A network meta-analysis of the sequencing and types of systemic therapies with definitive radiotherapy in locally advanced squamous cell carcinoma of head and neck (LASCCHN).
Bibliographic record
Abstract
6082 Background: Many randomized controlled trials (RCTs) have evaluated definitive radiotherapy (RT) with different sequencing (induction (I+RT), concurrent (CRT), adjuvant, induction + concurrent (I+CRT)) and types of systemic therapies (chemotherapy (chemo), EGFR inhibitors) in the treatment of LASCCHN. Some therapies have not been compared directly. We performed a network meta-analysis to enable direct and indirect comparisons of all existing treatment modalities for LASCCHN simultaneously. Methods: A systematic review was conducted using MEDLINE, EMBASE, ASCO abstracts, ASTRO abstracts and Cochrane Central of Registered Trials using Cochrane methodology to identify RCTs up to February 2015 investigating sequencing or types of systemic treatments that involved the same definitive radiotherapy in the arms for the RCT. Two reviewers independently reviewed the RCTs and discrepancies were resolved either by discussion or by a third reviewer. The Parmar method was used to extract OS hazard ratios (HR). A Bayesian network meta-analysis (NMA) with random effects was constructed using WinBUGS to compare the relative efficacy of different sequencing and types of systemic therapies simultaneously. Results: Fifty-nine RCTs involving 11,991 patients and 13 different treatment strategies were identified. Selected comparisons are shown in the table. Conclusions: Our findings support that CRT remains the standard treatment for LASCCHN. Concurrent radiotherapy with an EGFR inhibitor does not confer an OS benefit for patients who are eligible for CRT (chemo). Induction taxane-based chemotherapy followed by CRT showed a strong trend for OS benefit when compared with CRT; this warrants further evaluation in RCTs. Comparisons HR 95% CrI CRT (chemo) vs. RT 0.72 0.66-0.78 CRT (EGFR) vs. RT 0.77 0.55-1.08 CRT (EGFR) vs. CRT (chemo) 1.06 0.75-1.52 I (no taxane) + RT vs. RT 0.88 0.66-1.00 I (taxane-based) + RT vs. RT 0.64 0.43-0.95 I (taxane-based) + RT vs. CRT (chemo) 0.89 0.59-1.33 I (taxane-based) + CRT (chemo) vs. RT 0.60 0.48-0.74 I (no taxane) + CRT (chemo) vs. CRT (chemo) 1.02 0.82-1.24 I (taxane-based) + CRT (chemo) vs. CRT (chemo) 0.83 0.67-1.01
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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 | 0.036 | 0.059 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.012 | 0.056 |
| Bibliometrics | 0.006 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 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".