scholarly journals Can the Risk of Dysphagia in Head and Neck Radiation Therapy Be Predicted by an Automated Transit Fluence Monitoring Process During Treatment? A First Comparative Study of Patient Reported Quality of Life and the Fluence-Based Decision Support Metric

2021 ◽  
Vol 20 ◽  
pp. 153303382110279
Author(s):  
Seng Boh Lim ◽  
Nancy Lee ◽  
Kaveh Zakeri ◽  
Peter Greer ◽  
Todsaporn Fuangrod ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Radiation Therapy ◽  
Decision Support ◽  
Head And Neck ◽  
Pearson Correlation ◽  
Region Of Interest ◽  
P Value ◽  
Patient Reported

Purpose/Objective(s): The additional personnel and imaging procedures required for Adaptive Radiation Therapy (ART) pose a challenge for a broad implementation. We hypothesize that a change in transit fluence during the treatment course is correlated with the change of quality of life and thus can be used as a replanning trigger. Materials/Methods: Twenty-one head and neck cancer (HNC) patients filled out an MD Anderson Dysphagia Inventory (MDADI) questionnaire, before-and-after the radiotherapy treatment course. The transit fluence was measured by the Watchdog (WD) in-vivo portal dosimetry system. The patients were monitored with daily WD and weekly CBCTs. The region of interest (ROI) of each patient was defined as the outer contour of the patient between approximate spine levels C1 to C4, essentially the neck and mandible inside the beam’s eye view. The nth day integrated transit fluence change, Δϕn, and the volume change, ΔVROI, of the ROI of each patient was calculated from the corresponding WD and CBCT measurements. The correlation between MDADI scores and age, gender, planning mean dose to salivary glands <Dsg>, weight change ΔW, ΔVROI, and Δϕn, were analyzed using the ranked-Pearson correlation. Results: No statistically significant correlation was found for age, gender and ΔW. <Dsg> was found to have clinically important correlation with functional MDADI (ρ = −0.39, P = 0.081). ΔVROI was found to have statistically significant correlation of 0.44, 0.47 and 0.44 with global, physical and functional MDADI ( P-value < 0.05). Δϕn was found to have statistically significant ranked-correlation (−0.46, −0.46 and −0.45) with physical, functional and total MDADI ( P-value < 0.05). Conclusion: A transit fluence based decision support metric (DSM) is statistically correlated with the dysphagia risk. It can not only be used as an early signal in assisting clinicians in the ART patient selection for replanning, but also lowers the resource barrier of ART implementation.

scholarly journals Investigation of a Novel Decision Support Metric for Head and Neck Adaptive Radiation Therapy Using a Real-Time In Vivo Portal Dosimetry System

2019 ◽  
Vol 18 ◽  
pp. 153303381987362
Author(s):  
S. B. Lim ◽  
C. J. Tsai ◽  
Y. Yu ◽  
P. Greer ◽  
T. Fuangrod ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Decision Support ◽  
Adaptive Radiation ◽  
Characteristic Curve ◽  
Region Of Interest ◽  
P Value ◽  
Adaptive Radiation Therapy ◽  
Chi Square ◽  
Portal Dosimetry

In adaptive radiation therapy of head and neck cancer, any significant anatomical changes observed are used to adapt the treatment plan to maintain target coverage without elevating the risk of xerostomia. However, the additional resources required for adaptive radiation therapy pose a challenge for broad-based implementation. It is hypothesized that a change in transit fluence is associated with volumetric change in the vicinity of the target and therefore can be used as a decision support metric for adaptive radiation therapy. This was evaluated by comparing the fluence with volumetric changes in 12 patients. Transit fluence was measured by an in vivo portal dosimetry system. Weekly cone beam computed tomography was used to determine volume change in the rectangular region of interest from condyloid process to C6. The integrated transit fluence through the region of interest on the day of the cone beam computed tomography scan was calculated with the first treatment as the baseline. The correlation between fluence change and volume change was determined. A logistic regression model was also used to associate the 5% region of interest volume reduction replanning trigger point and the fluence change. The model was assessed by a chi-square test. The area under the receiver–operating characteristic curve was also determined. A total of 46 pairs of measurements were obtained. The correlation between fluence and volumetric changes was found to be −0.776 ( P value <.001). The negative correlation is attributed to the increase in the photon fluence transport resulting from the volume reduction. The chi-square of the logistic regression was found to be 17.4 ( P value <.001). The area under the receiver–operating characteristic curve was found to be 0.88. Results indicate the change in transit fluence, which can be measured without consuming clinical resources or requiring additional time in the treatment room, can be used as a decision support metric for adaptive therapy.

scholarly journals Patient-reported quality-of-life outcomes in relation to provider-assessed adverse events during head and neck radiotherapy

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Joshua R. Niska ◽  
Cameron S. Thorpe ◽  
Michele Y. Halyard ◽  
Angelina D. Tan ◽  
Pamela J. Atherton ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Adverse Events ◽  
Head And Neck ◽  
Life Outcomes ◽  
Quality Of Life Outcomes ◽  
Patient Reported ◽  
Head And Neck Radiotherapy
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