EP-1401: FDG and FMISO-PET for guided dose escalation with intensity-modulated radiotherapy in lung cancers
Bibliographic record
Abstract
Purpose or ObjectiveAt our institution, we commonly treat brain metastases (BM) adjacent to critical structures with a reduced marginal dose prescription (DP) to reduce the likelihood of toxicity.We sought to evaluate the impact of DP on local failure (LF) and radionecrosis (RN) for small-to medium-sized BM (≤ 2 cm) from non-small cell lung cancer. Material and MethodsA prospective registry of BM patients treated with gamma knife SRS between 2008 and 2016 was reviewed to determine per lesion rates of LF and RN.Each lesion was followed until LF or RN or at last MRI follow-up.Defined criteria were used to differentiate LF from RN. Whole brain irradiation (WBI) was a censoring event.Freedom from LF (FFLF) and RN (FFRN) were calculated using the Kaplan-Meier product-limit method.Log-rank test was used as a univariate analysis to compare potential predictive factors of LF or RN events. ResultsFrom 1,465 potential subjects, 345 small-to mediumsized BM from 151 lung cancer patients were evaluated.Median radiographic follow-up was 10.2 months.Median lesion volume and diameter were 0.17 cm 3 , and 0.81 cm, respectively.Median OS was 17 months (95CI 14.9-19.09)with 1 year OS of 69.13% (95CI 62.9-74.4%).The DP for 71 lesions (21%) was 15 Gy, and ≥ 20 Gy (median 21 Gy; 20-24Gy) for 274(79%).Most lesions were ≤ 1 cm (65%).Median number of SRS courses was 2 (1-4) and 36 patients received salvage WBI.Sixteen lesions (4%) developed LF and 12 (3%) developed RN.Freedom from local failure at 1 year (FFLF) for 15 Gy, and ≥ 20 Gy, was 80%, and 95%, respectively (p<0.05).FFLF for lesions ≤1cm, and >1 cm, was 95%, and 78%, respectively (p<0.01).Freedom from RN at 1-year (FFRN) for DP 15 Gy, and ≥ 20 Gy, was 98%, and 96%, respectively (p=0.3).FFRN for lesions ≤ 1cm, and > 1 cm, was 98%, and 93%, respectively (p<0.05).FFLF and FFRN for lesions ≤1 cm and >1 cm, according to DP, are shown in Table 1.Conclusion Lesions > 1 cm showed improved FFLF improvement with higher DP, although this trend did not reach statistical significance.Prospective randomized evaluation is urged to define the optimal DP.
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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) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".