Yang Tianyu, Ji Zhe, Lei Runhong, Qu Ang, Jiang Weijuan, Deng Xiuwen, Jiang Ping
Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China.
Curr Oncol. 2025 Jan 1;32(1):26. doi: 10.3390/curroncol32010026.
(1) Background: Volumetric modulated arc therapy (VMAT) can deliver more accurate dose distribution and reduce radiotherapy-induced toxicities for postoperative cervical and endometrial cancer. This study aims to retrospectively analyze the relationship between dosimetric parameters of organs at risk (OARs) and acute toxicities and provide suggestions for the dose constraints. (2) Methods: A total of 164 postoperative cervical and endometrial cancer patients were retrospectively analyzed, and the endpoints were grade ≥ 2 acute urinary toxicity (AUT) and acute lower gastrointestinal toxicity (ALGIT). The normal tissue complication probability (NTCP) model was established using the logistic regression model. Restricted cubic spline (RCS) curves were used to explore the association between dosimetric parameters and toxicities. The receiver operating characteristic (ROC) curve, calibration curve, Akaike's corrected information criterion (AICc), decision curve analysis (DCA), and clinical impact curve (CIC) were analyzed to evaluate the performance of NTCP models. (3) Results: Bladder V was identified to develop the NTCP model of AUT, and the mean AUC was 0.69 (CI: 0.58-0.80). Three candidate predictors, namely the small intestine V, colon D, and rectum D, were identified to develop the NTCP model of ALGIT, and the mean AUC was 0.71 (CI: 0.61-0.80). Both models were considered to have relatively good discriminative accuracy and could provide a high net benefit in clinical applications. (4) Conclusions: We developed NTCP models to predict the probability for grade ≥ 2 AUT and ALGIT. We recommend that bladder V, the small intestine V, colon D, and rectum D be controlled below 42%, 20.4%, 16.9 Gy, and 32.0 Gy, respectively.
（1）背景：容积调强弧形放疗（VMAT）可为宫颈癌和子宫内膜癌术后患者提供更精确的剂量分布，并降低放疗引起的毒性。本研究旨在回顾性分析危及器官（OARs）剂量学参数与急性毒性之间的关系，并为剂量限制提供建议。（2）方法：回顾性分析164例宫颈癌和子宫内膜癌术后患者，终点指标为≥2级急性泌尿系统毒性（AUT）和急性下消化道毒性（ALGIT）。采用逻辑回归模型建立正常组织并发症概率（NTCP）模型。使用受限立方样条（RCS）曲线探索剂量学参数与毒性之间的关联。分析受试者工作特征（ROC）曲线、校准曲线、赤池校正信息准则（AICc）、决策曲线分析（DCA）和临床影响曲线（CIC），以评估NTCP模型的性能。（3）结果：确定膀胱V用于建立AUT的NTCP模型，平均AUC为0.69（CI：0.58 - 0.80）。确定小肠V、结肠D和直肠D这三个候选预测因子用于建立ALGIT的NTCP模型，平均AUC为0.71（CI：0.61 - 0.80）。两个模型均被认为具有相对较好的判别准确性，并且在临床应用中可以提供较高的净效益。（4）结论：我们建立了NTCP模型来预测≥2级AUT和ALGIT的发生概率。我们建议将膀胱V、小肠V、结肠D和直肠D分别控制在42%、20.4%、16.9 Gy和32.0 Gy以下。
