Differences between planned and delivered dose for head and neck cancer, and their consequences for normal tissue complication probability and treatment adaptation
Differences between planned and delivered dose for head and neck cancer, and their consequences for normal tissue complication probability and treatment adaptation
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DOI：
10.1016/j.radonc.2019.07.034
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发表时间：
2020-01-01
影响因子：
5.7
通讯作者：
Sonke, Jan-Jakob
中科院分区：
文献类型：
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作者：
Heukelom, Jolien;Kantor, Michael E.;Sonke, Jan-Jakob
背景和目的：解剖学变化导致计划剂量和交付剂量之间的差异。适应性放射治疗（ART）可能会减少这些差异，但最佳实施方案尚不清楚。本研究的目的是量化 HNC 患者的计划剂量和交付剂量之间的差异，评估正常组织并发症概率 (Delta NTCP) 的间接差异，并探索 Delta NTCP 作为 ART 客观选择策略的价值。材料和方法：对于 52 名患者，累积每日剂量以估计交付剂量。分析了 CTV 和 9 个危及器官 (OAR) 与计划剂量的差异。计算 6 个月时口干、吞咽困难、腮腺功能障碍和管饲依赖的 Delta NTCP。如果 Delta NTCP > 5%，则认为有必要进行 ART。计算阳性预测值 (PPV)，用于通过临床判断识别 ART 患者，以及分数 10 和 15 的 Delta NTCP。结果：吞咽困难出现 5 次 Delta NTCP >5%，其他毒性出现 2 次。尽管 13/52 名患者接受了 ART（PPV：0.38），但只有 5/9 Delta NTCP > 5% 的患者在临床上接受了 ART。使用分配 5% ART 的 Delta NTCP 截止值，第 10 次和第 15 次的累积剂量的 PPV 分别为 0.86 和 0.75。使用其他 Delta NTCP 截止值并没有显着改善 PPV。以此截止值，分数 10 和分数 15 的 Delta NTCP 方法的阴性预测值为 0.93，临床判断的阴性预测值为 0.90。结论：为了准确识别 ART 患者，基于分数 10 的计划剂量和交付剂量之间的剂量差异进行的 NTCP 计算优于临床判断。 (C) 2019 年由 Elsevier B.V. 出版
Background and purpose: Anatomical changes induce differences between planned and delivered dose. Adaptive radiotherapy (ART) may reduce these differences but the optimal implementation is insufficiently clear. The aims of this study were to quantify the difference between planned and delivered dose in HNC patients, assess the consequential difference in normal tissue complication probability (Delta NTCP) and to explore the value of Delta NTCP as an objective selection strategy for ART.Materials and methods: For 52 patients, daily doses were accumulated to estimate the delivered dose. The difference from planned dose was analyzed for CTVs and 9 organs-at-risk (OAR). Delta NTCP was calculated for xerostomia, dysphagia, parotid gland dysfunction and tube feeding dependency at 6 months. ART was deemed necessary if Delta NTCP was >5%. The positive predicted value (PPV) was calculated for identification of ART-patients by clinical judgement, and Delta NTCP at fraction 10 and 15.Results: Delta NTCP >5% was seen five times for dysphagia and twice for the other toxicities. Only 5/9 patients with any Delta NTCP >5% clinically received ART, although ART had been done for 13/52 patients (PPV: 0.38). PPV was 0.86 and 0.75 for accumulated dose at fraction 10 and 15, respectively, using a Delta NTCP cut-off for the allocation of ART of 5%. Using other Delta NTCP cut-offs did not substantially improve PPV. With this cutoff the negative predictive value was 0.93 for Delta NTCP method of fraction 10 and fraction 15, and 0.90 for clinical judgement.Conclusion: To identify patients accurately for ART, NTCP calculations based on the dose differences between planned and delivered dose at fraction 10 are superior to clinical judgement. (C) 2019 Published by Elsevier B.V.