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The normal tissue complication probability model-based approach considering uncertainties for the selective use of radiation modality in primary liver cancer patients. | LitMetric

The normal tissue complication probability model-based approach considering uncertainties for the selective use of radiation modality in primary liver cancer patients.

Radiother Oncol

Global Station for Quantum Biomedical Science and Engineering, Global Institute for Cooperative Research and Education, Hokkaido University, Sapporo, Japan; Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan. Electronic address:

Published: June 2019

AI Article Synopsis

  • The study aimed to predict the likelihood of radiation-induced liver toxicity (RILT) in primary liver cancer patients by using an NTCP model, helping to select candidates for advanced treatments like proton beam therapy based on specific toxicity thresholds.
  • The researchers analyzed data from 239 patients, finding a 55% incidence of grade ≥2 RILT; notable differences were observed in risk based on liver function status (Child-Pugh classification) and the presence of viral hepatitis.
  • The outcomes suggest that accounting for individual patient characteristics and uncertainties can enhance treatment decisions, highlighting that patients with certain conditions are more at risk for severe RILT.

Article Abstract

Purpose: To predict the probability of radiation-induced liver toxicity (RILT) and implement the normal tissue complication probability (NTCP) model-based approach considering confidence intervals (CIs) to select patients for new treatment techniques, such as proton beam therapy, based on a certain NTCP reduction (ΔNTCP) threshold for primary liver cancer patients.

Methods And Materials: Common Toxicity Criteria for Adverse Events (CTCAE) grade ≥2 RILT was scored. The Lyman NTCP models predicting the probability of CTCAE grade ≥2 RILT as a function of the fraction-size adjusted mean liver dose (MLD), using reference fraction size = 2 Gy/fraction and α/β ratio = 2 Gy, were fitted using the maximum likelihood method. At certain combinations of MLDs, ΔNTCP with a CI was evaluated by the delta method.

Results: Of the 239 patients, the incidence of CTCAE grade ≥2 RILT was 55% (46% in the Child-Pugh (CP)-A vs. 81% in the CP-B/C, p < 0.001). Among 180 CP-A patients, 40% who had viral hepatitis infections experienced toxicity vs. 32% in the nonhepatitis subgroup. The MLD was 18 Gy in the toxicity group vs. 16.1 Gy in the nontoxicity group (p = 0.002). The estimated NTCP model parameters specific to the patient subgroups and the ΔNTCP with CI assuming a particular CP classification and viral hepatitis infection status were considerably different which possible changed treatment decision.

Conclusions: Patients with CP-A and viral hepatitis infection or CP-B/C cirrhosis had greater susceptibility to CTCAE grade ≥2 RILT. The estimated NTCP and ΔNTCP for individual patients along with a consideration of uncertainties improve the reliability of the NTCP model-based approach.

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Source
http://dx.doi.org/10.1016/j.radonc.2019.03.003DOI Listing

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