Optimal timing of organs-at-risk-sparing adaptive radiation therapy for head-and-neck cancer under re-planning resource constraints

被引：0

作者：

Nosrat, Fatemeh ^{[1
]}

Dede, Cem ^{[2
]}

Mccullum, Lucas B. ^{[3
]}

Garcia, Raul ^{[1
]}

Mohamed, Abdallah S. R. ^{[2
,4
]}

Scott, Jacob G. ^{[5
]}

Bates, James E. ^{[6
]}

Mcdonald, Brigid A.

Wahid, Kareem A. ^{[2
]}

Naser, Mohamed A. ^{[2
]}

He, Renjie ^{[2
]}

Karagoz, Aysenur ^{[1
]}

Moreno, Amy C. ^{[2
]}

Dijk, Lisanne V. van ^{[2
,7
]}

Brock, Kristy K. ^{[8
]}

Heukelom, Jolien ^{[9
]}

Hosseinian, Seyedmohammadhossein ^{[10
]}

Hemmati, Mehdi ^{[11
]}

Schaefer, Andrew J. ^{[1
]}

Fuller, Clifton D. ^{[1
,2
]}

机构：

[1] Rice Univ, Dept Computat Appl Math & Operat Res, Houston, TX 77005 USA

[2] Univ Texas MD Anderson Canc Ctr, Dept Radiat Oncol, Houston, TX USA

[3] Univ Texas MD Anderson Canc Ctr, Grad Sch Biomed Sci, UTHealth Houston, Houston, TX 77030 USA

[4] Baylor Coll Med, Dept Radiat Oncol, Houston, TX USA

[5] Lerner Res Inst, Dept Translat Hematol & Oncol Res, Cleveland, OH 44195 USA

[6] Emory Univ, Dept Radiat Oncol, Atlanta, GA USA

[7] Univ Groningen, Univ Med Ctr Groningen, Dept Radiat Oncol, Groningen, Netherlands

[8] Univ Texas MD Anderson Canc Ctr, Dept Imaging Phys, Houston, TX USA

[9] Maastricht Univ, GROW Sch Oncol, Dept Radiat Oncol Maastro, Med Ctr, Maastricht, Netherlands

[10] North Carolina State Univ, Edward P Fitts Dept Ind & Syst Engn, Raleigh, NC USA

[11] Univ Oklahoma, Sch Ind & Syst Engn, Norman, OK 73019 USA

来源：

PHYSICS & IMAGING IN RADIATION ONCOLOGY | 2025年 / 33卷

关键词：

Personalized adaptive radiation therapy; Organs at risk; Normal tissue complication probability; Markov decision process; Optimal strategy; TUMOR VOLUMES; PHASE-II; RADIOTHERAPY; TIME;

D O I：

10.1016/j.phro.2025.100715

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background and purpose: Prior work on adaptive organ-at-risk (OAR)-sparing radiation therapy has typically reported outcomes based on fixed-number or fixed-interval re-planning, which represent one-size-fits-all approaches and do not account for the variable progression of individual patients' toxicities. The purpose of this study was to determine the personalized optimal timing of re-planning in adaptive OAR-sparing radiation therapy, considering limited re-planning resources, for patients with head and neck cancer (HNC). Materials and methods: A novel Markov decision process (MDP) model was developed to determine optimal timing of re-planning based on the patient's expected toxicity, characterized by normal tissue complication probability (NTCP), for four toxicities. The MDP parameters were derived from a dataset comprising 52 HNC patients treated between 2007 and 2013. Kernel density estimation was used to smooth the sample distributions. Optimal re-planning strategies were obtained when the permissible number of re-plans throughout the treatment was limited to 1, 2, and 3, respectively. Results: The MDP (optimal) solution recommended re-planning when the difference between planned and actual NTCPs (Delta NTCP) was greater than or equal to 1%, 2%, 2%, and 4% at treatment fractions 10, 15, 20, and 25, respectively, exhibiting a temporally increasing pattern. The Delta NTCP thresholds remained constant across the number of re-planning allowances (1, 2, and 3). Conclusion: In limited-resource settings that impeded high-frequency adaptations, Delta NTCP thresholds obtained from an MDP model could derive optimal timing of re-planning to minimize the likelihood of treatment toxicities.

引用

页数：6

共 44 条

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