplatin–5FU, 13 carboplatin–5FU, 26 carboplatin–paclitaxel) were all prescribed concomitant radiotherapy of 50 Gy in 25 daily fractions. The diagnosis was adenocarcinoma in 64% and squamous cell carcinoma in 36%. Median overall survival (OS) duration for the cisplatin–5FU group was 28 months [95% confidence interval (CI): 19 to 41 months], with a 3-year OS rate of 44%, in contrast to the 15 months (95% CI: 11 to 17 months) and 15% in the carboplatin–paclitaxel group (log-rank p = 0.0047). Median OS duration for the carboplatin–5FU group was 17 months (95% CI: 11 to 68 months) with a 3-year OS rate of 31%. Adjusting for patient and disease factors, better OS durations and rates were associated with cisplatin–5FU (hazard ratio: 0.34; p = 0.0016) and carboplatin–5FU (hazard ratio: 0.55; p = 0.20) than with carboplatin–paclitaxel. Conclusions: In a dCRT regimen, a better OS is associated with cisplatin–5FU than with carboplatin–paclitaxel. Clinical trials to determine optimal chemotherapy regimens are warranted for patients who are not suitable for surgery.
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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 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".