Comparison of hypofractionated radiation with temozolomide to the current standard of care in the treatment of glioblastoma: Results from a single institution.
Bibliographic record
Abstract
2089 Background: The multimodality treatment of patients with glioblastoma (GBM) includes adjuvant radiation with concomitant chemotherapy. At this time the optimal radiation fractionation is yet to be determined. In this retrospective study, we compared different fractionation regimens and identified independent prognostic variables associated with outcome. Methods: 457 underwent surgery for GBM between January 2005 and December 2012. Data related to clinical information, extent of surgery and adjuvant treatment was collected using electronic records and patient charts. Patients excluded were those who did not receive or complete adjuvant radiation and patients with infra-tentorial lesions. Univariate and multivariate analysis was performed using Cox model in order to identify variables associated with the primary endpoint, overall survival (OS). Results: 276 patients with a median follow-up of 13.4 months were included in this analysis. There were 147 patients in the conventional fractionation (CF) group of 60 Gy/30 fractions, 86 patients in the hypofractionation group of 60 G/20 fractions (HF60), and 43 patients in the 40 Gy/15 fractions group (HF40). Ninety-five percent of patients in both the CF and HF60 group received concomitant temozolomide, while 49% in HF40 group of patients received it. The median survival (MS) was 15.7 months for the CF group with a 2 year OS of 30.6%. MS was 13.8 months and 7 months in the HF60 and HF40 groups with a 2-year OS of 26.2% and 5.3%, respectively. Cox analysis showed no significant difference in terms of OS between the CF and HF60 group (HR1.22, P=0.20) but worse outcome in the HF40 group (HR 2.09, P=0.004). Multivariate analysis showed age, performance status, extent of surgery, repeat surgery, concomitant chemotherapy and methylation status to be significant factors associated with survival. Conclusions: HF60 shows OS comparable to CF while allowing for a shorter treatment time and potential radiobiological benefit without added toxicity. Our data also confirms that HF40 should be reserved for the palliative setting. There is a need for a prospective trial comparing the HF60 regimen to the current standard of care.
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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 | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| 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".