MDB-08. Pattern of relapse and outcome of early childhood medulloblastoma treated with upfront adjuvant focal radiotherapy
Bibliographic record
Abstract
Abstract Background Infant MB (iMB) treatment strategies may include adjuvant focal RT (fRT) for local control, to minimize neurocognitive side-effect of craniospinal irradiation (CSI). From a large international cohort of 380 relapsed iMB, we previously described fRT was associated with worse post relapse survival (PRS) compared to chemotherapy alone, in univariate analysis. Methods We performed a sub-analysis of patients initially treated with adjuvant fRT, to describe their pattern of relapse and salvage practices. Results The cohort included 51 patients who relapsed after initial fRT (median dose: 54 Gy) along with conventional in 47 patients or high-dose chemotherapy (HDC) in 4 patients. Median age at diagnosis was 34.2 months (range 11-55). At initial diagnosis, 42(85.7%) achieved gross total resection and 46(90.2%) were localized. Maintenance therapy or intrathecal/intraventricular chemotherapy were added in 14 patients. Molecular subgrouping was available in 31 patients (8 SHH, 17 group 3, 6 group 4). Median time of relapse was 13 months from diagnosis (5-51.9). Relapse was disseminated or combined (local and distant) in 96% of the cases. Twelve patients (24%) underwent palliative management. Thirty-nine (76%) patients received curative intent salvage therapy, of which 31 (79%) received CSI (median dose of 36 Gy, range 18-39.6). CSI was administered alone in 22% or with conventional chemotherapy or HDC in 65% and 13% . The 5 years PRS was 20.8% (±9%). Female sex, age <24 months at diagnosis, late relapse ≥12 months from diagnosis, asymptomatic relapse, salvage CSI, CR post-salvage therapy were associated with better PRS. Patients salvaged with CSI had a 5-year PRS of 26.5% vs 0% without. Conclusion Following adjuvant fRT, almost all patients who relapsed presented with dissemination, despite initial localized disease, and dismal PRS. Focal RT in combination with upfront therapy is ineffective to prevent leptomeningeal relapses and the success of salvage CSI is limited.
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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) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| 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) | 0.000 | 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".