An efficient strategy to select head and neck cancer patients for adaptive radiotherapy

作者：Yong Gan, Johannes A. Langendijk, A. van der Schaaf, L. Van den Bosch, Edwin Oldehinkel, Zhixiong Lin, Stefan Both, Charlotte L. Brouwer · 发表于：Radiotherapy and Oncology · 年份：2023 · DOI：10.1016/j.radonc.2023.109763 · 被引用次数：19 · 研究领域：Advanced Radiotherapy Techniques、Head and Neck Cancer Studies、Effects of Radiation Exposure

Background and purpose Adaptive radiotherapy (ART) is workload intensive but only benefits a subgroup of patients. We aimed to develop an efficient strategy to select candidates for ART in the first two weeks of head and neck cancer (HNC) radiotherapy. Materials and methods This study retrospectively enrolled 110 HNC patients who underwent modern photon radiotherapy with at least 5 weekly in-treatment re-scan CTs. A semi auto-segmentation method was applied to obtain the weekly mean dose (D mean ) to OARs. A comprehensive NTCP-profile was applied to obtain NTCP's. The difference between planning and actual values of D mean (ΔD mean ) and dichotomized difference of clinical relevance (BIOΔNTCP) were used for modelling to determine the cut-off maximum ΔD mean of OARs in week 1 and 2 (maxΔD mean_1 and maxΔD mean_2 ). Four strategies to select candidates for ART, using cut-off maxΔD mean were compared. Results The Spearman's rank correlation test showed significant positive correlation between maxΔD mean and BIOΔNTCP ( p -value <0.001). For major BIOΔNTCP (>5%) of acute and late toxicity, 10.9% and 4.5% of the patients were true candidates for ART. Strategy C using both cut-off maxΔD mean_1 (3.01 and 5.14 Gy) and cut-off maxΔD mean_2 (3.41 and 5.30 Gy) showed the best sensitivity, specificity, positive and negative predictive values (0.92, 0.82, 0.38, 0.99 for acute toxicity and 1.00, 0.92, 0.38, 1.00 for late toxicity, respectively). Conclusions We propose an efficient selection...