Swallowing sparing intensity modulated radiotherapy (SW-IMRT) in head and neck cancer: Clinical validation according to the model-based approach

Miranda E. M. C. Christianen; Arjen van der Schaaf; Hans Paul van der Laan; Irma M. Verdonck-de Leeuw; Patricia Doornaert; Olga Chouvalova; Roel J. H. M. Steenbakkers; Charles Rene Leemans; Sjoukje F. Oosting; Bernard F. A. M. van der Laan; Jan L. N. Roodenburg; Ben J. Slotman; Hendrik P. Bijl; Johannes A. Langendijk

doi:10.1016/j.radonc.2015.11.009

Swallowing sparing intensity modulated radiotherapy (SW-IMRT) in head and neck cancer: Clinical validation according to the model-based approach

Miranda E. M. C. Christianen, Arjen van der Schaaf, Hans Paul van der Laan, Irma M. Verdonck-de Leeuw, Patricia Doornaert, Olga Chouvalova, Roel J. H. M. Steenbakkers, Charles Rene Leemans, Sjoukje F. Oosting, Bernard F. A. M. van der Laan, Jan L. N. Roodenburg, Ben J. Slotman, Hendrik P. Bijl, Johannes A. Langendijk^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Purpose: The aim of this study was to clinically validate a multivariable normal tissue complication probability (NTCP) model for grade 2-4 swallowing dysfunction at 6 months after radiotherapy or chemoradiation (SWAL(M6)) in head and neck cancer patients treated with swallowing sparing intensity modulated radiotherapy (SW-IMRT) and to test if SW-IMRT resulted in a reduction of the prevalence of SWAL(M6).

Materials and methods: The primary endpoint was SWAL(M6). For all 186 patients, a standard IMRT (parotid sparing) and a SW-IMRT plan (additional constraints for swallowing organs at risk) was created. The difference in NTCP for SWALM6 (Delta NTCPSWALM6 = NTCPstandard - standard NTCPSW-IMRT) was calculated. Patients were treated with SW-IMRT. The external validation of the NTCP model was analyzed by comparing performance measures.

Results: The mean Delta NTCPSWALM6 was 4.9% (range 0.01-17.3%), with a significant lower mean predicted NTCPSW-IMRT of 22.6% (95% CI 20.2-24.9%), compared to NTCPstandard standard of 27.5% (95% CI 24.9-29.9%) (p <0.001). There was a perfect correspondence of NTCPSW-IMRT with the observed prevalence of SWAL(M6) (22.6%). The overall model performance, discrimination and 'goodness of fit' were good.

Conclusion: We externally validated the multivariable NTCP model for SWAL(M6) in SW-IMRT treated patients, showing reduced swallowing dysfunction by reducing the dose parameters included in this NTCP model. (C) 2015 The Authors. Published by Elsevier Ireland Ltd.

Original language	English
Pages (from-to)	298-303
Number of pages	6
Journal	Radiotherapy and Oncology
Volume	118
Issue number	2
DOIs	https://doi.org/10.1016/j.radonc.2015.11.009
Publication status	Published - Feb-2016

Keywords

Radiotherapy
Head and neck cancer
Swallowing sparing IMRT
Model based approach
QUALITY-OF-LIFE
OROPHARYNGEAL CANCER
VOLUME PARAMETERS
PREDICTION MODELS
DYSPHAGIA
IMPACT
PERFORMANCE
DYSFUNCTION
DEPENDENCE
TOXICITY

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Christianen, M. E. M. C., van der Schaaf, A., van der Laan, H. P., Verdonck-de Leeuw, I. M., Doornaert, P., Chouvalova, O., Steenbakkers, R. J. H. M., Leemans, C. R., Oosting, S. F., van der Laan, B. F. A. M., Roodenburg, J. L. N., Slotman, B. J., Bijl, H. P., & Langendijk, J. A. (2016). Swallowing sparing intensity modulated radiotherapy (SW-IMRT) in head and neck cancer: Clinical validation according to the model-based approach. Radiotherapy and Oncology, 118(2), 298-303. https://doi.org/10.1016/j.radonc.2015.11.009

@article{1325ac5056d64b63b0df1d3748a01be0,

title = "Swallowing sparing intensity modulated radiotherapy (SW-IMRT) in head and neck cancer: Clinical validation according to the model-based approach",

abstract = "Purpose: The aim of this study was to clinically validate a multivariable normal tissue complication probability (NTCP) model for grade 2-4 swallowing dysfunction at 6 months after radiotherapy or chemoradiation (SWAL(M6)) in head and neck cancer patients treated with swallowing sparing intensity modulated radiotherapy (SW-IMRT) and to test if SW-IMRT resulted in a reduction of the prevalence of SWAL(M6).Materials and methods: The primary endpoint was SWAL(M6). For all 186 patients, a standard IMRT (parotid sparing) and a SW-IMRT plan (additional constraints for swallowing organs at risk) was created. The difference in NTCP for SWALM6 (Delta NTCPSWALM6 = NTCPstandard - standard NTCPSW-IMRT) was calculated. Patients were treated with SW-IMRT. The external validation of the NTCP model was analyzed by comparing performance measures.Results: The mean Delta NTCPSWALM6 was 4.9% (range 0.01-17.3%), with a significant lower mean predicted NTCPSW-IMRT of 22.6% (95% CI 20.2-24.9%), compared to NTCPstandard standard of 27.5% (95% CI 24.9-29.9%) (p <0.001). There was a perfect correspondence of NTCPSW-IMRT with the observed prevalence of SWAL(M6) (22.6%). The overall model performance, discrimination and 'goodness of fit' were good.Conclusion: We externally validated the multivariable NTCP model for SWAL(M6) in SW-IMRT treated patients, showing reduced swallowing dysfunction by reducing the dose parameters included in this NTCP model. (C) 2015 The Authors. Published by Elsevier Ireland Ltd.",

keywords = "Radiotherapy, Head and neck cancer, Swallowing sparing IMRT, Model based approach, QUALITY-OF-LIFE, OROPHARYNGEAL CANCER, VOLUME PARAMETERS, PREDICTION MODELS, DYSPHAGIA, IMPACT, PERFORMANCE, DYSFUNCTION, DEPENDENCE, TOXICITY",

author = "Christianen, {Miranda E. M. C.} and {van der Schaaf}, Arjen and {van der Laan}, {Hans Paul} and {Verdonck-de Leeuw}, {Irma M.} and Patricia Doornaert and Olga Chouvalova and Steenbakkers, {Roel J. H. M.} and Leemans, {Charles Rene} and Oosting, {Sjoukje F.} and {van der Laan}, {Bernard F. A. M.} and Roodenburg, {Jan L. N.} and Slotman, {Ben J.} and Bijl, {Hendrik P.} and Langendijk, {Johannes A.}",

year = "2016",

month = feb,

doi = "10.1016/j.radonc.2015.11.009",

language = "English",

volume = "118",

pages = "298--303",

journal = "Radiotherapy and Oncology",

issn = "0167-8140",

publisher = "ELSEVIER IRELAND LTD",

number = "2",

}

Christianen, MEMC, van der Schaaf, A , van der Laan, HP, Verdonck-de Leeuw, IM, Doornaert, P, Chouvalova, O , Steenbakkers, RJHM, Leemans, CR, Oosting, SF, van der Laan, BFAM, Roodenburg, JLN, Slotman, BJ, Bijl, HP & Langendijk, JA 2016, 'Swallowing sparing intensity modulated radiotherapy (SW-IMRT) in head and neck cancer: Clinical validation according to the model-based approach', Radiotherapy and Oncology, vol. 118, no. 2, pp. 298-303. https://doi.org/10.1016/j.radonc.2015.11.009

Swallowing sparing intensity modulated radiotherapy (SW-IMRT) in head and neck cancer: Clinical validation according to the model-based approach. / Christianen, Miranda E. M. C.; van der Schaaf, Arjen ; van der Laan, Hans Paul et al.
In: Radiotherapy and Oncology, Vol. 118, No. 2, 02.2016, p. 298-303.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Swallowing sparing intensity modulated radiotherapy (SW-IMRT) in head and neck cancer

T2 - Clinical validation according to the model-based approach

AU - Christianen, Miranda E. M. C.

AU - van der Schaaf, Arjen

AU - van der Laan, Hans Paul

AU - Verdonck-de Leeuw, Irma M.

AU - Doornaert, Patricia

AU - Chouvalova, Olga

AU - Steenbakkers, Roel J. H. M.

AU - Leemans, Charles Rene

AU - Oosting, Sjoukje F.

AU - van der Laan, Bernard F. A. M.

AU - Roodenburg, Jan L. N.

AU - Slotman, Ben J.

AU - Bijl, Hendrik P.

AU - Langendijk, Johannes A.

PY - 2016/2

Y1 - 2016/2

N2 - Purpose: The aim of this study was to clinically validate a multivariable normal tissue complication probability (NTCP) model for grade 2-4 swallowing dysfunction at 6 months after radiotherapy or chemoradiation (SWAL(M6)) in head and neck cancer patients treated with swallowing sparing intensity modulated radiotherapy (SW-IMRT) and to test if SW-IMRT resulted in a reduction of the prevalence of SWAL(M6).Materials and methods: The primary endpoint was SWAL(M6). For all 186 patients, a standard IMRT (parotid sparing) and a SW-IMRT plan (additional constraints for swallowing organs at risk) was created. The difference in NTCP for SWALM6 (Delta NTCPSWALM6 = NTCPstandard - standard NTCPSW-IMRT) was calculated. Patients were treated with SW-IMRT. The external validation of the NTCP model was analyzed by comparing performance measures.Results: The mean Delta NTCPSWALM6 was 4.9% (range 0.01-17.3%), with a significant lower mean predicted NTCPSW-IMRT of 22.6% (95% CI 20.2-24.9%), compared to NTCPstandard standard of 27.5% (95% CI 24.9-29.9%) (p <0.001). There was a perfect correspondence of NTCPSW-IMRT with the observed prevalence of SWAL(M6) (22.6%). The overall model performance, discrimination and 'goodness of fit' were good.Conclusion: We externally validated the multivariable NTCP model for SWAL(M6) in SW-IMRT treated patients, showing reduced swallowing dysfunction by reducing the dose parameters included in this NTCP model. (C) 2015 The Authors. Published by Elsevier Ireland Ltd.

AB - Purpose: The aim of this study was to clinically validate a multivariable normal tissue complication probability (NTCP) model for grade 2-4 swallowing dysfunction at 6 months after radiotherapy or chemoradiation (SWAL(M6)) in head and neck cancer patients treated with swallowing sparing intensity modulated radiotherapy (SW-IMRT) and to test if SW-IMRT resulted in a reduction of the prevalence of SWAL(M6).Materials and methods: The primary endpoint was SWAL(M6). For all 186 patients, a standard IMRT (parotid sparing) and a SW-IMRT plan (additional constraints for swallowing organs at risk) was created. The difference in NTCP for SWALM6 (Delta NTCPSWALM6 = NTCPstandard - standard NTCPSW-IMRT) was calculated. Patients were treated with SW-IMRT. The external validation of the NTCP model was analyzed by comparing performance measures.Results: The mean Delta NTCPSWALM6 was 4.9% (range 0.01-17.3%), with a significant lower mean predicted NTCPSW-IMRT of 22.6% (95% CI 20.2-24.9%), compared to NTCPstandard standard of 27.5% (95% CI 24.9-29.9%) (p <0.001). There was a perfect correspondence of NTCPSW-IMRT with the observed prevalence of SWAL(M6) (22.6%). The overall model performance, discrimination and 'goodness of fit' were good.Conclusion: We externally validated the multivariable NTCP model for SWAL(M6) in SW-IMRT treated patients, showing reduced swallowing dysfunction by reducing the dose parameters included in this NTCP model. (C) 2015 The Authors. Published by Elsevier Ireland Ltd.

KW - Radiotherapy

KW - Head and neck cancer

KW - Swallowing sparing IMRT

KW - Model based approach

KW - QUALITY-OF-LIFE

KW - OROPHARYNGEAL CANCER

KW - VOLUME PARAMETERS

KW - PREDICTION MODELS

KW - DYSPHAGIA

KW - IMPACT

KW - PERFORMANCE

KW - DYSFUNCTION

KW - DEPENDENCE

KW - TOXICITY

U2 - 10.1016/j.radonc.2015.11.009

DO - 10.1016/j.radonc.2015.11.009

M3 - Article

C2 - 26700602

SN - 0167-8140

VL - 118

SP - 298

EP - 303

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

IS - 2

ER -

Swallowing sparing intensity modulated radiotherapy (SW-IMRT) in head and neck cancer: Clinical validation according to the model-based approach

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Keywords

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