RMTD-10 THERAPIES FOR LEPTOMENINGEAL METASTATIC DISEASE: A NETWORK META-ANALYSIS
Bibliographic record
Abstract
Abstract INTRODUCTION Leptomeningeal metastatic disease (LMD) literature has had extremely limited head-to-head comparison of available therapies, including systemic chemotherapy (SysCT), intrathecal (IT) or intraventricular therapy (ITV), whole-brain radiotherapy (WBRT), or cranio-spinal irradiation (CSI). No network meta-analysis (NMA) of randomized controlled trials (RCTs) of LMD has been reported so far. METHODS NMA was conducted using published LMD RCTs and reported following PRISMA-NMA guidelines. Primary outcome was survival, assessed using hazard ratios (HRs) and 95% confidence intervals (95%CI). Survival times were converted to HRs under exponential distribution assumption. LogHR standard errors were calculated using deaths per RCT arm. P-scores were used to estimate probability of treatment being superior. Analysis was performed in R using frequentist approach, followed by back-transforming logHRs for indirect/direct comparisons. Incremental effects were estimated using additive model. Analyses were performed separately for main subnetwork, with disconnected subnetworks accommodated in additive model. RESULTS Seven studies were included, incorporating 7 pairwise comparisons and 9 treatments. 3 subnetworks were identified. Primary subnetwork analysis included 5 studies. Compared to SysCT±RT (reference), logHRs (95%CI) for survival were: IT/ITV DepoCyt±SysCT±RT -0.094(-0.468,0.281); IT/ITV methotrexate(MTX)±cytarabine(AraC)±SysCT±RT 0.8567(0.066,1.647). IT/ITV MTX±SysCT±RT 0.318(-0.163,0.798); ITV Thiotepa±SysCT±RT 0.438(-0.294,1.169). Heterogeneity and inconsistency were not detected (τ²=0,I²=0%,Q-statistic=0.57,P=0.45). P-scores were highest for IT/ITV DepoCyt±SysCT±RT (0.894), followed by SysCT±RT (0.769). Disconnected-component-NMA demonstrated incremental logHR: AraC 0.539(-0.347,1.425); IT/ITV DepoCyt 0.052(-0.566,0.670); IT/ITV MTX 0.179(-0.484,0.840); ITV thiotepa 0.298(-0.767,1.362); proton CSI -0.250(-0.726,0.225). No component demonstrated statistically significant incremental benefit, with moderate heterogeneity and adequate fit present (τ²=0.1017,I²=57%,Q-statistic=4.65,P=0.098). CONCLUSIONS IT/ITV DepoCyt±SysCT±RT and SysCT±RT were found most effective. A lack of significant incremental benefit warrants evaluating older therapies in contemporary RCTs.
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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 | 0.000 | 0.000 |
| 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 | 0.000 |
| 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".