Evaluation of decentralised model-based selection of head and neck cancer patients for a proton treatment study. DAHANCA 35

Christian Rønn Hansen*, Kenneth Jensen, Bob Smulders, Anne Ivalu Sander Holm, Eva Samsøe, Martin Skovmos Nielsen, Patrik Sibolt, Peter Skyt, Ulrik Vindelev Elstrøm, Camilla Panduro Nielsen, Jørgen Johansen, Ruta Zukauskaite, Jesper Grau Eriksen, Mohammed Farhadi, Maria Andersen, Elo Andersen, Jens Overgaard, Cai Grau, Jeppe Friborg

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

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.

Original languageEnglish
Article number109812
JournalRadiotherapy and Oncology
Volume190
Number of pages7
ISSN0167-8140
DOIs
Publication statusPublished - Jan 2024

Bibliographical note

Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.

Keywords

  • Decentralised plan comparison
  • Head and neck proton treatment
  • Model selection
  • NTCP
  • Proton RCT

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