Patient anatomy-specific trade-offs between sub-clinical disease coverage and normal tissue dose reduction in head-and-neck cancer

Laura Patricia Kaplan; Anne Ivalu Sander Holm; Jesper Grau Eriksen; Ben J.M. Heijmen; Stine Sofia Korreman; Linda Rossi

doi:10.1016/j.radonc.2023.109526

Patient anatomy-specific trade-offs between sub-clinical disease coverage and normal tissue dose reduction in head-and-neck cancer

Laura Patricia Kaplan^*, Anne Ivalu Sander Holm, Jesper Grau Eriksen, Ben J.M. Heijmen, Stine Sofia Korreman, Linda Rossi

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

Abstract

Purpose: Risk of subclinical disease decreases with increasing distance from the GTV in head- and-neck squamous cell carcinoma (HNSCC). Depending on individual patient anatomy, OAR sparing could be improved by reducing target coverage in regions with low risk of subclinical spread. Using automated multi-criteria optimization, we investigate patient-specific optimal trade-offs between target periphery coverage and OAR sparing. Methods: VMAT plans for 39 HNSCC patients were retrospectively created following our clinical three-target-level protocol: high-risk (PTV1), intermediate-risk (PTV2, 5 mm expansion from PTV1), and elective (PTV3). A baseline plan fulfilling clinical constraints (D 99 % ≥95 % for all PTVs) was compared to three plans with reduced PTV2 coverage (goals: PTV2 D 99 % ≥90 % or 85 %, or no PTV2) at the outer edge of PTV2. Plans were compared on PTV D 99 %, OAR D mean, and NTCP (xerostomia/dysphagia). Results: Trade-offs between PTV2 coverage and OAR doses varied considerably between patients. For plans with PTV2 D 99 % -goal 90 %, median PTV2 D 99 % was 91.5 % resulting in xerostomia (≥grade 4) and dysphagia (≥grade 2) NTCP decrease of median [maximum] 1.9 % [5.3 %] and 1.1 % [4.1 %], respectively, compared to nominal PTV2 D 99 % -goal 95 %. For PTV2 D 99 % -goal 85 % median PTV D 99 % was 87 % with NTCP improvements of 4.6 % [9.9 %] and 1.5 % [5.4 %]. For no-margin plans, PTV2 D 99 % decreased to 83.3 % with NTCP reductions of 5.1 % [10.2 %] and 1.4 % [6.1 %]. Conclusion: Clinically relevant, patient-specific reductions in OARs and NTCP were observed at limited cost in target under-coverage at the outermost PTV edge. Given the observed inter-patient variations, individual evaluation is warranted to determine whether trade- offs would benefit a specific patient.

Originalsprog	Engelsk
Artikelnummer	109526
Tidsskrift	Radiotherapy and Oncology
Vol/bind	182
Antal sider	8
ISSN	0167-8140
DOI	https://doi.org/10.1016/j.radonc.2023.109526
Status	Udgivet - maj 2023

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10.1016/j.radonc.2023.109526

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@article{273b6d6dcab14c918acfb7fb62388407,

title = "Patient anatomy-specific trade-offs between sub-clinical disease coverage and normal tissue dose reduction in head-and-neck cancer",

abstract = "Purpose: Risk of subclinical disease decreases with increasing distance from the GTV in head- and-neck squamous cell carcinoma (HNSCC). Depending on individual patient anatomy, OAR sparing could be improved by reducing target coverage in regions with low risk of subclinical spread. Using automated multi-criteria optimization, we investigate patient-specific optimal trade-offs between target periphery coverage and OAR sparing. Methods: VMAT plans for 39 HNSCC patients were retrospectively created following our clinical three-target-level protocol: high-risk (PTV1), intermediate-risk (PTV2, 5 mm expansion from PTV1), and elective (PTV3). A baseline plan fulfilling clinical constraints (D 99 % ≥95 % for all PTVs) was compared to three plans with reduced PTV2 coverage (goals: PTV2 D 99 % ≥90 % or 85 %, or no PTV2) at the outer edge of PTV2. Plans were compared on PTV D 99 %, OAR D mean, and NTCP (xerostomia/dysphagia). Results: Trade-offs between PTV2 coverage and OAR doses varied considerably between patients. For plans with PTV2 D 99 % -goal 90 %, median PTV2 D 99 % was 91.5 % resulting in xerostomia (≥grade 4) and dysphagia (≥grade 2) NTCP decrease of median [maximum] 1.9 % [5.3 %] and 1.1 % [4.1 %], respectively, compared to nominal PTV2 D 99 % -goal 95 %. For PTV2 D 99 % -goal 85 % median PTV D 99 % was 87 % with NTCP improvements of 4.6 % [9.9 %] and 1.5 % [5.4 %]. For no-margin plans, PTV2 D 99 % decreased to 83.3 % with NTCP reductions of 5.1 % [10.2 %] and 1.4 % [6.1 %]. Conclusion: Clinically relevant, patient-specific reductions in OARs and NTCP were observed at limited cost in target under-coverage at the outermost PTV edge. Given the observed inter-patient variations, individual evaluation is warranted to determine whether trade- offs would benefit a specific patient.",

keywords = "Automated planning, Head-and-neck squamous cell carcinoma, Multi-criteria optimization, Patient anatomy-specific target/OAR trade-offs, Radiotherapy Dosage, Squamous Cell Carcinoma of Head and Neck/radiotherapy, Radiotherapy Planning, Computer-Assisted/methods, Radiotherapy, Intensity-Modulated/methods, Humans, Organs at Risk, Head and Neck Neoplasms/radiotherapy, Deglutition Disorders, Retrospective Studies, Drug Tapering",

author = "Kaplan, {Laura Patricia} and Holm, {Anne Ivalu Sander} and Eriksen, {Jesper Grau} and Heijmen, {Ben J.M.} and Korreman, {Stine Sofia} and Linda Rossi",

note = "Funding Information: LPK was supported by DCCC Radiotherapy - The Danish National Research Center for Radiotherapy, Danish Cancer Society (Grant No. R191-A11526] and Danish Comprehensive Cancer Center, and the Danish Cancer Society (Grant No. R167-A11003]. Funding Information: LPK and SK were supported by Aarhus University Research Foundation (Grant No AUFF-F-2016-FLS-8-4). Publisher Copyright: {\textcopyright} 2023 Elsevier B.V.",

year = "2023",

month = may,

doi = "10.1016/j.radonc.2023.109526",

language = "English",

volume = "182",

journal = "Radiotherapy and Oncology",

issn = "0167-8140",

publisher = "Elsevier Ireland Ltd.",

}

Patient anatomy-specific trade-offs between sub-clinical disease coverage and normal tissue dose reduction in head-and-neck cancer. / Kaplan, Laura Patricia; Holm, Anne Ivalu Sander; Eriksen, Jesper Grau et al.
I: Radiotherapy and Oncology, Bind 182, 109526, 05.2023.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Patient anatomy-specific trade-offs between sub-clinical disease coverage and normal tissue dose reduction in head-and-neck cancer

AU - Kaplan, Laura Patricia

AU - Holm, Anne Ivalu Sander

AU - Eriksen, Jesper Grau

AU - Heijmen, Ben J.M.

AU - Korreman, Stine Sofia

AU - Rossi, Linda

N1 - Funding Information: LPK was supported by DCCC Radiotherapy - The Danish National Research Center for Radiotherapy, Danish Cancer Society (Grant No. R191-A11526] and Danish Comprehensive Cancer Center, and the Danish Cancer Society (Grant No. R167-A11003]. Funding Information: LPK and SK were supported by Aarhus University Research Foundation (Grant No AUFF-F-2016-FLS-8-4). Publisher Copyright: © 2023 Elsevier B.V.

PY - 2023/5

Y1 - 2023/5

N2 - Purpose: Risk of subclinical disease decreases with increasing distance from the GTV in head- and-neck squamous cell carcinoma (HNSCC). Depending on individual patient anatomy, OAR sparing could be improved by reducing target coverage in regions with low risk of subclinical spread. Using automated multi-criteria optimization, we investigate patient-specific optimal trade-offs between target periphery coverage and OAR sparing. Methods: VMAT plans for 39 HNSCC patients were retrospectively created following our clinical three-target-level protocol: high-risk (PTV1), intermediate-risk (PTV2, 5 mm expansion from PTV1), and elective (PTV3). A baseline plan fulfilling clinical constraints (D 99 % ≥95 % for all PTVs) was compared to three plans with reduced PTV2 coverage (goals: PTV2 D 99 % ≥90 % or 85 %, or no PTV2) at the outer edge of PTV2. Plans were compared on PTV D 99 %, OAR D mean, and NTCP (xerostomia/dysphagia). Results: Trade-offs between PTV2 coverage and OAR doses varied considerably between patients. For plans with PTV2 D 99 % -goal 90 %, median PTV2 D 99 % was 91.5 % resulting in xerostomia (≥grade 4) and dysphagia (≥grade 2) NTCP decrease of median [maximum] 1.9 % [5.3 %] and 1.1 % [4.1 %], respectively, compared to nominal PTV2 D 99 % -goal 95 %. For PTV2 D 99 % -goal 85 % median PTV D 99 % was 87 % with NTCP improvements of 4.6 % [9.9 %] and 1.5 % [5.4 %]. For no-margin plans, PTV2 D 99 % decreased to 83.3 % with NTCP reductions of 5.1 % [10.2 %] and 1.4 % [6.1 %]. Conclusion: Clinically relevant, patient-specific reductions in OARs and NTCP were observed at limited cost in target under-coverage at the outermost PTV edge. Given the observed inter-patient variations, individual evaluation is warranted to determine whether trade- offs would benefit a specific patient.

AB - Purpose: Risk of subclinical disease decreases with increasing distance from the GTV in head- and-neck squamous cell carcinoma (HNSCC). Depending on individual patient anatomy, OAR sparing could be improved by reducing target coverage in regions with low risk of subclinical spread. Using automated multi-criteria optimization, we investigate patient-specific optimal trade-offs between target periphery coverage and OAR sparing. Methods: VMAT plans for 39 HNSCC patients were retrospectively created following our clinical three-target-level protocol: high-risk (PTV1), intermediate-risk (PTV2, 5 mm expansion from PTV1), and elective (PTV3). A baseline plan fulfilling clinical constraints (D 99 % ≥95 % for all PTVs) was compared to three plans with reduced PTV2 coverage (goals: PTV2 D 99 % ≥90 % or 85 %, or no PTV2) at the outer edge of PTV2. Plans were compared on PTV D 99 %, OAR D mean, and NTCP (xerostomia/dysphagia). Results: Trade-offs between PTV2 coverage and OAR doses varied considerably between patients. For plans with PTV2 D 99 % -goal 90 %, median PTV2 D 99 % was 91.5 % resulting in xerostomia (≥grade 4) and dysphagia (≥grade 2) NTCP decrease of median [maximum] 1.9 % [5.3 %] and 1.1 % [4.1 %], respectively, compared to nominal PTV2 D 99 % -goal 95 %. For PTV2 D 99 % -goal 85 % median PTV D 99 % was 87 % with NTCP improvements of 4.6 % [9.9 %] and 1.5 % [5.4 %]. For no-margin plans, PTV2 D 99 % decreased to 83.3 % with NTCP reductions of 5.1 % [10.2 %] and 1.4 % [6.1 %]. Conclusion: Clinically relevant, patient-specific reductions in OARs and NTCP were observed at limited cost in target under-coverage at the outermost PTV edge. Given the observed inter-patient variations, individual evaluation is warranted to determine whether trade- offs would benefit a specific patient.

KW - Automated planning

KW - Head-and-neck squamous cell carcinoma

KW - Multi-criteria optimization

KW - Patient anatomy-specific target/OAR trade-offs

KW - Radiotherapy Dosage

KW - Squamous Cell Carcinoma of Head and Neck/radiotherapy

KW - Radiotherapy Planning, Computer-Assisted/methods

KW - Radiotherapy, Intensity-Modulated/methods

KW - Humans

KW - Organs at Risk

KW - Head and Neck Neoplasms/radiotherapy

KW - Deglutition Disorders

KW - Retrospective Studies

KW - Drug Tapering

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U2 - 10.1016/j.radonc.2023.109526

DO - 10.1016/j.radonc.2023.109526

M3 - Journal article

C2 - 36764458

AN - SCOPUS:85148669314

SN - 0167-8140

VL - 182

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

M1 - 109526

ER -

Patient anatomy-specific trade-offs between sub-clinical disease coverage and normal tissue dose reduction in head-and-neck cancer

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