Quantifying Unnecessary Normal Tissue Complication Risks due to Suboptimal Planning: A Secondary Study of RTOG 0126

被引:117
作者
Moore, Kevin L. [1 ]
Schmidt, Rachel [2 ]
Moiseenko, Vitali [1 ]
Olsen, Lindsey A. [3 ]
Tan, Jun [3 ]
Xiao, Ying [4 ]
Galvin, James [4 ]
Pugh, Stephanie [5 ]
Seider, Michael J. [6 ]
Dicker, Adam P. [4 ]
Bosch, Walter [3 ]
Michalski, Jeff [3 ]
Mutic, Sasa [3 ]
机构
[1] Univ Calif San Diego, Dept Radiat Med & Appl Sci, La Jolla, CA 92093 USA
[2] Ft Hays State Univ, Dept Phys, Hays, KS 67601 USA
[3] Washington Univ, Dept Radiat Oncol, St Louis, MO USA
[4] Thomas Jefferson Univ Hosp, Philadelphia, PA 19107 USA
[5] NRG, Oncol Stat & Data Management Ctr, Philadelphia, PA USA
[6] Akron City Hosp, Akron, OH USA
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2015年 / 92卷 / 02期
关键词
MODULATED RADIATION-THERAPY; CLINICAL-TRIALS; NECK-CANCER; AT-RISK; RADIOTHERAPY; QUALITY; TOXICITY; OUTCOMES; IMPACT; HEAD;
D O I
10.1016/j.ijrobp.2015.01.046
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: The purpose of this study was to quantify the frequency and clinical severity of quality deficiencies in intensity modulated radiation therapy (IMRT) planning in the Radiation Therapy Oncology Group 0126 protocol. Methods and Materials: A total of 219 IMRT patients from the high-dose arm (79.2 Gy) of RTOG 0126 were analyzed. To quantify plan quality, we used established knowledge-based methods for patient-specific dose-volume histogram (DVH) prediction of organs at risk and a Lyman-Kutcher-Burman (LKB) model for grade >= 2 rectal complications to convert DVHs into normal tissue complication probabilities (NTCPs). The LKB model was validated by fitting dose-response parameters relative to observed toxicities. The 90th percentile (22 of 219) of plans with the lowest excess risk (difference between clinical and model-predicted NTCP) were used to create a model for the presumed best practices in the protocol (pDVH(0126,top10%)). Applying the resultant model to the entire sample enabled comparisons between DVHs that patients could have received to DVHs they actually received. Excess risk quantified the clinical impact of suboptimal planning. Accuracy of pDVH predictions was validated by replanning 30 of 219 patients (13.7%), including equal numbers of presumed "high-quality," "low-quality," and randomly sampled plans. NTCP-predicted toxicities were compared to adverse events on protocol. Results: Existing models showed that bladder-sparing variations were less prevalent than rectum quality variations and that increased rectal sparing was not correlated with target metrics (dose received by 98% and 2% of the PTV, respectively). Observed toxicities were consistent with current LKB parameters. Converting DVH and pDVH(0126,top10%) to rectal NTCPs, we observed 94 of 219 patients (42.9%) with >= 5% excess risk, 20 of 219 patients (9.1%) with >= 10% excess risk, and 2 of 219 patients (0.9%) with >= 15% excess risk. Replanning demonstrated the predicted NTCP reductions while maintaining the volume of the PTV receiving prescription dose. An equivalent sample of high-quality plans showed fewer toxicities than low-quality plans, 6 of 73 versus 10 of 73 respectively, although these differences were not significant (P = .21) due to insufficient statistical power in this retrospective study. Conclusions: Plan quality deficiencies in RTOG 0126 exposed patients to substantial excess risk for rectal complications. (C) 2015 Elsevier Inc. All rights reserved.
引用
收藏
页码:228 / 235
页数:8
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