title: Development of a multivariable normal tissue complication probability (NTCP) model for tube feeding dependence after curative radiotherapy/chemo-radiotherapy in head and neck cancer.
abstract: OBJECTIVE
  Curative radiotherapy/chemo-radiotherapy for head and neck cancer (HNC) may result in severe acute and late side effects, including tube feeding dependence. The purpose of this prospective cohort study was to develop a multivariable normal tissue complication probability (NTCP) model for tube feeding dependence 6 months (TUBEM6) after definitive radiotherapy, radiotherapy plus cetuximab or concurrent chemoradiation based on pre-treatment and treatment characteristics.
  
  
  METHODS
  The study included 355 patients with HNC. TUBEM6 was scored prospectively in a standard follow-up program. To design the prediction model, the penalized learning method LASSO was used, with TUBEM6 as the endpoint.
  
  
  RESULTS
  The prevalence of TUBEM6 was 10.7%. The multivariable model with the best performance consisted of the variables: advanced T-stage, moderate to severe weight loss at baseline, accelerated radiotherapy, chemoradiation, radiotherapy plus cetuximab, the mean dose to the superior and inferior pharyngeal constrictor muscle, to the contralateral parotid gland and to the cricopharyngeal muscle.
  
  
  CONCLUSIONS
  We developed a multivariable NTCP model for TUBEM6 to identify patients at risk for tube feeding dependence. The dosimetric variables can be used to optimize radiotherapy treatment planning aiming at prevention of tube feeding dependence and to estimate the benefit of new radiation technologies.
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands. Electronic address: k.wopken@umcg.nl.
authors.forename: Kim
authors.initials: K
authors.lastname: Wopken
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Hendrik P
authors.initials: HP
authors.lastname: Bijl
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Arjen
authors.initials: A
authors.lastname: van der Schaaf
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Hans Paul
authors.initials: HP
authors.lastname: van der Laan
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Olga
authors.initials: O
authors.lastname: Chouvalova
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Roel J H M
authors.initials: RJ
authors.lastname: Steenbakkers
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Patricia
authors.initials: P
authors.lastname: Doornaert
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Slotman
authors.affiliation: Department of Medical Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Sjoukje F
authors.initials: SF
authors.lastname: Oosting
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Miranda E M C
authors.initials: ME
authors.lastname: Christianen
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Bernard F A M
authors.initials: BF
authors.lastname: van der Laan
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Jan L N
authors.initials: JL
authors.lastname: Roodenburg
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: C René
authors.initials: CR
authors.lastname: Leemans
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Irma M
authors.initials: IM
authors.lastname: Verdonck-de Leeuw
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendijk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D000068818:Cetuximab; D059248:Chemoradiotherapy / Q000009:adverse effects*; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D004750:Enteral Nutrition; D004812:Epidemiologic Methods; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D059351:Organ Sparing Treatments / Q000379:methods; D011874:Radiometry; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D016190:Carboplatin; D000068818:Cetuximab; D005472:Fluorouracil
keywords: (chemo-)radiotherapy; Head and neck cancer; IMRT