Development of an isotoxic decision support system integrating genetic markers of toxicity for the implantation of a rectum spacer

Wijk, Yvonka van; Vanneste, Ben; Jochems, Arthur; Walsh, Seán; Oberije, Cary; Pinkawa, Michael; Ramaekers, Bram; Vega, Ana; Lambin, Philippe

doi:10.1080/0284186x.2018.1484156

Cited by 6 publications

(6 citation statements)

References 34 publications

(40 reference statements)

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“…[18]). Reliable NTCP models can also be used to optimize the treatment strategy [19,20]. While a meta-analysis of DVH-based NTCP models for rectal bleeding shows that there is a consensus on the parameter values based on several large studies [1], an even higher association between the dose and the risk of rectal bleeding was found when spatial features were considered [3].…”

Section: Introductionmentioning

confidence: 99%

Patterns in ano-rectal dose maps and the risk of late toxicity after prostate IMRT

et al. 2019

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The aim of this work was to determine how the spatial pattern of dose in the ano-rectal wall is related to late gastro-intestinal toxicity for prostate cancer patients treated with mainly IMRT. Patients and methods: Patients from the DUE-01 multicentre study with patient-reported (prospective) follow-up and available dosimetric data were included. Conventionally fractionated patients received 74-80 Gy and hypofractionated patients received 65-75.2 Gy. A large majority of the patients were treated with intensity-modulated radiotherapy (IMRT). Dose-surface maps (DSMs) for the anal canal and rectum as a single structure, and for the anal canal and the rectum separately, were co-registered rigidly in two dimensions and, for the patients with and without toxicity, respectively, the mean value of the dose in each pixel was calculated. A pixel-wise t-test was used to highlight the anatomical areas where there was a significant difference between the 'mean dose maps' of each group. Univariate models were also fitted to a range of spatial parameters. The endpoints considered were a mean grade !1 late fecal incontinence and a maximum grade !2 late rectal bleeding. Results: Twenty-six out of 213 patients had fecal incontinence, while 21/225 patients had rectal bleeding. Incontinence was associated with a higher dose in the caudal region of the anal canal; the most relevant spatial parameter was the lateral extent of the low and medium isodoses (5-49 Gy in EQD2). Bleeding was associated with high isodoses reaching the posterior rectal wall. The spatial dose parameters with the highest AUC value (.69) were the lateral extent of the 60-70 Gy isodoses. Conclusions: To avoid fecal incontinence it is important to limit the portion of the anal canal irradiated. Our analysis confirms that rectal bleeding is a function of similar spatial dose parameters for patients treated with IMRT, compared to previous studies on patients treated with three-dimensional conformal radiotherapy.

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Section: Introductionmentioning

confidence: 99%

Patterns in ano-rectal dose maps and the risk of late toxicity after prostate IMRT

et al. 2019

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“…Short-term future work includes merging this DSS with previously developed DSSs, including one where the effectiveness of an implantable rectum spacer is accessed on the patient level [ 37 , 38 ] as well as a DSS that compares photon to proton therapy. We also plan to expand the NTCP models by including single nucleotide polymorphisms and tumor somatic mutations to incorporate genetic information into the decision-making process [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Modeling-Based Decision Support System for Radical Prostatectomy Versus External Beam Radiotherapy for Prostate Cancer Incorporating an In Silico Clinical Trial and a Cost–Utility Study

Wijk

Ramaekers

Vanneste

et al. 2021

Cancers

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The aim of this study is to build a decision support system (DSS) to select radical prostatectomy (RP) or external beam radiotherapy (EBRT) for low- to intermediate-risk prostate cancer patients. We used an individual state-transition model based on predictive models for estimating tumor control and toxicity probabilities. We performed analyses on a synthetically generated dataset of 1000 patients with realistic clinical parameters, externally validated by comparison to randomized clinical trials, and set up an in silico clinical trial for elderly patients. We assessed the cost-effectiveness (CE) of the DSS for treatment selection by comparing it to randomized treatment allotment. Using the DSS, 47.8% of synthetic patients were selected for RP and 52.2% for EBRT. During validation, differences with the simulations of late toxicity and biochemical failure never exceeded 2%. The in silico trial showed that for elderly patients, toxicity has more influence on the decision than TCP, and the predicted QoL depends on the initial erectile function. The DSS is estimated to result in cost savings (EUR 323 (95% CI: EUR 213–433)) and more quality-adjusted life years (QALYs; 0.11 years, 95% CI: 0.00–0.22) than randomized treatment selection.

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“…Nguyen et al (2009)[50] suggested 15 different combinations of treatment options, and this did not include the use of rectal displacement devices [65, 66] or proton therapy. The treatment mDSS that were found by the current study primarily involved RT, including treatment plan selection [46], proton compared to photon therapy [49], SBRT compared to IMRT [43], and the use of an implantable rectum spacer in EBRT [47]. Nguyen et al (2009) attempted to create a general overview of prediction tools to create a clear overview for patients, and they found most prediction tools to be focused on RT and radical prostatectomy.…”

Section: Discussionmentioning

confidence: 99%

Decision Support Systems in Prostate Cancer Treatment: An Overview

Wijk

Halilaj

Limbergen

et al. 2019

BioMed Research International

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Background. A multifactorial decision support system (mDSS) is a tool designed to improve the clinical decision-making process, while using clinical inputs for an individual patient to generate case-specific advice. The study provides an overview of the literature to analyze current available mDSS focused on prostate cancer (PCa), in order to better understand the availability of decision support tools as well as where the current literature is lacking. Methods. We performed a MEDLINE literature search in July 2018. We divided the included studies into different sections: diagnostic, which aids in detection or staging of PCa; treatment, supporting the decision between treatment modalities; and patient, which focusses on informing the patient. We manually screened and excluded studies that did not contain an mDSS concerning prostate cancer and study proposals. Results. Our search resulted in twelve diagnostic mDSS; six treatment mDSS; two patient mDSS; and eight papers that could improve mDSS. Conclusions. Diagnosis mDSS is well represented in the literature as well as treatment mDSS considering external-beam radiotherapy; however, there is a lack of mDSS for other treatment modalities. The development of patient decision aids is a new field of research, and few successes have been made for PCa patients. These tools can improve personalized medicine but need to overcome a number of difficulties to be successful and require more research.

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Development of an isotoxic decision support system integrating genetic markers of toxicity for the implantation of a rectum spacer

Abstract: This study was a proof-of-concept for an isotoxic model with genetic biomarkers with a V-IRS as a multifactorial decision support system for the decision of a placement of an IRS.

Cited by 6 publications

References 34 publications

Patterns in ano-rectal dose maps and the risk of late toxicity after prostate IMRT

Patterns in ano-rectal dose maps and the risk of late toxicity after prostate IMRT

Modeling-Based Decision Support System for Radical Prostatectomy Versus External Beam Radiotherapy for Prostate Cancer Incorporating an In Silico Clinical Trial and a Cost–Utility Study

Decision Support Systems in Prostate Cancer Treatment: An Overview

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