Evaluation of a comprehensive set of normal tissue complication probability models for patients with head and neck cancer in an international cohort

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology Pub Date : 2025-03-01 DOI:10.1016/j.oraloncology.2025.107224

Suzanne P.M. de Vette , Maria I. van Rijn-Dekker , Lisa Van den Bosch , Kylie Keijzer , Hendrike Neh , Hung Chu , Yan Li , Mark L. Frederiks , Hans Paul van der Laan , Jolien Heukelom , Peter van Luijk , Arjen van der Schaaf , Roel J.H.M. Steenbakkers , Nanna M. Sijtsema , Katherine A. Hutcheson , Clifton D. Fuller , Johannes A. Langendijk , Amy C. Moreno , Lisanne V. van Dijk

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引用次数: 0

Abstract

Background/purpose

Normal tissue complication probability (NTCP) models can be used to guide radiation therapy (RT) decisions by estimating side-effect risks pretreatment to minimize (late) side-effects. Recently, a comprehensive individual toxicity risk (CITOR) profile of NTCP models addressing common side-effects in head and neck cancer (HNC) patients was developed. This study investigates the generalizability of these models in an international setting, with different treatment approaches and side-effect assessments, promoting their integration into more widespread clinical practice.

Materials/methods

From a prospective registry study, 407 HNC patients were included who were treated with definitive RT with or without systemic therapy between 2015 and 2022. NTCP models predicting dysphagia, aspiration, xerostomia, sticky saliva, taste loss, speech problems, oral pain, and fatigue at 6 and 12 months after RT were evaluated. All side-effects were patient-rated using the MDASI-HN, except dysphagia which was reported by clinicians using the PSS-HN diet normalcy score. Model performance was appraised by discrimination (area under the curve [AUC]) and calibration.

Results

CITOR models showed moderate-to-high performance in this cohort (mean AUC = 0.67[range = 0.55–0.80], moderate-to-good calibration). NTCP models for dysphagia, xerostomia, sticky saliva, and fatigue were the top performing models. Models for aspiration, taste loss and speech problems performed moderately well, which was partly explained by lower incidences.

Conclusion

Despite differences between the CITOR development and this evaluation cohort, including use of different side-effect scoring systems, most models exhibited moderate-to-high performance. This demonstrated that the dose–effect relations were generalizable. Therefore, this study supports further integration of these NTCP models in clinical practice.

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评估国际队列中头颈癌患者的一整套正常组织并发症概率模型

背景/目的正常组织并发症概率（NTCP）模型可用于指导放射治疗（RT）决策，通过估计副作用风险预处理以减少（晚期）副作用。最近，一项针对头颈癌（HNC）患者常见副作用的NTCP模型的综合个体毒性风险（CITOR）概况被开发出来。本研究通过不同的治疗方法和副作用评估，探讨了这些模型在国际环境下的普遍性，促进它们融入更广泛的临床实践。材料/方法一项前瞻性登记研究纳入了407例HNC患者，这些患者在2015年至2022年期间接受了有或无全身治疗的最终RT治疗。评估RT后6个月和12个月预测吞咽困难、误吸、口干、唾液粘稠、味觉丧失、语言问题、口腔疼痛和疲劳的NTCP模型。所有的副作用都是用MDASI-HN评分的，除了吞咽困难是由临床医生用PSS-HN饮食正常评分报告的。通过判别（曲线下面积[AUC]）和校准来评价模型的性能。结果scitor模型在该队列中表现出中高的性能（平均AUC = 0.67[范围= 0.55-0.80]，中等至良好的校准）。吞咽困难、口干、唾液粘稠和疲劳的NTCP模型表现最好。对于误吸、味觉丧失和语言问题的模型表现得比较好，部分原因是发病率较低。结论：尽管CITOR开发与本评估队列存在差异，包括使用不同的副作用评分系统，但大多数模型表现出中高的性能。这表明剂量-效应关系是可推广的。因此，本研究支持在临床实践中进一步整合这些NTCP模型。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oral oncology 医学-牙科与口腔外科

CiteScore

8.70

自引率

10.40%

发文量

505

审稿时长

20 days

期刊介绍： Oral Oncology is an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, editorials, and commentaries relating to the etiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck. Oral Oncology is of interest to head and neck surgeons, radiation and medical oncologists, maxillo-facial surgeons, oto-rhino-laryngologists, plastic surgeons, pathologists, scientists, oral medical specialists, special care dentists, dental care professionals, general dental practitioners, public health physicians, palliative care physicians, nurses, radiologists, radiographers, dieticians, occupational therapists, speech and language therapists, nutritionists, clinical and health psychologists and counselors, professionals in end of life care, as well as others interested in these fields.