Comparison of Estimated Late Toxicities between IMPT and IMRT Based on Multivariable NTCP Models for High-Risk Prostate Cancers Treated with Pelvic Nodal Radiation.

IF 2.1 Q3 ONCOLOGY International Journal of Particle Therapy Pub Date : 2022-06-13 eCollection Date: 2022-01-01 DOI:10.14338/IJPT-21-00042.1
Srinivas Chilukuri, Sham Sundar, Kartikeswar Patro, Mayur Sawant, Rangasamy Sivaraman, Manikandan Arjunan, Pankaj Kumar Panda, Dayananda Sharma, Rakesh Jalali
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Abstract

Purpose: To compare the late gastrointestinal (GI) and genitourinary toxicities (GU) estimated using multivariable normal tissue complication probability (NTCP) models, between pencil-beam scanning proton beam therapy (PBT) and helical tomotherapy (HT) in patients of high-risk prostate cancers requiring pelvic nodal irradiation (PNI) using moderately hypofractionated regimen.

Materials and methods: Twelve consecutive patients treated with PBT at our center were replanned with HT using the same planning goals. Six late GI and GU toxicity domains (stool frequency, rectal bleeding, fecal incontinence, dysuria, urinary incontinence, and hematuria) were estimated based on the published multivariable NTCP models. The ΔNTCP (difference in absolute NTCP between HT and PBT plans) for each of the toxicity domains was calculated. A one-sample Kolmogorov-Smirnov test was used to analyze distribution of data, and either a paired t test or a Wilcoxon matched-pair signed rank test was used to test statistical significance.

Results: Proton beam therapy and HT plans achieved adequate target coverage. Proton beam therapy plans led to significantly better sparing of bladder, rectum, and bowel bag especially in the intermediate range of 15 to 40 Gy, whereas doses to penile bulb and femoral heads were higher with PBT plans. The average ΔNTCP for grade (G)2 rectal bleeding, fecal incontinence, stool frequency, dysuria, urinary incontinence, and G1 hematuria was 12.17%, 1.67%, 2%, 5.83%, 2.42%, and 3.91%, respectively, favoring PBT plans. The average cumulative ΔNTCP for GI and GU toxicities (ΣΔNTCP) was 16.58% and 11.41%, respectively, favoring PBT. Using a model-based selection threshold of any G2 ΔNTCP >10%, 67% (8 patients) would be eligible for PBT.

Conclusion: Proton beam therapy plans led to superior sparing of organs at risk compared with HT, which translated to lower NTCP for late moderate GI and GU toxicities in patients of prostate cancer treated with PNI. For two-thirds of our patients, the difference in estimated absolute NTCP values between PBT and HT crossed the accepted threshold for minimal clinically important difference.

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基于多变量NTCP模型的盆腔淋巴结放射治疗高危前列腺癌IMPT和IMRT的估计晚期毒性比较
目的:比较使用多变量正常组织并发症概率(NTCP)模型估计的晚期胃肠道(GI)和泌尿生殖系统毒性(GU),铅笔束扫描质子束治疗(PBT)和螺旋断层治疗(HT)对需要盆腔淋巴结放射治疗(PNI)的高危前列腺癌患者采用中度低分割方案。材料和方法:12例连续在本中心接受PBT治疗的患者使用相同的计划目标重新计划HT。根据已发表的多变量NTCP模型估计了6个晚期GI和GU毒性域(大便频率、直肠出血、大便失禁、排尿困难、尿失禁和血尿)。计算每个毒性区域的ΔNTCP (HT和PBT方案之间的绝对NTCP差异)。采用单样本Kolmogorov-Smirnov检验分析数据分布,采用配对t检验或Wilcoxon配对对符号秩检验检验统计显著性。结果:质子束治疗和高温疗法计划达到了足够的目标覆盖率。质子束治疗方案能更好地保护膀胱、直肠和肠袋,特别是在15 - 40 Gy的中间范围内,而PBT方案对阴茎球和股骨头的剂量更高。(G)2级直肠出血、大便失禁、大便频率、排尿困难、尿失禁和G1级血尿的平均ΔNTCP分别为12.17%、1.67%、2%、5.83%、2.42%和3.91%,支持PBT方案。GI和GU毒性(ΣΔNTCP)的平均累积ΔNTCP分别为16.58%和11.41%,有利于PBT。使用基于模型的选择阈值,任何G2 ΔNTCP >10%, 67%(8名患者)将符合PBT。结论:与HT相比,质子束治疗方案能更好地保留有危险的器官,这意味着PNI治疗前列腺癌患者中晚期GI和GU毒性的NTCP降低。对于三分之二的患者,PBT和HT之间估计的绝对NTCP值的差异超过了最小临床重要差异的可接受阈值。
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来源期刊
International Journal of Particle Therapy
International Journal of Particle Therapy Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
3.70
自引率
5.90%
发文量
23
审稿时长
20 weeks
期刊最新文献
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