TY - JOUR
T1 - Evaluation of decentralised model-based selection of head and neck cancer patients for a proton treatment study. DAHANCA 35
AU - Hansen, Christian Rønn
AU - Jensen, Kenneth
AU - Smulders, Bob
AU - Holm, Anne Ivalu Sander
AU - Samsøe, Eva
AU - Nielsen, Martin Skovmos
AU - Sibolt, Patrik
AU - Skyt, Peter
AU - Elstrøm, Ulrik Vindelev
AU - Nielsen, Camilla Panduro
AU - Johansen, Jørgen
AU - Zukauskaite, Ruta
AU - Eriksen, Jesper Grau
AU - Farhadi, Mohammed
AU - Andersen, Maria
AU - Andersen, Elo
AU - Overgaard, Jens
AU - Grau, Cai
AU - Friborg, Jeppe
N1 - Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.
PY - 2024/1
Y1 - 2024/1
N2 - INTRODUCTION: Proton treatment can potentially spare patients with H&N cancer for substantial treatment-related toxicities. The current study investigated the reproducibility of a decentralised model-based selection of patients for a proton treatment study when the selection plans were compared to the clinical treatment plans performed at the proton centre.METHODS: Sixty-three patients were selected for proton treatment in the six Danish Head and Neck Cancer (DAHANCA) centres. The patients were selected based on normal tissue complication probability (NTCP) estimated from local photon and proton treatment plans, which showed a ΔNTCP greater than 5%-point for either grade 2 + dysphagia or grade 2 + xerostomia at six months. The selection plans were compared to the clinical treatment plans performed at the proton centre.RESULTS: Of the 63 patients, 49 and 25 were selected based on an estimated benefit in risk of dysphagia and xerostomia, respectively. Eleven patients had a potential gain in both toxicities. The mean ΔNTCP changed from the local selection plan comparison to the clinical comparison from 6.9 to 5.3 %-points (p = 0.01) and 7.3 to 4.9 %-points (p = 0.03) for dysphagia and xerostomia, respectively. Volume differences in both CTV and OAR could add to the loss in ΔNTCP. 61 of the 63 clinical plans had a positive ΔNTCP, and 38 had a ΔNTCP of 5%-points for at least one of the two endpoints.CONCLUSION: A local treatment plan comparison can be used to select candidates for proton treatment. The local comparative proton plan overestimates the potential benefit of the clinical proton plan. Continuous quality assurance of the delineation procedures and planning is crucial in the subsequent randomised clinical trial setting.
AB - INTRODUCTION: Proton treatment can potentially spare patients with H&N cancer for substantial treatment-related toxicities. The current study investigated the reproducibility of a decentralised model-based selection of patients for a proton treatment study when the selection plans were compared to the clinical treatment plans performed at the proton centre.METHODS: Sixty-three patients were selected for proton treatment in the six Danish Head and Neck Cancer (DAHANCA) centres. The patients were selected based on normal tissue complication probability (NTCP) estimated from local photon and proton treatment plans, which showed a ΔNTCP greater than 5%-point for either grade 2 + dysphagia or grade 2 + xerostomia at six months. The selection plans were compared to the clinical treatment plans performed at the proton centre.RESULTS: Of the 63 patients, 49 and 25 were selected based on an estimated benefit in risk of dysphagia and xerostomia, respectively. Eleven patients had a potential gain in both toxicities. The mean ΔNTCP changed from the local selection plan comparison to the clinical comparison from 6.9 to 5.3 %-points (p = 0.01) and 7.3 to 4.9 %-points (p = 0.03) for dysphagia and xerostomia, respectively. Volume differences in both CTV and OAR could add to the loss in ΔNTCP. 61 of the 63 clinical plans had a positive ΔNTCP, and 38 had a ΔNTCP of 5%-points for at least one of the two endpoints.CONCLUSION: A local treatment plan comparison can be used to select candidates for proton treatment. The local comparative proton plan overestimates the potential benefit of the clinical proton plan. Continuous quality assurance of the delineation procedures and planning is crucial in the subsequent randomised clinical trial setting.
KW - Decentralised plan comparison
KW - Head and neck proton treatment
KW - Model selection
KW - NTCP
KW - Proton RCT
UR - http://www.scopus.com/inward/record.url?scp=85166120952&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2023.109812
DO - 10.1016/j.radonc.2023.109812
M3 - Journal article
C2 - 37479061
SN - 0167-8140
VL - 190
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
M1 - 109812
ER -