Quantifying Unnecessary Normal Tissue Complication Risks due to Suboptimal Planning: A Secondary Study of RTOG 0126.
Quantifying Unnecessary Normal Tissue Complication Risks due to Suboptimal Planning: A Secondary Study of RTOG 0126.
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DOI：
10.1016/j.ijrobp.2015.01.046
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发表时间：
2015-06-01
影响因子：
7
通讯作者：
Mutic, Sasa
中科院分区：
文献类型：
--
作者：
Moore, Kevin L.;Schmidt, Rachel;Moiseenko, Vitali;Olsen, Lindsey A.;Tan, Jun;Xiao, Ying;Galvin, James;Pugh, Stephanie;Seider, Michael J.;Dicker, Adam P.;Bosch, Walter;Michalski, Jeff;Mutic, Sasa
本研究的目的是量化 RTOG0126 方案调强放射治疗 (IMRT) 计划中质量缺陷的频率和临床严重程度。对来自 RTOG0126 高剂量组 (79.2Gy) 的 219 名 IMRT 患者进行了分析。为了量化计划质量，我们使用既定的基于知识的方法来预测患者特定的危险器官 DVH，并使用针对 ≥2 级直肠并发症的 Lyman-Kutcher-Burman (LKB) 模型将 DVH 转换为正常组织并发症概率 (NTCP)。通过根据观察到的毒性拟合剂量反应参数来验证 LKB 模型。具有最低超额风险（临床和模型预测 NTCP 之间的差异）的计划的 90% (22/219) 用于为协议中假定的最佳实践创建模型 (pDVH0126，top10%)。将所得模型应用于整个样本，可以将患者可能收到的 DVH 与他们实际收到的 DVH 进行比较。过度风险量化了次优计划的临床影响。 pDVH 预测的准确性通过重新计划 30/219 (13.7%) 患者得到验证，包括同等数量的假定“高质量”、“低质量”和随机抽样计划。将 NTCP 预测的毒性与方案中的不良事件进行比较。现有模型表明，膀胱保留变化不如直肠质量变化普遍，并且直肠保留的增加与目标指标不相关（D98%，D2%）。观察到的毒性与当前的 LKB 参数一致。将 DVH 和 pDVH0126,top10% 转换为直肠 NTCP，我们观察到 94/219 (42.9%) 具有 ≥5% 超额风险，20/219 (9.1%) 具有 ≥10% 超额风险，2/219 (0.9%) 具有 ≥15% 超额风险。重新规划证明了预测的 NTCP 减少量，同时保持目标 V100%。高质量计划的同等样本显示出比低质量计划更少的毒性，分别为 6/73 和 10/73，尽管由于本回顾性研究中统计功效不足，这些差异并不显着 (p=0.21)。 RTOG0126 的计划质量缺陷使患者面临直肠并发症的巨大风险。
The purpose of this study was to quantify the frequency and clinical severity of quality deficiencies in intensity-modulated radiotherapy (IMRT) planning on the RTOG0126 protocol. 219 IMRT patients from the high-dose arm (79.2Gy) of RTOG0126 were analyzed. To quantify plan quality, we used established knowledge-based methods for patient-specific DVH prediction of organs-at-risk and a Lyman-Kutcher-Burman (LKB) model for Grade ≥2 rectal complications to convert DVHs into normal tissue complication probabilities (NTCPs). The LKB model was validated by fitting dose-response parameters against observed toxicities. The 90th-percentile (22/219) of plans with the lowest excess risk (difference between clinical and model-predicted NTCP) were used to create a model for the presumed best practices in the protocol (pDVH0126,top10%). Applying the resultant model to the entire sample enabled comparisons between DVHs that patients could have received to DVHs they actually received. Excess risk quantified the clinical impact of sub-optimal planning. Accuracy of pDVH predictions was validated by re-planning 30/219 (13.7%) patients, including equal numbers of presumed “high-quality”, “low-quality”, and randomly-sampled plans. NTCP-predicted toxicities were compared to adverse events on protocol. Existing models showed that bladder sparing variations were less prevalent than rectum quality variations, and increased rectal sparing was not correlated with target metrics (D98%,D2%). Observed toxicities were consistent with current LKB parameters. Converting DVH and pDVH0126,top10% to rectal NTCP, we observed 94/219 (42.9%) with ≥5% excess risk, 20/219 (9.1%) with ≥10% excess risk, and 2/219 (0.9%) with ≥15% excess risk. Re-planning demonstrated the predicted NTCP reductions while maintaining target V100%. An equivalent sample of high-quality plans showed fewer toxicities than low-quality plans, 6/73 vs. 10/73 respectively, though these differences were not significant (p=0.21) due to insufficient statistical power in this retrospective study. Plan quality deficiencies in RTOG0126 exposed patients to substantial excess risk for rectal complications.
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影响因子：
3.8
作者：
Zhu, Xiaofeng;Ge, Yaorong;Wu, Q. Jackie
通讯作者：
Wu, Q. Jackie
影响因子：
3.8
作者：
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影响因子：
5.7
作者：
ROBERTS, SA;HENDRY, JH
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影响因子：
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作者：
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通讯作者：
FitzGerald, Thomas J.
DOI：
10.1016/j.ijrobp.2009.03.078
发表时间：
2010-03-01
影响因子：
7
作者：
Michalski, Jeff M.;Gay, Hiram;Jackson, Andrew;Tucker, Susan L.;Deasy, Joseph O.
通讯作者：
Deasy, Joseph O.