TY - JOUR
T1 - Comprehensive toxicity risk profiling in radiation therapy for head and neck cancer
T2 - A new concept for individually optimised treatment
AU - Van den Bosch, Lisa
AU - van der Schaaf, Arjen
AU - van der Laan, Hans Paul
AU - Hoebers, Frank J. P.
AU - Wijers, Oda B.
AU - van den Hoek, Johanna G. M.
AU - Moons, Karel G. M.
AU - Reitsma, Johannes B.
AU - Steenbakkers, Roel J. H. M.
AU - Schuit, Ewoud
AU - Langendijk, Johannes A.
PY - 2021/4
Y1 - 2021/4
N2 - 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 pre-dictors 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 tox-icity burden for an individual HNC patient who needs to undergo radiation treatment. (C) 2021 The Author(s). Published by Elsevier B.V.
AB - 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 pre-dictors 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 tox-icity burden for an individual HNC patient who needs to undergo radiation treatment. (C) 2021 The Author(s). Published by Elsevier B.V.
KW - Head and neck cancer
KW - Radiation-induced toxicity
KW - NTCP modeling
KW - INTENSITY-MODULATED RADIOTHERAPY
KW - COMPLICATION PROBABILITY-MODELS
KW - MULTIVARIABLE PREDICTION MODEL
KW - NORMAL TISSUE
KW - REDUCING XEROSTOMIA
KW - DIAGNOSIS TRIPOD
KW - NTCP MODELS
KW - VALIDATION
KW - IMRT
KW - APPLICABILITY
U2 - 10.1016/j.radonc.2021.01.024
DO - 10.1016/j.radonc.2021.01.024
M3 - Article
C2 - 33545258
SN - 0167-8140
VL - 157
SP - 147
EP - 154
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -