The impact of treatment accuracy on proton therapy patient selection for oropharyngeal cancer patients

The impact of treatment accuracy on NTCP-based patient selection for proton therapy is currently unknown. This study investigates this impact for oropharyngeal cancer patients. Data of 78 patients was used to automatically generate treatment plans for a simultaneously integrated boost prescribing 70...

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Published in	Radiotherapy and oncology Vol. 125; no. 3; pp. 520 - 525
Main Authors	Arts, Tine, Breedveld, Sebastiaan, de Jong, Martin A., Astreinidou, Eleftheria, Tans, Lisa, Keskin-Cambay, Fatma, Krol, Augustinus D.G., van de Water, Steven, Bijman, Rik G., Hoogeman, Mischa S.
Format	Journal Article
Language	English
Published	Ireland Elsevier B.V 01.12.2017
Subjects	Adult Aged Female Head and neck cancer Hematology, Oncology, and Palliative Medicine Humans IMPT IMRT Male Middle Aged Oropharyngeal cancer Oropharyngeal Neoplasms - radiotherapy Patient Selection Proton therapy Proton Therapy - adverse effects Proton Therapy - methods Radiotherapy Planning, Computer-Assisted - methods Radiotherapy, Intensity-Modulated - methods Robust optimization Xerostomia - etiology Head and neck cancer IMPT Robust optimization Proton therapy IMRT Oropharyngeal cancer
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ISSN	0167-8140 1879-0887 1879-0887
DOI	10.1016/j.radonc.2017.09.028

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Abstract	The impact of treatment accuracy on NTCP-based patient selection for proton therapy is currently unknown. This study investigates this impact for oropharyngeal cancer patients. Data of 78 patients was used to automatically generate treatment plans for a simultaneously integrated boost prescribing 70 GyRBE/54.25 GyRBE in 35 fractions. IMRT treatment plans were generated with three different margins; intensity modulated proton therapy (IMPT) plans for five different setup and range robustness settings. Four NTCP models were evaluated. Patients were selected for proton therapy if NTCP reduction was ≥10% or ≥5% for grade II or III complications, respectively. The degree of robustness had little impact on patient selection for tube feeding dependence, while the margin had. For other complications the impact of the robustness setting was noticeably higher. For high-precision IMRT (3 mm margin) and high-precision IMPT (3 mm setup/3% range error), most patients were selected for proton therapy based on problems swallowing solid food (51.3%) followed by tube feeding dependence (37.2%), decreased parotid flow (29.5%), and patient-rated xerostomia (7.7%). Treatment accuracy has a significant impact on the number of patients selected for proton therapy. Therefore, it cannot be ignored in estimating the number of patients for proton therapy.
AbstractList	The impact of treatment accuracy on NTCP-based patient selection for proton therapy is currently unknown. This study investigates this impact for oropharyngeal cancer patients. Data of 78 patients was used to automatically generate treatment plans for a simultaneously integrated boost prescribing 70 GyRBE/54.25 GyRBE in 35 fractions. IMRT treatment plans were generated with three different margins; intensity modulated proton therapy (IMPT) plans for five different setup and range robustness settings. Four NTCP models were evaluated. Patients were selected for proton therapy if NTCP reduction was ≥10% or ≥5% for grade II or III complications, respectively. The degree of robustness had little impact on patient selection for tube feeding dependence, while the margin had. For other complications the impact of the robustness setting was noticeably higher. For high-precision IMRT (3 mm margin) and high-precision IMPT (3 mm setup/3% range error), most patients were selected for proton therapy based on problems swallowing solid food (51.3%) followed by tube feeding dependence (37.2%), decreased parotid flow (29.5%), and patient-rated xerostomia (7.7%). Treatment accuracy has a significant impact on the number of patients selected for proton therapy. Therefore, it cannot be ignored in estimating the number of patients for proton therapy. The impact of treatment accuracy on NTCP-based patient selection for proton therapy is currently unknown. This study investigates this impact for oropharyngeal cancer patients. Data of 78 patients was used to automatically generate treatment plans for a simultaneously integrated boost prescribing 70 Gy /54.25 Gy in 35 fractions. IMRT treatment plans were generated with three different margins; intensity modulated proton therapy (IMPT) plans for five different setup and range robustness settings. Four NTCP models were evaluated. Patients were selected for proton therapy if NTCP reduction was ≥10% or ≥5% for grade II or III complications, respectively. The degree of robustness had little impact on patient selection for tube feeding dependence, while the margin had. For other complications the impact of the robustness setting was noticeably higher. For high-precision IMRT (3 mm margin) and high-precision IMPT (3 mm setup/3% range error), most patients were selected for proton therapy based on problems swallowing solid food (51.3%) followed by tube feeding dependence (37.2%), decreased parotid flow (29.5%), and patient-rated xerostomia (7.7%). Treatment accuracy has a significant impact on the number of patients selected for proton therapy. Therefore, it cannot be ignored in estimating the number of patients for proton therapy. The impact of treatment accuracy on NTCP-based patient selection for proton therapy is currently unknown. This study investigates this impact for oropharyngeal cancer patients.BACKGROUND AND PURPOSEThe impact of treatment accuracy on NTCP-based patient selection for proton therapy is currently unknown. This study investigates this impact for oropharyngeal cancer patients.Data of 78 patients was used to automatically generate treatment plans for a simultaneously integrated boost prescribing 70 GyRBE/54.25 GyRBE in 35 fractions. IMRT treatment plans were generated with three different margins; intensity modulated proton therapy (IMPT) plans for five different setup and range robustness settings. Four NTCP models were evaluated. Patients were selected for proton therapy if NTCP reduction was ≥10% or ≥5% for grade II or III complications, respectively.MATERIALS AND METHODSData of 78 patients was used to automatically generate treatment plans for a simultaneously integrated boost prescribing 70 GyRBE/54.25 GyRBE in 35 fractions. IMRT treatment plans were generated with three different margins; intensity modulated proton therapy (IMPT) plans for five different setup and range robustness settings. Four NTCP models were evaluated. Patients were selected for proton therapy if NTCP reduction was ≥10% or ≥5% for grade II or III complications, respectively.The degree of robustness had little impact on patient selection for tube feeding dependence, while the margin had. For other complications the impact of the robustness setting was noticeably higher. For high-precision IMRT (3 mm margin) and high-precision IMPT (3 mm setup/3% range error), most patients were selected for proton therapy based on problems swallowing solid food (51.3%) followed by tube feeding dependence (37.2%), decreased parotid flow (29.5%), and patient-rated xerostomia (7.7%).RESULTSThe degree of robustness had little impact on patient selection for tube feeding dependence, while the margin had. For other complications the impact of the robustness setting was noticeably higher. For high-precision IMRT (3 mm margin) and high-precision IMPT (3 mm setup/3% range error), most patients were selected for proton therapy based on problems swallowing solid food (51.3%) followed by tube feeding dependence (37.2%), decreased parotid flow (29.5%), and patient-rated xerostomia (7.7%).Treatment accuracy has a significant impact on the number of patients selected for proton therapy. Therefore, it cannot be ignored in estimating the number of patients for proton therapy.CONCLUSIONSTreatment accuracy has a significant impact on the number of patients selected for proton therapy. Therefore, it cannot be ignored in estimating the number of patients for proton therapy. AbstractBackground and purposeThe impact of treatment accuracy on NTCP-based patient selection for proton therapy is currently unknown. This study investigates this impact for oropharyngeal cancer patients. Materials and methodsData of 78 patients was used to automatically generate treatment plans for a simultaneously integrated boost prescribing 70 Gy RBE/54.25 Gy RBE in 35 fractions. IMRT treatment plans were generated with three different margins; intensity modulated proton therapy (IMPT) plans for five different setup and range robustness settings. Four NTCP models were evaluated. Patients were selected for proton therapy if NTCP reduction was ≥10% or ≥5% for grade II or III complications, respectively. ResultsThe degree of robustness had little impact on patient selection for tube feeding dependence, while the margin had. For other complications the impact of the robustness setting was noticeably higher. For high-precision IMRT (3 mm margin) and high-precision IMPT (3 mm setup/3% range error), most patients were selected for proton therapy based on problems swallowing solid food (51.3%) followed by tube feeding dependence (37.2%), decreased parotid flow (29.5%), and patient-rated xerostomia (7.7%). ConclusionsTreatment accuracy has a significant impact on the number of patients selected for proton therapy. Therefore, it cannot be ignored in estimating the number of patients for proton therapy.
Author	de Jong, Martin A. Tans, Lisa Hoogeman, Mischa S. Astreinidou, Eleftheria Arts, Tine Keskin-Cambay, Fatma Krol, Augustinus D.G. van de Water, Steven Breedveld, Sebastiaan Bijman, Rik G.
Author_xml	– sequence: 1 givenname: Tine surname: Arts fullname: Arts, Tine email: t.arts-3@umcutrecht.nl organization: Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands – sequence: 2 givenname: Sebastiaan surname: Breedveld fullname: Breedveld, Sebastiaan organization: Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands – sequence: 3 givenname: Martin A. surname: de Jong fullname: de Jong, Martin A. organization: Department of Radiation Oncology, LUMC, Leiden, The Netherlands – sequence: 4 givenname: Eleftheria surname: Astreinidou fullname: Astreinidou, Eleftheria organization: Department of Radiation Oncology, LUMC, Leiden, The Netherlands – sequence: 5 givenname: Lisa surname: Tans fullname: Tans, Lisa organization: Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands – sequence: 6 givenname: Fatma surname: Keskin-Cambay fullname: Keskin-Cambay, Fatma organization: Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands – sequence: 7 givenname: Augustinus D.G. surname: Krol fullname: Krol, Augustinus D.G. organization: Department of Radiation Oncology, LUMC, Leiden, The Netherlands – sequence: 8 givenname: Steven surname: van de Water fullname: van de Water, Steven organization: Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands – sequence: 9 givenname: Rik G. surname: Bijman fullname: Bijman, Rik G. organization: Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands – sequence: 10 givenname: Mischa S. surname: Hoogeman fullname: Hoogeman, Mischa S. organization: Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/29074078$$D View this record in MEDLINE/PubMed
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Snippet	The impact of treatment accuracy on NTCP-based patient selection for proton therapy is currently unknown. This study investigates this impact for oropharyngeal... AbstractBackground and purposeThe impact of treatment accuracy on NTCP-based patient selection for proton therapy is currently unknown. This study investigates...
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SubjectTerms	Adult Aged Female Head and neck cancer Hematology, Oncology, and Palliative Medicine Humans IMPT IMRT Male Middle Aged Oropharyngeal cancer Oropharyngeal Neoplasms - radiotherapy Patient Selection Proton therapy Proton Therapy - adverse effects Proton Therapy - methods Radiotherapy Planning, Computer-Assisted - methods Radiotherapy, Intensity-Modulated - methods Robust optimization Xerostomia - etiology
Title	The impact of treatment accuracy on proton therapy patient selection for oropharyngeal cancer patients
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