Patterns of care in recurrent glioblastoma in Switzerland: a multicentre national approach based on diagnostic nodes.

Despite moderate improvements in outcome of glioblastoma after first-line treatment with chemoradiation recent clinical trials failed to improve the prognosis of recurrent glioblastoma. In the absence of a standard of care we aimed to investigate institutional treatment strategies to identify similarities and differences in the pattern of care for recurrent glioblastoma. We investigated re-treatment criteria and therapeutic pathways for recurrent glioblastoma of eight neuro-oncology centres in Switzerland having an established multidisciplinary tumour-board conference. Decision algorithms, differences and consensus were analysed using the objective consensus methodology. A total of 16 different treatment recommendations were identified based on combinations of eight different decision criteria. The set of criteria implemented as well as the set of treatments offered was different in each centre. For specific situations, up to 6 different treatment recommendations were provided by the eight centres. The only wide-range consensus identified was to offer best supportive care to unfit patients. A majority recommendation was identified for non-operable large early recurrence with unmethylated MGMT promoter status in the fit patients: here bevacizumab was offered. In fit patients with late recurrent non-operable MGMT promoter methylated glioblastoma temozolomide was recommended by most. No other majority recommendations were present. In the absence of strong evidence we identified few consensus recommendations in the treatment of recurrent glioblastoma. This contrasts the limited availability of single drugs and treatment modalities. Clinical situations of greatest heterogeneity may be suitable to be addressed in clinical trials and second opinion referrals are likely to yield diverging recommendations

Towards open and reproducible multi-instrument analysis in gamma-ray astronomy

The analysis and combination of data from different gamma-ray instruments involves the use of collaboration proprietary software and case-by-case methods. The effort of defining a common data format for high-level data, namely event lists and instrument response functions (IRFs), has recently started for very-high-energy gamma-ray instruments, driven by the upcoming Cherenkov Telescope Array (CTA). In this work we implemented this prototypical data format for a small set of MAGIC, VERITAS, FACT, and H.E.S.S. Crab nebula observations, and we analyzed them with the open-source gammapy software package. By combining data from $Fermi$-LAT, and from four of the currently operating imaging atmospheric Cherenkov telescopes, we produced a joint maximum likelihood fit of the Crab nebula spectrum. Aspects of the statistical errors and the evaluation of systematic uncertainty are also commented upon, along with the release format of spectral measurements. The results presented in this work are obtained using open-access on-line assets that allow for a long-term reproducibility of the results

Towards open and reproducible multi-instrument analysis in gamma-ray astronomy

The analysis and combination of data from different gamma-ray instruments involves the use of collaboration proprietary software and case-by-case methods. The effort of defining a common data format for high-level data, namely event lists and instrument response functions (IRFs), has recently started for very-high-energy gamma-ray instruments, driven by the upcoming Cherenkov Telescope Array (CTA). In this work we implemented this prototypical data format for a small set of MAGIC, VERITAS, FACT, and H.E.S.S. Crab nebula observations, and we analyzed them with the open-source gammapy software package. By combining data from $Fermi$-LAT, and from four of the currently operating imaging atmospheric Cherenkov telescopes, we produced a joint maximum likelihood fit of the Crab nebula spectrum. Aspects of the statistical errors and the evaluation of systematic uncertainty are also commented upon, along with the release format of spectral measurements. The results presented in this work are obtained using open-access on-line assets that allow for a long-term reproducibility of the results