A phase II study of whole brain radiotherapy with simultaneous integrated boost using volumetric modulated arc therapy for 1 to 10 brain metastases.
Bibliographic record
Abstract
2078 Background: Local control of brain metastases reduces risk of death from intracranial progression and improves survival in selected patients. Volumetric modulated arc therapy can deliver a fraction of whole brain radiotherapy (WBRT) and a simultaneous integrated boost (SIB) to multiple brain metastases in about 5 minutes. This is the first registered clinical trial (NCT01046123) to report WBRT and SIB for up to 10 brain metastases. Methods: Sixty subjects with 1-10 brain metastases were accrued to a single-institution phase II study of a 5-fraction course of 20 Gy WBRT and 50 Gy SIB. Eligible subjects had Karnofsky Performance Status (KPS) 70 - 100, maximum diameter of the largest metastasis ≤ 3 cm, and estimated ≥ 6-month median life expectancy. The phase II primary endpoint was a comparison of 3-month local control with that of the WBRT (37.5 Gy/15) and stereotactic radiosurgery (SRS: 15-24 Gy/1) arm of the RTOG 95-08 study (90%). Overall survival for subgroups with 1-3 and 4-10 metastases were compared. Results: The median number of brain metastases was 3 (range: 1-10). Known prognostic factors for overall survival in the 1-3 subgroup (n = 33) and the 4-10 subgroup (n = 27) were not significantly different. The cancers were: 53% lung, 32% breast and 15% other. The minimum follow-up was 5 months and the median follow-up was 9 months. The 3-month radiographic responses were: 10% complete, 48% partial, 33% stable (90% local control) and 10% progressive disease. Grade 3-4 radionecrosis occurred in 7% (4/60) of subjects at a median of 9 months. The median survival was 10 months in the 1-3 subgroup and 12 months in the 4-10 subgroup (p = 0.8). Multivariable analysis of overall survival showed that KPS 70-80 (HR = 3.2, p < 0.004), extracranial disease (HR = 2.9, p = 0.04) and no use of targeted systemic therapy (HR = 7.5, p = 0.0003) were associated with worse survival, but age (HR = 0.98, p = 0.1) and number of metastases 1-3 vs. 4-10 (HR = 1.1, P = 0.8) were not. Conclusions: WBRT and SIB had similar 3-month local control to the WBRT and SRS arm of RTOG 95-08. Equivalent survival of the 1-3 and 4-10 subgroups justifies including selected patients with 4-10 brain metastases in phase III trials for brain metastases. Clinical trial information: NCT01046123.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 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) | 0.000 | 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 teacher head, 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".