Independent validation of a dysphagia dose response model for the selection of head and neck cancer patients to proton therapy

Kalendralis, Petros; Sloep, Matthijs; George, Nibin Moni; Snel, Jasper; Veugen, Joeri; Hoebers, Frank; Wesseling, Frederik; Unipan, Mirko; Veening, Martijn; Langendijk, Johannes A.; Dekker, André; Soest, Johan van; Fijten, Rianne

doi:10.1016/j.phro.2022.09.005

Cited by 3 publications

(7 citation statements)

References 23 publications

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“…Another factor that influences the quality of data included in the NTCP model adaption might be the interobserver variability among different clinicians for head and neck cancer patients. As reported by Kalendralis and Sloep et al, these variabilities can directly influence the performance of the adapted NTCP model in different independent patient cohorts [44]. It is also worth noting that in a related study, the biophysical model displayed sensitivity to parameter variations, where even a 1% deviation in TD 50 resulted in a substantial 10% deviation in the NTCP [6,23].…”

Section: Discussionmentioning

confidence: 67%

“…Multiple studies have evaluated the reduction in treatment volume and prescribed dose as well as the adoption of modern conformal techniques, in order to limit treatment-induced side-effects [2]. In 2011, a large, randomized trial confirmed the equivalence in terms of response rate and local control of 24 Gy for indolent NHL and 30 Gy in 2 Gy fractions for aggressive NHL, compared with the doses previously considered as standard (40)(41)(42)(43)(44)(45) [3]. Furthermore, the reduction in treatment volume from mantle field to involved-field radiotherapy first and further to involved-site or -node radiotherapy demonstrated comparable control of disease with reduced irradiation of organs at risk (OAR) [4].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Modern Low Dose Involved Site Radiation Therapy on Normal Tissue Toxicity in Cervicothoracic Non-Hodgkin Lymphomas: A Biophysical Study

Roers,

Rolf,

Baehr

et al. 2023

Cancers

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This biophysical study aimed to determine fitting parameters for the Lyman–Kutcher–Burman (LKB) dose–response model for normal tissue complication probability (NTCP) calculations of acute side effects and to investigate the impact of reduced radiation doses on the probability of their occurrence in supradiaphragmatic non-Hodgkin lymphoma (NHL) irradiation. A cohort of 114 patients with NHL in the cervicothoracic region, treated between 2015 and 2021 at the University Hospitals of Münster, Hamburg, and Essen, with involved site radiation therapy (ISRT), were included. Among them, 68 patients with aggressive NHL (a-NHL) received consolidative radiation therapy with 24–54 Gy following (R-)CHOP chemotherapy. Additionally, 46 patients with indolent NHL (i-NHL) underwent radiotherapy with 22.5–45.0 Gy. Two treatment plans were prospectively created for each patient (a-NHL: 30.0/40.0 Gy; i-NHL: 24.0/30.0 Gy). NTCP were then calculated using the optimized LKB model. The adapted dose–response models properly predicted the patient’s probability of developing acute side effects when receiving doses ≤ 50 Gy. In addition, it was shown that reduced radiation doses can influence the NTCP of acute side effects depending on the aggressiveness of NHL significantly. This study provided a foundation to prospectively assess the probability of adverse side effects among today’s reduced radiation doses in the treatment of NHL.

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Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Impact of Modern Low Dose Involved Site Radiation Therapy on Normal Tissue Toxicity in Cervicothoracic Non-Hodgkin Lymphomas: A Biophysical Study

Roers,

Rolf,

Baehr

et al. 2023

Cancers

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“…Both studies applied the closed testing procedure [14] , which is an automated method that evaluate to what degree an NTCP model needs to be adjusted in order to improve performance when applied in the new patient cohort. The results from the external validation in the above mentioned studies differed, in the Danish patient cohort, updating the intercept resulted in a significant improvement in the model performance, whereas re-estimation of model coefficients significantly improved the performance in Kalendralis et al [13] .…”

mentioning

confidence: 89%

“…In summary, the contribution of Kalendralis et al [13] in the current volume is an important achievement within a research area that is essential for the further expansion of the scientifically founded indications of proton therapy.…”

mentioning

confidence: 92%

“…Recently, a previously published NTCP model for dysphagia [11] was externally validated in a Danish patient cohort [12] and in the current volume of this journal, Kalendralis et al [13] report the results from an external validation of an NTCP model for grade II dysphagia in 270 HNC patients. Both studies applied the closed testing procedure [14] , which is an automated method that evaluate to what degree an NTCP model needs to be adjusted in order to improve performance when applied in the new patient cohort.…”

mentioning

confidence: 99%

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Achievements and challenges in normal tissue response modelling for proton therapy

Engeseth¹,

Stokkevåg²,

Muren³

2022

Physics and Imaging in Radiation Oncology

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Predictive Factors for Chemoradiation-Induced Oral Mucositis and Dysphagia in Head and Neck Cancer: A Scoping Review

Nicol,

Ching,

Tam

et al. 2023

Cancers

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Despite advances in head and neck cancer treatment, virtually all patients experience chemoradiation-induced toxicities. Oral mucositis (OM) and dysphagia are among the most prevalent and have a systemic impact on patients, hampering treatment outcome and harming quality of life. Accurate prediction of severe cases is crucial for improving management strategies and, ultimately, patient outcomes. This scoping review comprehensively maps the reported predictors and critically evaluates the performance, methodology, and reporting of predictive models for these conditions. A total of 174 studies were identified from database searches, with 73 reporting OM predictors, 97 reporting dysphagia predictors, and 4 reporting both OM and dysphagia predictors. These predictors included patient demographics, tumor classification, chemoradiotherapy regimen, radiation dose to organs-at-risk, genetic factors, and results of clinical laboratory tests. Notably, many studies only conducted univariate analysis or focused exclusively on certain predictor types. Among the included studies, numerous predictive models were reported: eight for acute OM, five for acute dysphagia, and nine for late dysphagia. The area under the receiver operating characteristic curve (AUC) ranged between 0.65 and 0.81, 0.60 and 0.82, and 0.70 and 0.85 for acute oral mucositis, acute dysphagia, and late dysphagia predictive models, respectively. Several areas for improvement were identified, including the need for external validation with sufficiently large sample sizes, further standardization of predictor and outcome definitions, and more comprehensive reporting to facilitate reproducibility.

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Independent validation of a dysphagia dose response model for the selection of head and neck cancer patients to proton therapy

Cited by 3 publications

References 23 publications

Impact of Modern Low Dose Involved Site Radiation Therapy on Normal Tissue Toxicity in Cervicothoracic Non-Hodgkin Lymphomas: A Biophysical Study

Impact of Modern Low Dose Involved Site Radiation Therapy on Normal Tissue Toxicity in Cervicothoracic Non-Hodgkin Lymphomas: A Biophysical Study

Achievements and challenges in normal tissue response modelling for proton therapy

Predictive Factors for Chemoradiation-Induced Oral Mucositis and Dysphagia in Head and Neck Cancer: A Scoping Review

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