Dose-volume analysis of planned versus accumulated dose as a predictor for late gastrointestinal toxicity in men receiving radiotherapy for high-risk prostate cancer

Ong, Ashley Li Kuan; Knight, Kellie; Panettieri, Vanessa; Dimmock, Mathew; Tuan, Jeffrey Kit Loong; Tan, Hong Qi; Wright, Caroline

doi:10.1016/j.phro.2022.07.001

Cited by 4 publications

(3 citation statements)

References 38 publications

(48 reference statements)

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“…Lastly, the use of DV-based metrics in MVA do not provide any geometrical information as every region of the OARs are considered equally critical, unlike the use of voxel-based metrics [46] , [47] . However, the utilization of DV-based metrics as the DV variable in correlating with toxicity outcomes were commonly used, thereby enabling a robust comparison across various institutions [17] , [21] .…”

Section: Discussionmentioning

confidence: 99%

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Predictors for late genitourinary toxicity in men receiving radiotherapy for high-risk prostate cancer using planned and accumulated dose

Ong

Knight

Panettieri

et al. 2023

Physics and Imaging in Radiation Oncology

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Section: Discussionmentioning

confidence: 99%

“…Table 1 presented patients’ clinical variables, acute and late toxicity profiles. Similar methodology has been adopted from previous publication based on clinical and DV associations with late gastrointestinal (GI) toxicity [21] .…”

Section: Methodsmentioning

confidence: 99%

Predictors for late genitourinary toxicity in men receiving radiotherapy for high-risk prostate cancer using planned and accumulated dose

Ong

Knight

Panettieri

et al. 2023

Physics and Imaging in Radiation Oncology

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“…RT planning plays a crucial role in minimizing the dose received by nearby healthy structures known as organs at risk (OARs), and hence the adverse effects, while accurately delivering the prescribed radiation amount to the Diagnostics 2024, 14, 465 2 of 12 tumor (planning target volume (PTV)) for effective treatment [8][9][10]. However, the rectum being in close proximity to the PTV, along with their overlapping regions, presents a unique challenge in prostate RT planning [11][12][13]. Sometimes, clinicians prefer reducing the dose given to the rectum to mitigate the risk of rectal toxicity at the expense of dose reduction to the PTV within an acceptable range, resulting in a decrease of treatment effectiveness [14,15].…”

Section: Introductionmentioning

confidence: 99%

Comparative Study of Eclipse and RayStation Multi-Criteria Optimization-Based Prostate Radiotherapy Treatment Planning Quality

Wong,

Leung,

Hung

et al. 2024

Diagnostics

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Multi-criteria optimization (MCO) function has been available on commercial radiotherapy (RT) treatment planning systems to improve plan quality; however, no study has compared Eclipse and RayStation MCO functions for prostate RT planning. The purpose of this study was to compare prostate RT MCO plan qualities in terms of discrepancies between Pareto optimal and final deliverable plans, and dosimetric impact of final deliverable plans. In total, 25 computed tomography datasets of prostate cancer patients were used for Eclipse (version 16.1) and RayStation (version 12A) MCO-based plannings with doses received by 98% of planning target volume having 76 Gy prescription (PTV76D98%) and 50% of rectum (rectum D50%) selected as trade-off criteria. Pareto optimal and final deliverable plan discrepancies were determined based on PTV76D98% and rectum D50% percentage differences. Their final deliverable plans were compared in terms of doses received by PTV76 and other structures including rectum, and PTV76 homogeneity index (HI) and conformity index (CI), using a t-test. Both systems showed discrepancies between Pareto optimal and final deliverable plans (Eclipse: −0.89% (PTV76D98%) and −2.49% (Rectum D50%); RayStation: 3.56% (PTV76D98%) and −1.96% (Rectum D50%)). Statistically significantly different average values of PTV76D98%,HI and CI, and mean dose received by rectum (Eclipse: 76.07 Gy, 0.06, 1.05 and 39.36 Gy; RayStation: 70.43 Gy, 0.11, 0.87 and 51.65 Gy) are noted, respectively (p < 0.001). Eclipse MCO-based prostate RT plan quality appears better than that of RayStation.

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Predictive modelling for late rectal and urinary toxicities after prostate radiotherapy using planned and delivered dose

Ong

Knight²,

Panettieri³

et al. 2022

Front. Oncol.

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Background and purposeNormal tissue complication probability (NTCP) parameters derived from traditional 3D plans may not be ideal in defining toxicity outcomes for modern radiotherapy techniques. This study aimed to derive parameters of the Lyman-Kutcher-Burman (LKB) NTCP model using prospectively scored clinical data for late gastrointestinal (GI) and genitourinary (GU) toxicities for high-risk prostate cancer patients treated using volumetric-modulated-arc-therapy (VMAT). Dose-volume-histograms (DVH) extracted from planned (DP) and accumulated dose (DA) were used.Material and methodsDP and DA obtained from the DVH of 150 prostate cancer patients with pelvic-lymph-nodes irradiation treated using VMAT were used to generate LKB-NTCP parameters using maximum likelihood estimations. Defined GI and GU toxicities were recorded up to 3-years post RT follow-up. Model performance was measured using Hosmer-Lemeshow goodness of fit test and the mean area under the receiver operating characteristics curve (AUC). Bootstrapping method was used for internal validation.ResultsFor mild-severe (Grade ≥1) GI toxicity, the model generated similar parameters based on DA and DP DVH data (DA-D50:71.6 Gy vs DP-D50:73.4; DA-m:0.17 vs DP-m:0.19 and DA/P-n 0.04). The 95% CI for DA-D50 was narrower and achieved an AUC of >0.6. For moderate-severe (Grade ≥2) GI toxicity, DA-D50 parameter was higher and had a narrower 95% CI (DA-D50:77.9 Gy, 95% CI:76.4-79.6 Gy vs DP-D50:74.6, 95% CI:69.1-85.4 Gy) with good model performance (AUC>0.7). For Grade ≥1 late GU toxicity, D50 and n parameters for DA and DP were similar (DA-D50: 58.8 Gy vs DP-D50: 59.5 Gy; DA-n: 0.21 vs DP-n: 0.19) with a low AUC of<0.6. For Grade ≥2 late GU toxicity, similar NTCP parameters were attained from DA and DP DVH data (DA-D50:81.7 Gy vs DP-D50:81.9 Gy; DA-n:0.12 vs DP-n:0.14) with an acceptable AUCs of >0.6.ConclusionsThe achieved NTCP parameters using modern RT techniques and accounting for organ motion differs from QUANTEC reported parameters. DA-D50 of 77.9 Gy for GI and DA/DP-D50 of 81.7-81.9 Gy for GU demonstrated good predictability in determining the risk of Grade ≥2 toxicities especially for GI derived D50 and are recommended to incorporate as part of the DV planning constraints to guide dose escalation strategies while minimising the risk of toxicity.

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Dose-volume analysis of planned versus accumulated dose as a predictor for late gastrointestinal toxicity in men receiving radiotherapy for high-risk prostate cancer

Cited by 4 publications

References 38 publications

Predictors for late genitourinary toxicity in men receiving radiotherapy for high-risk prostate cancer using planned and accumulated dose

Predictors for late genitourinary toxicity in men receiving radiotherapy for high-risk prostate cancer using planned and accumulated dose

Comparative Study of Eclipse and RayStation Multi-Criteria Optimization-Based Prostate Radiotherapy Treatment Planning Quality

Predictive modelling for late rectal and urinary toxicities after prostate radiotherapy using planned and delivered dose

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