Is there a role for hypofractionated thoracic radiotherapy in limited-stage small cell lung cancer? a propensity score matched analysis.
Bibliographic record
Abstract
e21107 Background: Concurrent chemoradiotherapy is the standard of care for limited-stage small cell lung cancer (LS-SCLC). While conventional fractionation (CF) and hyperfractionation are the most commonly used radiotherapy schedules worldwide, hypofractionation (HF) continues to be a standard radiation regimen used in several countries. In the absence of randomized evidence comparing CF and HF, the aim of this study was to compare overall survival (OS), progression-free survival (PFS), and toxicity outcomes for CF and HF in LS-SCLC. Methods: In this single institution retrospective review, consecutive LS-SCLC patients treated between 2000-2013 with HF (40Gy/15, 45Gy/15, 45Gy/20 fractions) or CF (60Gy/30 or 66Gy/33 fractions) were included. Propensity scores were generated using a multivariable logistic regression model. Patients were matched on a 1:1 ratio with a caliper distance of 0.20. OS and PFS were estimated using the Kaplan-Meier method with differences evaluated using log-rank tests. As a sensitivity analysis, univariable and multivariable Cox regression was performed in all unmatched patients. Logistic regression was performed to identify predictors of all pulmonary and esophageal adverse events. Results: In the 117 patients, there were significant baseline differences between the CF and HF cohorts. Patients who received CF were older, smoked more often concurrently with treatment, had higher ECOG performance status, different T and N stage patterns, and more commonly received concurrent chemoradiotherapy and prophylactic cranial irradiation. After propensity score matching, 72 patients were included, 36 in the HF and CF cohorts respectively. No statistically significant difference was noted between matched HF and CF cohorts for OS (P = 0.724) or PFS (P = 0.862). Similarly, multivariable Cox regression revealed no differences in OS (P = 0.886) or PFS (P = 0.717) between HF and CF in all unmatched patients. There was no difference in any pulmonary (P = 0.350) or esophageal (P = 0.097) adverse events between matched HF and CF cohorts. Skin adverse events were significantly higher for CF (41.7%) compared with HF (16.7%, P = 0.020) in matched patients. No grade 5 adverse events were observed. Conclusions: In this propensity score matched comparison of HF and CF in LS-SCLC patients who underwent curative-intent radiation treatment, HF and CF were associated with comparable OS, PFS, and toxicity outcomes. HF may therefore be a reasonable alternative to CF, should its efficacy be confirmed in prospective studies.
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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 | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| 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 | 0.001 |
| 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".