open access publication

Article, 2023

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

Radiotherapy and Oncology, ISSN 1879-0887, 0167-8140, Volume 190, Page 109812, 10.1016/j.radonc.2023.109812

Contributors

Hansen, Christian Rønn 0000-0001-5716-6069 (Corresponding author) [1] [2] [3] Jensen, Kenneth 0000-0002-2364-965X [3] Smulders, Bob [3] [4] Holm, Anne Ivalu Sander [3] Samsøe, Eva 0000-0002-8011-669X [3] [5] Nielsen, Martin Skovmos 0000-0002-3955-7266 [6] Sibolt, Patrik 0000-0001-8621-7777 [7] Skyt, Peter Sandegaard [3] Elstrøm, Ulrik Vindelev [3] Nielsen, Camilla Panduro 0000-0001-7547-5455 [1] [2] Johansen, Jørgen 0000-0003-3911-3929 [1] Zukauskaite, Ruta 0000-0003-0915-6880 [1] [2] Eriksen, Jesper Grau 0000-0002-1145-6033 [3] Farhadi, Mohamma [5] Andersen, Maria R [6] Andersen, Elo 0000-0002-2476-1037 [7] Overgaard, J O Jens 0000-0002-0814-8179 [3] Grau, C G Cai 0000-0003-3548-3527 [3] Friborg, Jeppe Tang 0000-0001-5423-0627 [3] [4]

Affiliations

  1. [1] Odense University Hospital
    2. [NORA names: Region of Southern Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
  2. [2] University of Southern Denmark
    3. [NORA names: SDU University of Southern Denmark; University; Denmark; Europe, EU; Nordic; OECD];
  3. [3] Aarhus University Hospital
    4. [NORA names: Central Denmark Region; Hospital; Denmark; Europe, EU; Nordic; OECD];
  4. [4] Rigshospitalet
    5. [NORA names: Capital Region of Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
  5. [5] Zealand University Hospital
    6. [NORA names: Region Zealand; Hospital; Denmark; Europe, EU; Nordic; OECD];

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.

Keywords

CTV, Danish, H&N, H&N cancer, NTCP, OARs, assurance, benefits, cancer, cancer patients, centre, clinical comparison, clinical plans, clinical treatment plans, clinical trial setting, comparison, complication probability, continuous quality assurance, delineation, delineation procedure, differences, dysphagia, endpoint, evaluation, gain, head, head and neck cancer, head and neck cancer patients, localized photons, loss, model-based selection, months, neck cancer, neck cancer patients, patients, photons, planned comparisons, planning, potential benefits, probability, procedure, proton, proton centres, proton plans, proton treatment, proton treatment planning, quality assurance, randomised clinical trial setting, reproducibility, risk, risk of dysphagia, selection, selection plans, sets, study, tissue, tissue complication probability, toxicity, treatment, treatment plan comparisons, treatment planning, treatment studies, trial setting, volume, volume differences, xerostomia

Funders

  • Novo Nordisk Foundation

Data Provider: Digital Science

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