University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, the Netherlands.
University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, the Netherlands.
Radiother Oncol. 2020 Oct;151:206-213. doi: 10.1016/j.radonc.2020.07.056. Epub 2020 Aug 6.
In the Netherlands, head and neck cancer (HNC) patients qualify for intensity modulated proton therapy (IMPT) based on model-based selection (MBS). The aim of this study was to evaluate the first experience in MBS of HNC patients.
Patients who were subjected to MBS (Jan 2018-Sep 2019) were evaluated. A VMAT plan was created for all patients with optimal sparing of organ at risks (OARs) in normal tissue complication probability (NTCP) models for a number of toxicities. An IMPT plan was created only for those with NTCP difference (ΔNTCP) between VMAT and best-case scenario for proton (assuming 0 Gy dose for all OARs in IMPT plan) that exceeded any ΔNTCP-thresholds defined in Dutch National Indication Protocol. These patients qualified for a robust IMPT-plan creation with similar target doses and subsequent plan comparison.
Of 227 patients, 141 (62%) qualified for plan comparison, of which 80 (35%) were eventually selected for proton therapy. Most patients were selected based on the ΔNTCP for dysphagia-related toxicities. The selection rate was higher among patients with advanced disease, pharyngeal tumors, and/or baseline complaints. A significant reduction in all OAR doses and NTCP values was obtained with IMPT compared with VMAT in both selected and non-selected patients, but more pronounced in patients selected for protons.
Model-based selection of patients with HNC for proton therapy is clinically feasible. Approximately one third of HNC patients qualify for protons and these patients have the highest probability to benefit from protons in terms of toxicity prevention.
在荷兰，头颈部癌症（HNC）患者有资格根据基于模型的选择（MBS）接受强度调制质子治疗（IMPT）。本研究的目的是评估 HNC 患者 MBS 的初步经验。
评估了接受 MBS（2018 年 1 月至 2019 年 9 月）的患者。为所有患者创建了 VMAT 计划，并在正常组织并发症概率（NTCP）模型中为 OAR 进行了最佳保护，以实现多种毒性的优化。仅为那些 VMAT 和质子最佳情况之间的 NTCP 差异（ΔNTCP）超过荷兰国家指示协议中定义的任何 ΔNTCP 阈值的患者创建了 IMPT 计划（假设 IMPT 计划中所有 OAR 的剂量均为 0Gy）。这些患者有资格进行稳健的 IMPT 计划创建，并具有类似的靶剂量和随后的计划比较。
在 227 名患者中，有 141 名（62%）有资格进行计划比较，其中 80 名（35%）最终选择进行质子治疗。大多数患者是根据与吞咽相关毒性的 ΔNTCP 进行选择的。在晚期疾病、咽肿瘤和/或基线投诉的患者中，选择率更高。与 VMAT 相比，IMPT 可显著降低所有 OAR 剂量和 NTCP 值，在选择和未选择的患者中均如此，但在选择质子治疗的患者中更为明显。
对头颈部癌症患者进行质子治疗的基于模型的选择在临床上是可行的。大约三分之一的 HNC 患者有资格接受质子治疗，这些患者在预防毒性方面最有可能从质子治疗中受益。
