Modelling duodenum radiotherapy toxicity using cohort dose-volume-histogram data

Holyoake, D.; Aznar, Marianne C.; Mukherjee, Somnath; Partridge, Mike; Hawkins, M.

doi:10.1016/j.radonc.2017.04.024

Cited by 17 publications

(20 citation statements)

References 37 publications

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“…Therefore, an accurate understanding of toxicity to normal tissue is critical. Significant efforts have been made in the development and validation of accurate normal tissue complication probability (NTCP) models, 6 , 7 , 8 , 9 which aim to characterize the correlation between dose and the likelihood of side effects. 10 Specifically, Lyman-Kutcher-Burman (LKB) NTCP models have been used to investigate the dose-volume response for liver cancer.…”

Section: Introductionmentioning

confidence: 99%

A simulation study to assess the potential impact of developing normal tissue complication probability models with accumulated dose

McCulloch

Muenz

Schipper

et al. 2018

Advances in Radiation Oncology

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PurposeThis study aimed to analyze the potential clinical impact of the differences between planned and accumulated doses on the development and use of normal tissue complication probability (NTCP) models.Methods and MaterialsThirty patients who were previously treated with stereotactic body radiation therapy for liver cancer and for whom the accumulated dose was computed were assessed retrospectively. The linear quadratic equivalent dose at 2 Gy per fraction and generalized equivalent uniform dose were calculated for planned and accumulated doses. Stomach and duodenal Lyman-Kutcher-Burman NTCP models (α/β = 2.5; n = .09) were developed on the basis of planned and accumulated generalized equivalent uniform doses and the differences between the models assessed. In addition, the error in determining the probability of toxicity on the basis of the planned dose was evaluated by comparing planned doses in the NTCP model that were created from accumulated doses.ResultsThe standard, planned-dose NTCP model overestimates toxicity risk for both the duodenal and stomach models at doses that are below approximately 20 Gy (6 fractions) and underestimates toxicity risk for doses above approximately 20 Gy (6 fractions). Building NTCP models with accumulated rather than planned doses changes the predicted risk by up to 16% (mean: 6%; standard deviation: 7%) for duodenal toxicity and 6% (mean: 2%; standard deviation: 2%) for stomach toxicity. For a protocol that plans a 10% iso-toxicity risk to the duodenum, a 15.7 Gy (6 fractions) maximum dose constraint would be necessary when using standard NTCP models on the basis of a planned dose and a 17.6 Gy (6 fractions) maximum dose would be allowed when using NTCP models on the basis of accumulated doses.ConclusionsAssuming that accumulated dose is a more accurate representation of the true delivered dose than the planned dose, this simulation study indicates the need for prospective clinical trials to evaluate the impact of building NTCP models on the basis of accumulated doses.

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Section: Introductionmentioning

confidence: 99%

A simulation study to assess the potential impact of developing normal tissue complication probability models with accumulated dose

McCulloch

Muenz

Schipper

et al. 2018

Advances in Radiation Oncology

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“…'e e tl Shi oto et al ha e pu lished a al sis of carbon-ion chemoradiotherapy dose-volume parameters, though the values themselves may not be directly comparable with those from photon radiotherapy [28]. It is worth noting that in our analysis we failed to show associations of GI toxicity with duodenum dose-volume, despite other studies having shown evidence of a relationship [29]. Murphy et al showed a trend for association of increased duodenal dose-olu e ith g ade ≥ GI to i it i patie ts t eated ith o o ita t gemcitabine [7], but Huang et al found the best predictor of toxicity in similar patients was the duodenum V35Gy (V25Gy when including patients who received concomitant erlotinib) [9].…”

Section: Discussionmentioning

confidence: 60%

Stomach Dose–Volume Predicts Acute Gastrointestinal Toxicity in Chemoradiotherapy for Locally Advanced Pancreatic Cancer

et al. 2018

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“…Where D is the total dose in Gy given in d Gy fractions of d = 2 Gy each using an r α/β ratio of 4. As published reports of late bowel toxicity have shown the appropriate α/β ratio is 3–5 [ 31 – 34 ].…”

Section: Methodsmentioning

confidence: 99%

Hyperfractionated abdominal reirradiation for gastrointestinal malignancies

et al. 2018

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BackgroundWe sought to determine the role of abdominal reirradiation for patients presenting with recurrent or new primary gastrointestinal (GI) malignancies. At our institution, we have established a hyperfractionated, accelerated reirradiation regimen consisting of 39 Gray (Gy) in 26 twice-daily fractions. Although this regimen is used frequently in the pelvis, we sought to determine its toxicity and efficacy for abdominal tumors.MethodsTwenty-four patients who received abdominal reirradiation with a hyperfractionated, accelerated approach from 2000 to 2017 were identified. Overall survival (OS) and local progression-free survival (LPFS) were calculated using the Kaplan-Meier method. Several patient, tumor and treatment characteristics were evaluated on univariate analyses for association with OS and LPFS using a Cox proportional hazards model.ResultsOf the twenty-four patients identified, the majority (n = 11, 46%) had pancreatic adenocarcinoma as their primary disease but also included upper GI adenocarcinoma (n = 4), colon adenocarcinoma (n = 3), hepatobiliary cancers (n = 4) and other malignancies (n = 2). The majority of patients received 45–50.4Gy in 1.8Gy fractions as their initial abdominal radiation course. The median reirradiation dose was 39Gy in 26 twice-daily fractions with a minimum six hour interval. The median [interquartile range (IQR)] interval between the courses of radiotherapy was 28 [18.6–38.9] months. Only palliative reirradiation intent was associated with decreased OS. While colon adenocarcinoma primary was significantly associated with increased LPFS, the sample size was small (n = 3). The 1-yr rate of LPFS was 38%. The median [IQR] duration of freedom from local progression was 8 [3.8–19.2] months. The 1-year OS was 50% and the median (IQR) OS was 14 [6.3–19.6] months. Thirteen patients (54%) had acute side effects with one patient experiencing G3 nausea and one experiencing a G4 bleed; the remaining patients experienced G1-G2 symptoms.ConclusionHyperfractionated, accelerated reirradiation to the abdomen was relatively well-tolerated but provided limited local control to recurrent or second primary abdominal malignancies. Reirradiation could play a role in treating these patients with palliative or curative intent, but alternative strategies for delivering increased biologically effective dose should be further explored.

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Modelling duodenum radiotherapy toxicity using cohort dose-volume-histogram data

Cited by 17 publications

References 37 publications

A simulation study to assess the potential impact of developing normal tissue complication probability models with accumulated dose

A simulation study to assess the potential impact of developing normal tissue complication probability models with accumulated dose

Stomach Dose–Volume Predicts Acute Gastrointestinal Toxicity in Chemoradiotherapy for Locally Advanced Pancreatic Cancer

Hyperfractionated abdominal reirradiation for gastrointestinal malignancies

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