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Modelling duodenum radiotherapy toxicity using cohort dose-volume-histogram data.

Daniel L P Holyoake1, Marianne Aznar2, Somnath Mukherjee3

  • 1CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, United Kingdom.

Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology
|June 11, 2017
PubMed
Summary

Updated Normal Tissue Complication Probability (NTCP) model parameters for gastro-intestinal toxicity in abdominal radiotherapy were derived. These refined parameters, based on published and prospective data, improve predictions for radiation-induced side effects.

Keywords:
DuodenumMeta-analysisNTCPNormal tissuePancreatic cancerToxicity

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Clinical Oncology

Background:

  • Gastro-intestinal toxicity is a primary dose-limiting factor in abdominal radiotherapy.
  • Duodenum dose-volume parameters are strongly correlated with the incidence of this toxicity.

Purpose of the Study:

  • To derive updated Normal Tissue Complication Probability (NTCP) model parameters for gastro-intestinal toxicity.
  • To utilize both published data and prospective, quality-assured cohort data for model refinement.

Main Methods:

  • Systematic literature search for duodenum dose-volume histogram (DVH) data from conventionally-fractionated radiotherapy studies.
  • Derivation of Lyman-Kutcher-Burman (LKB) NTCP model parameters using sum-squared-error minimization and cross-validation.
  • Correction for fraction size, weighting by patient numbers, and refinement with individual patient DVH data from prospective trials.

Main Results:

  • Analysis included six studies with published DVH data and individual patient data from two prospective cohorts, totaling 531 patients.
  • Observed gastro-intestinal toxicity rates varied from 0% to 14% (median 8%).
  • LKB parameters derived from published data (n=0.070, m=0.46, TD50(1)=183.8 Gy) were consistent with those from individual patient data (n=0.193, m=0.51, TD50(1)=299.1 Gy).

Conclusions:

  • The derived LKB parameters using published data align with previous findings from individual patient data.
  • The results support a small volume effect and a dependency on exposure to high threshold doses for gastro-intestinal toxicity.
  • Updated NTCP model parameters enhance the prediction of radiation-induced gastro-intestinal toxicity in abdominal radiotherapy.