A Quantitative Clinical Decision-Support Strategy Identifying Which Patients With Oropharyngeal Head and Neck Cancer May Benefit the Most From Proton Radiation Therapy.
A Quantitative Clinical Decision-Support Strategy Identifying Which Patients With Oropharyngeal Head and Neck Cancer May Benefit the Most From Proton Radiation Therapy.
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DOI：
10.1016/j.ijrobp.2018.11.039
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发表时间：
2019-07-01
期刊：
影响因子：
--
通讯作者：
Tomé WA
中科院分区：
文献类型：
--
作者：
Brodin NP;Kabarriti R;Pankuch M;Schechter CB;Gondi V;Kalnicki S;Guha C;Garg MK;Tomé WA
开发定量决策支持策略，评估头颈部癌（HNC）确定性放射治疗（RT）对正常组织并发症的影响。我们制定了这一战略，以确定口咽HNC患者，可能受益最大的质子RT。最近正常组织并发症概率（NTCP）模型吞咽困难，食管炎，甲状腺功能减退症，口干和口腔粘膜炎被用来估计NTCP为33口咽HNC患者以前接受光子调强放疗。比较质子治疗计划是在合作质子中心使用HNC RT的临床方案生成的。使用光子和质子RT计划中的危及器官（OAR）剂量计算NTCP，Monte Carlo对每位患者进行10，000次采样，以说明模型参数的不确定性。每种并发症的潜伏期和持续时间都是根据计算的NTCP建模的，考虑了年龄、性别、吸烟和p16特异性条件生存概率。然后根据并发症的严重程度分配质量调整因子，以计算每种并发症的质量调整生命年（Qs）损失。基于我们的机构提供的光子IMRT剂量和可实现的质子治疗剂量，光子和质子治疗的所有HNC RT并发症的平均QALY降低为1.52 QALY vs. 1.15 QALY，质子治疗平均节省0.37 QALY（复合95% CI：0.27，2.53 QALY）。长期并发症吞咽困难和口干是导致QALY下降的最主要原因。质子RT的Qs在患者之间变化很大，从0.06到0.84 Qs。吸烟≤10包-年的p16阳性肿瘤年轻患者可能从质子治疗中获益最多，尽管这一发现应使用更大的患者系列进行验证。一项敏感性分析将所有OAR的光子IMRT剂量降低20%，结果表明质子治疗的总体估计获益为-0.02 Qs，尽管在这种情况下，一些患者仍有估计获益，范围为-0.50至0.43 Qs。这种定量决策支持策略使我们能够识别可能从质子RT中获益最大的口咽癌患者，尽管质子治疗的估计获益最终取决于现代光子IMRT解决方案可实现的器官风险剂量。这些结果可以帮助放射肿瘤学家和质子治疗中心优化资源配置，提高HNC患者的生活质量。我们开发并实施了一个数据驱动的决策支持系统，用于识别那些可能从质子治疗中获益最大的口咽癌患者。我们发现，与光子IMRT相比，吸烟≤10包年的p16阳性肿瘤年轻患者估计在质子治疗中获得最多的质量调整生命年（QALY）。重要的是，质子治疗的估计获益在很大程度上取决于光子调强放射治疗可达到的危及器官剂量。
Developing a quantitative decision-support strategy estimating the impact of normal tissue complications from definitive radiation therapy (RT) for head and neck cancer (HNC). We developed this strategy to identify oropharyngeal HNC patients that may benefit most from receiving proton RT. Recent normal tissue complication probability (NTCP) models for dysphagia, esophagitis, hypothyroidism, xerostomia and oral mucositis were used to estimate NTCP for 33 oropharyngeal HNC patients previously treated with photon IMRT. Comparative proton therapy plans were generated using clinical protocols for HNC RT at a collaborating proton center. Organ-at-risk (OAR) doses from photon and proton RT plans were used to calculate NTCPs, Monte Carlo sampling 10,000 times for each patient to account for model parameter uncertainty. The latency and duration of each complication were modeled from calculated NTCP, accounting for age-, sex-, smoking- and p16-specific conditional survival probability. Complications were then assigned quality-adjustment factors based on severity to calculate quality-adjusted life years (QALYs) lost from each complication. Based on our institutional delivered photon IMRT doses, and the achievable proton therapy doses, the average QALY reduction from all HNC RT complications for photon and proton therapy was 1.52 QALYs vs. 1.15 QALYs, with proton therapy sparing 0.37 QALYs on average (composite 95% CI: 0.27 , 2.53 QALYs). Long-term complications dysphagia and xerostomia contributed most to the QALY reduction. The QALYs spared with proton RT varied considerably between patients, from 0.06 to 0.84 QALYs. Younger patients with p16-positive tumors who smoked ≤10 pack-years may benefit most from proton therapy, although this finding should be validated using larger patient series. A sensitivity analysis reducing photon IMRT doses to all OARs by 20% resulted in no overall estimated benefit with proton therapy with −0.02 QALYs spared, although some patients still had an estimated benefit in this scenario, ranging from −0.50 to 0.43 QALYs spared. This quantitative decision-support strategy allowed us to identify oropharyngeal cancer patients that might have the greatest benefit from proton RT, although the estimated benefit of proton therapy ultimately depends on the organ-at-risk doses achievable with modern photon IMRT solutions. These results can help radiation oncologists and proton therapy centers optimize resource allocation and improve HNC patients’ quality of life. We developed and implemented a data-driven decision support system for identifying those oropharyngeal cancer patients likely to have the greatest benefit from proton therapy. We found that younger patients with p16-positive tumors who smoked ≤10 pack-years were estimated to have the most quality-adjusted life years (QALYs) spared with proton therapy, as compared to photon IMRT. Importantly, the estimated benefit of proton therapy depends strongly on the organ-at-risk doses achievable with photon IMRT.
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DOI：
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发表时间：
2012-04-01
影响因子：
7
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2016-12
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Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
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