Lisa Van den Bosch1, Arjen van der Schaaf2, Hans Paul van der Laan2, Frank J P Hoebers3, Oda B Wijers4, Johanna G M van den Hoek2, Karel G M Moons5, Johannes B Reitsma5, Roel J H M Steenbakkers2, Ewoud Schuit5, Johannes A Langendijk2. 1. Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands. Electronic address: l.g.l.j.van.den.bosch@umcg.nl. 2. Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands. 3. Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands. 4. Radiotherapeutic Institute Friesland, Leeuwarden, The Netherlands. 5. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands.
Abstract
BACKGROUND AND PURPOSE: A comprehensive individual toxicity risk profile is needed to improve radiation treatment optimisation, minimising toxicity burden, in head and neck cancer (HNC) patients. We aimed to develop and externally validate NTCP models for various toxicities at multiple time points. MATERIALS AND METHODS: Using logistic regression, we determined the relationship between normal tissue irradiation and the risk of 22 toxicities at ten time points during and after treatment in 750 HNC patients. The toxicities involved swallowing, salivary, mucosal, speech, pain and general complaints. Studied predictors included patient, tumour and treatment characteristics and dose parameters of 28 organs. The resulting NTCP models were externally validated in 395 HNC patients. RESULTS: The NTCP models involved 14 organs that were associated with at least one toxicity. The oral cavity was the predominant organ, associated with 12 toxicities. Other important organs included the parotid and submandibular glands, buccal mucosa and swallowing muscles. In addition, baseline toxicity, treatment modality, and tumour site were common predictors of toxicity. The median discrimination performance (AUC) of the models was 0.71 (interquartile range: 0.68-0.75) at internal validation and 0.67 (interquartile range: 0.62-0.71) at external validation. CONCLUSION: We established a comprehensive individual toxicity risk profile that provides essential insight into how radiation exposure of various organs translates into multiple acute and late toxicities. This comprehensive understanding of radiation-induced toxicities enables a new radiation treatment optimisation concept that balances multiple toxicity risks simultaneously and minimises the overall toxicity burden for an individual HNC patient who needs to undergo radiation treatment.
BACKGROUND AND PURPOSE: A comprehensive individual toxicity risk profile is needed to improve radiation treatment optimisation, minimising toxicity burden, in head and neck cancer (HNC) patients. We aimed to develop and externally validate NTCP models for various toxicities at multiple time points. MATERIALS AND METHODS: Using logistic regression, we determined the relationship between normal tissue irradiation and the risk of 22 toxicities at ten time points during and after treatment in 750 HNC patients. The toxicities involved swallowing, salivary, mucosal, speech, pain and general complaints. Studied predictors included patient, tumour and treatment characteristics and dose parameters of 28 organs. The resulting NTCP models were externally validated in 395 HNC patients. RESULTS: The NTCP models involved 14 organs that were associated with at least one toxicity. The oral cavity was the predominant organ, associated with 12 toxicities. Other important organs included the parotid and submandibular glands, buccal mucosa and swallowing muscles. In addition, baseline toxicity, treatment modality, and tumour site were common predictors of toxicity. The median discrimination performance (AUC) of the models was 0.71 (interquartile range: 0.68-0.75) at internal validation and 0.67 (interquartile range: 0.62-0.71) at external validation. CONCLUSION: We established a comprehensive individual toxicity risk profile that provides essential insight into how radiation exposure of various organs translates into multiple acute and late toxicities. This comprehensive understanding of radiation-induced toxicities enables a new radiation treatment optimisation concept that balances multiple toxicity risks simultaneously and minimises the overall toxicity burden for an individual HNC patient who needs to undergo radiation treatment.
Authors: Samuel L Mulder; Jolien Heukelom; Brigid A McDonald; Lisanne Van Dijk; Kareem A Wahid; Keith Sanders; Travis C Salzillo; Mehdi Hemmati; Andrew Schaefer; Clifton D Fuller Journal: Cancers (Basel) Date: 2022-04-10 Impact factor: 6.575
Authors: Petros Kalendralis; Matthijs Sloep; Nibin Moni George; Jasper Snel; Joeri Veugen; Frank Hoebers; Frederik Wesseling; Mirko Unipan; Martijn Veening; Johannes A Langendijk; Andre Dekker; Johan van Soest; Rianne Fijten Journal: Phys Imaging Radiat Oncol Date: 2022-09-17