Multivariable normal tissue complication probability model-based treatment plan optimization for grade 2-4 dysphagia and tube feeding dependence in head and neck radiotherapy.
Radiotherapy of the head and neck is challenged by the relatively large number of organs-at-risk close to the tumor. Biologically-oriented objective functions (OF) could optimally distribute the dose among the organs-at-risk. We aimed to explore OFs based on multivariable normal tissue complication probability (NTCP) models for grade 2-4 dysphagia (DYS) and tube feeding dependence (TFD).



One hundred head and neck cancer patients were studied. Additional to the clinical plan, two more plans (an OFDYSand OFTFD-plan) were optimized per patient. The NTCP models included up to four dose-volume parameters and other non-dosimetric factors. A fully automatic plan optimization framework was used to optimize the OFNTCP-based plans.



All OFNTCP-based plans were reviewed and classified as clinically acceptable. On average, the Δdose and ΔNTCP were small comparing the OFDYS-plan, OFTFD-plan, and clinical plan. For 5% of patients NTCPTFDreduced >5% using OFTFD-based planning compared to the OFDYS-plans.



Plan optimization using NTCPDYS- and NTCPTFD-based objective functions resulted in clinically acceptable plans. For patients with considerable risk factors of TFD, the OFTFDsteered the optimizer to dose distributions which directly led to slightly lower predicted NTCPTFDvalues as compared to the other studied plans.
University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands. Electronic address: R.G.J.Kierkels@umcg.nl.
Roel G J
RGJ
Kierkels
University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands.
Kim
K
Wopken
University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands; Department of Medical Imaging and Radiation Therapy, Hanze University of Applied Sciences, Groningen, The Netherlands.
Ruurd
R
Visser
University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands.
Erik W
EW
Korevaar
University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands.
Arjen
A
van der Schaaf
University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands.
Hendrik P
HP
Bijl
University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands.
Johannes A
JA
Langendijk
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control*; D004750:Enteral Nutrition; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000379:methods; D058958:Organs at Risk / Q000000981:diagnostic imaging / Q000528:radiation effects; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed
Biological-oriented treatment plan optimization; Head and neck cancer; Multi-criteria optimization; Multivariable NTCP models; Swallowing dysfunction; Tube feeding dependence