A nomogram for predicting late radiation-induced xerostomia among locoregionally advanced nasopharyngeal carcinoma in intensity modulated radiation therapy era

Abstract

Background: Dry mouth sensation cannot be improved completely even though parotids are spared correctly. Our purpose is to develop a nomogram to predict the moderate-to-severe late radiation xerostomia for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) in intensity modulated radiation therapy (IMRT) / volumetric modulated arc radiotherapy (VMAT) era. Methods: A dataset of 311 patients was retrospectively collected between January 2010 and February 2013. The binary logistic regression was to estimate each factor’s prognostic value for development of moderate-to-severe patient-reported xerostomia at least 2 years (Xer2y) after completion of radiotherapy. Therefore, we can develop a nomogram according to binary logistic regression coefficients. This novel model was validated by bootstrapping analyses. Results: Contralateral Parotid mean dose (coMD<24.4Gy), VMAT (yes), and platinum-based concurrent chemoradiotherapy (no) were significantly related to patient-reported xerostomia at least 2 years (Xer2y) (all p < 0.001), and were included in the nomogram. Receiver operating characteristic (ROC) analysis revealed AUC (area under the ROC curve) with the value of 0.811 (0.710-0.912) of the nomogram, which was significantly higher than coMD 0.698 (0.560-0.840) from QUANTEC2010 (p<0.001). Calibration plots illustrated that the predicted Xer2y was close to the actual observation, and decision curve analyses (DCA) indicated valid positive net benefits. Conclusion: We developed a feasible nomogram to predict patient-rated Xer2y based on comprehensive individual data in patients with LA-NPC in the real world. The proposed model is able to facilitate the development of treatment plan and quality of life improvement.

A modified survival model for patients with esophageal squamous cell carcinoma based on lymph nodes: A study based on SEER database and external validation

“…In addition, some researchers put forward other different views on TNM stage (15,34,35). By figuring out the C-index value and performing tdROC and DCA, we demonstrated nomogram was more effective on clinical usability compared to the TNM staging system, which was also tested by many previous studies (32,33).…”

“…studies (15,30,31). Considering the AUC value of ROC, the nomogram performed well with a value of 0.7 and was better compared to the 8th TNM staging (32,33). In addition, some researchers put forward other different views on TNM stage (15,34,35).…”

Study the Quality of Nasopharyngeal plans Using Evaluation Indexes of IMRT and VMAT Treatment planning Techniques

“…Intensity-modulated radiotherapy (IMRT) is the state-of-the-art method of pinpoint radiation delivery due to recent advancements in radiation equipment and technology 1 . Previous studies [2][3][4][5][6] have shown a significant improvement in IMRT regarding tumor control and quality of life in NPC.…”

Neural network and spline-based regression for the prediction of salivary hypofunction in patients undergoing radiation therapy

“…More recently, Beetz et al [ 8 ] and Li et al [ 9 ] developed regression models that predict salivary hypofunction using a variety of clinical and demographic information in addition to a DVH-derived mean organ dose in cohorts of size 167 and 365 respectively. Still others have attempted to predict either xerostomia or salivary hypofunction without using any data on the radiation plan [ 10 , 11 ] while others have turned to delta radiomics [ 12 ] for prediction, although these calculations cannot be performed in the radiation planning phase.…”