P17.13.B NANO-LM: AN UPDATED SCORECARD FOR THE CLINICAL ASSESSMENT OF PATIENTS WITH LEPTOMENINGEAL METASTASES
Bibliographic record
Abstract
Abstract BACKGROUND There are no validated tools for the clinical neurological assessment of patients with leptomeningeal metastases. However, clinical examination during the course of the disease guides medical management and is part of response assessment in clinical trials. Standardization of clinical neurological assessment in LM is therefore essential, also because MRI may not always be obtained owing to rapid clinical deterioration and itself subject to rater disagreement. MATERIAL AND METHODS The RANO-LM group launched a 2-steps process, aiming at improving and homogenizing the clinical assessment in patients with leptomeningeal metastasis. We report here on the first step: the establishment of a consensus scorecard. The RANO-LM group had 9 virtual meetings to define general recommendations on neurological assessment and selected domains of interest that should be tested. Domains of interest were selected from the Neurological Assessment in Neuro-Oncology (NANO) scale and from the first RANO-LM proposal. RESULTS Fourteen domains in neurological assessment were selected: level of consciousness, cognition, nausea and vomiting, vision, eye movement, facial strength, hearing, swallowing, dysarthria, limb strength, ataxia, walking, cauda equina symptoms-bowels and cauda equina symptoms-bladder). For each item, a clear instruction on how to perform the assessment is provided with scoring criteria between 0 and 2. The general status of the patient and use of steroids, pain medications, and anti-emetics should be considered when assessing the patient. Neurological sequelae from previous brain metastases or treatment (neuropathy, post-radiotherapy toxicities) should be rated at the baseline evaluation; it should be specified in the comments when symptoms or signs may be related to a condition other than leptomeningeal metastasis. The evaluation should be declared as non-evaluable when neurological symptoms or signs that develop during the follow-up are related or suspected to be related to comorbidities or any other medical event. In these situations, specific details should be included in the comments. If these signs and symptoms are retrospectively interpreted as related to leptomeningeal metastasis and not to any comorbidity, the date of symptoms or signs appearance should be retrospectively back-dated to assess the response. CONCLUSION A NANO-LM consensus scorecard has been established. A prospective validation of the proposal is currently ongoing at various medical centers.
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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 | 0.014 | 0.032 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
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".