RTHP-34. CRANIOSPINAL IRRADIATION (CSI) AS PART OF RE-IRRADIATION (RT2) FOR CHILDREN WITH RECURRENT INTRACRANIAL EPENDYMOMA
Bibliographic record
Abstract
PURPOSE: To evaluate outcomes in children with relapsed intracranial ependymoma who received focal initial radiotherapy (RT1) and subsequently underwent RT2 with or without CSI. 32 patients under age 18 were identified in this retrospective review. Patients with distant relapse received craniospinal irradiation (CSI) as part of RT2. Prior to 2012, those with local relapse were treated with 54 Gy focal RT2 (1.8 Gy/fraction). From 2012 onwards, our practice changed to include 23.4–36 Gy CSI, followed by boost RT2 to all sites of resected or gross disease (CSI+RT2). The Kaplan-Meier method was used to calculate overall survival (OS) and freedom-from-progression (FFP); groups were compared using the log-rank test. Median follow-up was 5.5 years. Of 10 patients with distant relapse after RT1, 2-year OS and FFP were 66.7% (95% CI 28.2–87.8) and 22.2% (95% CI 3.4–51.3); amongst this group, there were no 5-year survivors. Of 22 patients with local-only recurrence after RT1, use of CSI (n = 7, median age 8.4 at RT2) was associated with a statistically significant improvement in FFP (5-year probability 83.3% [95% CI 27.3–97.5] with CSI+RT2 vs. 15.6% [95% CI 2.6–38.7] with focal RT2, p = 0.025). In those with posterior fossa (PF) ependymoma and local-only recurrence after RT1 (n = 16), 5-year FFP was 100% (95% CI 100-100) with CSI+RT2 vs. 10.4% (95% CI 0.6–36.4, p = 0.034) with focal RT2. There was no OS difference between those who received CSI+RT2 vs. focal RT2 (5-year OS; all tumour locations: 80.0% [95% CI 20.4–96.9] vs. 43.1% [95% CI 17.9–66.2], respectively, p = 0.24; PF subgroup: 100% [95% CI 100-100] vs. 36.7% [95% CI 11.3–63.0], respectively; p = 0.093). There were no cases of radiation necrosis attributable to RT2. Re-irradiation with CSI is a safe and effective approach to control recurrent disease in children with ependymoma.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".