Neurocognitive outcomes following 30.6-Gy whole-ventricular radiotherapy with 54-Gy total dose focal tumor bed boost for CNS non-germinomatous germ cell tumors: A Children’s Oncology Group study (ACNS1123).
Bibliographic record
Abstract
10036 Background: COG ACNS1123 stratum 1 was a prospective, phase II trial treating children with localized non-germinomatous germ cell tumors of the brain with chemotherapy followed by whole ventricular (WV) radiotherapy (RT, 30.6 Gy) and a focal tumor bed boost (54 Gy total dose) Given the potential adverse impact of RT on survivors’ neurocognitive development, ACNS1123 had a co-primary objective to evaluate and longitudinally model cognitive and behavioral outcomes. Methods: Cognition was prospectively examined at 9, 30, and 60-months post-diagnosis via COG protocol ALTE07C1. Attention/concentration, processing speed (PS), and estimated intelligence quotient (est. IQ) were assessed by Wechsler Intelligence tests. Survey-reported attention and executive functioning (EF) were also obtained. Multivariable linear mixed-effects models examined trends over time, as well as associations and interactions with age, gender, tumor location (pineal gland versus other) and insurance type (private versus other and private versus public). Results: Seventy patients were evaluable and received WVRT followed by focal RT boost. Mean age at initiation of RT was 11.8 ± 4.3 years; 74% were male. A total of 56, 60, and 61 patients had at least one valid assessment score across 3 time points for attention/concentration, est. IQ and PS, respectively. Nine, 20 and 20 patients had data at all 3 time points for attention, est. IQ and PS, respectively. The average PS scores fell below the normative mean at all three time points. The average Est.IQ was below the normative mean at 9 months only. Males had higher attention scores on average (p < .01), while patients with other insurance had lower attention compared to the private group (p < .01). For the model-estimated longitudinal trajectories and their interactions with clinical factors, younger children had declining processing speed (p = 0.012), females had declining est.IQ scores (p < .01) and patients with tumors at pineal gland had improving est.IQ scores (p = 0.010) over time. For survey-reported outcomes, there was no change in attention while younger children had improved EF over time (p = 0.045). Conclusions: Treatment associated with the ACNS1123 stratum 1 protocol had variable impact on patient’s longitudinal neurocognitive functioning. Younger age at irradiation and female gender were risk-factors for worse neurocognitive outcomes on examiner-administered measures. Only average PS was significantly below the normative mean at all 3 times in the collective sample. Patients should be proactively monitored for cognitive and educational supportive care services. These data could potentially serve for comparison of neurocognitive outcomes in future clinical studies that modify treatment approaches; however, the notable attrition must be considered as a limitation.
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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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| 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".