Multivariable normal tissue complication probability model-based treatment plan optimization for grade 2-4 dysphagia and tube feeding dependence in head and neck radiotherapy

Roel G J Kierkels*, Kim Wopken, Ruurd Visser, Erik W Korevaar, Arjen van der Schaaf, Hendrik P Bijl, Johannes A Langendijk

*Bijbehorende auteur voor dit werk

OnderzoeksoutputAcademicpeer review

15 Citaten (Scopus)


Background and purpose: Radiotherapy of the head and neck is challenged by the relatively large number of organs-at-risk close to the tumor. Biologically-oriented objective functions (OF) could optimally distribute the dose among the organs-at-risk. We aimed to explore OFs based on multivariable normal tissue complication probability (NTCP) models for grade 2-4 dysphagia (DYS) and tube feeding dependence (TFD).

Materials and methods: One hundred head and neck cancer patients were studied. Additional to the clinical plan, two more plans (an OFDYS and OFTFD-plan) were optimized per patient. The NTCP models included up to four dose-volume parameters and other non-dosimetric factors. A fully automatic plan optimization framework was used to optimize the Of(NTCP)-based plans.

Results: All OFNTCP-based plans were reviewed and classified as clinically acceptable. On average, the Delta dose and Delta NTCP were small comparing the OFDYS-plan, OFTFD-plan, and clinical plan. For 5% of patients NTCPTFD reduced >5% using OFTFD-based planning compared to the OFDYS-plans.

Conclusions: Plan optimization using NTCPDYS- and NTCPTFD-based objective functions resulted in clinically acceptable plans. For patients with considerable risk factors of TFD, the OFTFD steered the optimizer to dose distributions which directly led to slightly lower predicted NTCPTFD values as compared to the other studied plans. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Originele taal-2English
Pagina's (van-tot)374-380
Aantal pagina's7
TijdschriftRadiotherapy and Oncology
Nummer van het tijdschrift3
Vroegere onlinedatum7-sep.-2016
StatusPublished - dec.-2016

Citeer dit