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Modeling freedom fr...
Modeling freedom from progression for standard-risk medulloblastoma : A mathematical tumor control model with multiple modes of failure
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- Brodin, N. Patrik (author)
- Copenhagen University Hospital,Niels Bohr Institute
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- Vogelius, Ivan R. (author)
- Copenhagen University Hospital
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- Björk-Eriksson, Thomas (author)
- Lund University,Lunds universitet,Urologisk cancerforskning, Malmö,Forskargrupper vid Lunds universitet,Urological cancer, Malmö,Lund University Research Groups,Skåne University Hospital
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- Munck Af Rosenschöld, Per (author)
- Niels Bohr Institute,Copenhagen University Hospital
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- Bentzen, Søren M. (author)
- University of Wisconsin-Madison,Copenhagen University Hospital
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(creator_code:org_t)
- Elsevier BV, 2013
- 2013
- English 8 s.
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In: International Journal of Radiation Oncology, Biology, Physics. - : Elsevier BV. - 0360-3016. ; 87:2, s. 422-429
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http://dx.doi.org/10...
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Abstract
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- Purpose As pediatric medulloblastoma (MB) is a relatively rare disease, it is important to extract the maximum information from trials and cohort studies. Here, a framework was developed for modeling tumor control with multiple modes of failure and time-to-progression for standard-risk MB, using published pattern of failure data. Methods and Materials Outcome data for standard-risk MB published after 1990 with pattern of relapse information were used to fit a tumor control dose-response model addressing failures in both the high-dose boost volume and the elective craniospinal volume. Estimates of 5-year event-free survival from 2 large randomized MB trials were used to model the time-to-progression distribution. Uncertainty in freedom from progression (FFP) was estimated by Monte Carlo sampling over the statistical uncertainty in input data. Results The estimated 5-year FFP (95% confidence intervals [CI]) for craniospinal doses of 15, 18, 24, and 36 Gy while maintaining 54 Gy to the posterior fossa was 77% (95% CI, 70%-81%), 78% (95% CI, 73%-81%), 79% (95% CI, 76%-82%), and 80% (95% CI, 77%-84%) respectively. The uncertainty in FFP was considerably larger for craniospinal doses below 18 Gy, reflecting the lack of data in the lower dose range. Conclusions Estimates of tumor control and time-to-progression for standard-risk MB provides a data-driven setting for hypothesis generation or power calculations for prospective trials, taking the uncertainties into account. The presented methods can also be applied to incorporate further risk-stratification for example based on molecular biomarkers, when the necessary data become available.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Radiologi och bildbehandling (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Radiology, Nuclear Medicine and Medical Imaging (hsv//eng)
Publication and Content Type
- art (subject category)
- ref (subject category)
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