EP.TH.603Hypofractionated radiotherapy for resectable pancreatic ductal adenocarcinoma: a world first in response to COVID19
Bibliographic record
Abstract
Abstract Introduction COVID-19 has challenged healthcare systems across the world, restricting resources for major hepato-pancreato-biliary resections. We report the experience of a unique temporising measure to overcome unavailability of upfront surgery, for select patients with resectable pancreatic ductal adenocarcinoma (rPDAC) during the pandemic. Methods Select patients with rPDAC who were assessed to be unsuitable for, or declined, upfront systemic chemotherapy, were considered for hypofractionated radiotherapy (hypoRT) as bridging therapy to Whipple’s pancreaticoduodenectomy. Results Three patients with EUS-biopsy confirmed rPDAC with no vascular involvement received 5 fractions of hypoRT followed by Whipple’s resection. Median patient age was 68 (range 63-77). All patients successfully completed hypoRT, with one case of transient grade 2 anorexia. Median interval from hypoRT to resection was 75 days (range 41-95 days), with median operative time including anaesthesia of 573 minutes (range 496-661 minutes). R0 resection was achieved in two cases, including one requiring portal vein resection. R1 resection was seen in one patient who required superior mesenteric vein resection. One patient experienced complication in the form of delayed gastric emptying. Median length of stay was 11 days (range 11-58 days). No patient experienced post-operative pancreatic fistula, and no patient has evidence of recurrence on 30-day follow up imaging. Conclusion This report provides initial experience for hypoRT in select patients with rPDAC prior to resection. Further work is required to quantify outcomes and long-term safety profile of this novel approach. The hypoRT programme allowed select patients to obtain treatment whilst awaiting availability of surgical resources.
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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 | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 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 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".