EP-1203 Characterization of DCE-MRI parameters associated with advanced mandibular osteonecrosis
Bibliographic record
Abstract
Purpose or ObjectiveOutcomes of oral cavity squamous cell carcinoma (OSCC) tend to be worse than other head and neck squamous cell carcinomas (HNSCC) despite modern surgical and radiation techniques and the use of postoperative concurrent chemotherapy in high risk OSCC.Anecdotal evidence has suggested that OSCC patients under the age of 40 have aggressive disease.We evaluated the outcomes of OSCC patients <40 treated in the modern IMRT era at our institution. Material and MethodsAfter obtaining REB and institutional approval, OSCC patients under 40 were identified from our prospectively collected database.Details were collected in relation to tumor and treatment factors.Oncologic outcomes including overall survival, disease free survival, and locoregional control were determined for this sub-set.Overall survival (OS) and disease-free survival (DFS) were analyzed using Kaplan Meier method and loco-regional control was evaluated using competing risk analysis. ResultsFrom 1183 consecutive patients with OSCC treated with curative intent between 2005 and 2017, 57 patients (5%) under the age of 40 were identified.The median age was 33 years (range 18-39).In the study cohort 42% of patients were female and 58% male; 61% of patients were lifelong non-smokers, with only 23% current smokers, and 16% exsmokers; 44% were non-drinkers.ECOG performance status was 0-1 in 92.9% ( one 2, 3 missing data).Surgery was to the primary lesion only in 26%, to the primary with an ipsilateral neck dissection in 53%, and 21% had surgery to the primary with bilateral neck dissections.Only 5% of patients had positive microscopic resection margins.Lymph node involvement with extra-nodal extension was seen in 17% of patients, 5% had LVI and 37% had PNI.Almost 60% received definitive surgery alone, while in 40% surgery was followed by adjuvant radiotherapy; among these, 65% received concurrent chemotherapy.The adjuvant radiotherapy dose received ranged from 56Gy in 40 fractions to 70.72Gy in 35 fractions; 26% of patients received 60Gy in 30 fractions, and 52% receiving 66Gy in 33 fractions.Almost half, 44%, had stage I disease, 10.5% stage II, 16% stage III, 28% stage IV; 1 patient's biopsy showed CIS despite a large tumor.Serious comorbidity was present in 8 patients: 6 with previous malignancies (10.5%), 1 with Fanconi's Anaemia, and 1 with severe SLE causing renal failure.With a median follow-up of 4.27 (5.03 in survivors) years, 1-year OS was 94% (0.88-1), 3-year OS 84% (0.75-0.95) and 5-year OS 82% (0.71-0.93).DFS was 84% (0.74-0.94) at one year, and 66% (0.54-0.81) at 5 years.Event free survival was 87% at 1 year (94-74), 79% at 3 years (88-65) and 74% at 5 years (84-57) . ConclusionThe clinical impression of poor outcomes for patients aged under 40yrs may represent recall bias.Such treated curatively for OSCC in our institution appear to have acceptable OS and DFS.
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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 | 0.001 | 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".