Optimizing the radiation therapy dose prescription for pediatric medulloblastoma : Minimizing the life years lost attributable to failure to control the disease and late complication risk
Brodin, N. Patrik ; Vogelius, Ivan R. ; Björk-Eriksson, Thomas ; Munck Af Rosenschöld, Per LU
; Maraldo, Maja V.
; Aznar, Marianne C.
; Specht, Lena
and Bentzen, Soren M.
(2014)
In Acta Oncologica
53(4).
p.462-470
- Abstract
Background. A mathematical framework is presented for simultaneously quantifying and evaluating the trade-off between tumor control and late complications for risk-based radiation therapy (RT) decision-support. To demonstrate this, we estimate life years lost (LYL) attributable to tumor recurrence, late cardiac toxicity and secondary cancers for standard-risk pediatric medulloblastoma (MB) patients and compare the effect of dose re-distribution on a common scale. Methods. Total LYL were derived, based on the LYL attributable to radiation-induced late complications and the LYL from not controlling the primary disease. We compared the estimated LYL for three different treatments in 10 patients: 1) standard 3D conformal RT; 2) proton... (More)
Background. A mathematical framework is presented for simultaneously quantifying and evaluating the trade-off between tumor control and late complications for risk-based radiation therapy (RT) decision-support. To demonstrate this, we estimate life years lost (LYL) attributable to tumor recurrence, late cardiac toxicity and secondary cancers for standard-risk pediatric medulloblastoma (MB) patients and compare the effect of dose re-distribution on a common scale. Methods. Total LYL were derived, based on the LYL attributable to radiation-induced late complications and the LYL from not controlling the primary disease. We compared the estimated LYL for three different treatments in 10 patients: 1) standard 3D conformal RT; 2) proton therapy; 3) risk-adaptive photon treatment lowering the dose to part of the craniospinal (CS) target volume situated close to critical risk organs. Results. Late toxicity is important, with 0.75 LYL (95% CI 0.60-7.2 years) for standard uniform 24 Gy CS irradiation. However, recurrence risk dominates the total LYL with 14.2 years (95% CI 13.4-16.6 years). Compared to standard treatment, a risk-adapted strategy prescribing 12 Gy to the spinal volume encompassing the 1st-10th thoracic vertebrae (Th1-Th10), and 36 Gy to the remaining CS volume, estimated a LYL reduction of 0.90 years (95% CI -0.18-2.41 years). Proton therapy with 36 Gy to the whole CS volume was associated with significantly fewer LYL compared to the risk-adapted photon strategies, with a mean LYL difference of 0.50 years (95% CI 0.25-2.60 years). Conclusions. Optimization of RT prescription strategies considering both late complications and the risk of recurrence, an all-cause mortality dose painting approach, was demonstrated. The risk-adapted techniques compared favorably to the standard, and although in this context, the gain is small compared to estimated uncertainty, this study demonstrates a framework for all-cause mortality risk estimation, rather than evaluates direct clinical applicability of risk-adapted strategies.
(Less)
- author
- Brodin, N. Patrik
; Vogelius, Ivan R.
; Björk-Eriksson, Thomas
; Munck Af Rosenschöld, Per
LU
; Maraldo, Maja V.
; Aznar, Marianne C.
; Specht, Lena
and Bentzen, Soren M.
- publishing date
- 2014-04
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Acta Oncologica
- volume
- 53
- issue
- 4
- pages
- 462 - 470
- publisher
- Taylor & Francis
- external identifiers
-
- pmid:24274390
- scopus:84896915055
- ISSN
- 0284-186X
- DOI
- 10.3109/0284186X.2013.858824
- language
- English
- LU publication?
- no
- additional info
- Funding Information: Work supported by a grant from the Danish Child Cancer Foundation to Patrik Brodin. søren Bentzen acknowledges support from the National Cancer institute grant no. 2P30 Ca 014520-34.
- id
- 05740871-5065-4092-9bfe-17477aeab626
- date added to LUP
- 2023-07-19 09:38:58
- date last changed
- 2024-01-05 03:25:53
@article{05740871-5065-4092-9bfe-17477aeab626,
abstract = {{<p>Background. A mathematical framework is presented for simultaneously quantifying and evaluating the trade-off between tumor control and late complications for risk-based radiation therapy (RT) decision-support. To demonstrate this, we estimate life years lost (LYL) attributable to tumor recurrence, late cardiac toxicity and secondary cancers for standard-risk pediatric medulloblastoma (MB) patients and compare the effect of dose re-distribution on a common scale. Methods. Total LYL were derived, based on the LYL attributable to radiation-induced late complications and the LYL from not controlling the primary disease. We compared the estimated LYL for three different treatments in 10 patients: 1) standard 3D conformal RT; 2) proton therapy; 3) risk-adaptive photon treatment lowering the dose to part of the craniospinal (CS) target volume situated close to critical risk organs. Results. Late toxicity is important, with 0.75 LYL (95% CI 0.60-7.2 years) for standard uniform 24 Gy CS irradiation. However, recurrence risk dominates the total LYL with 14.2 years (95% CI 13.4-16.6 years). Compared to standard treatment, a risk-adapted strategy prescribing 12 Gy to the spinal volume encompassing the 1st-10th thoracic vertebrae (Th1-Th10), and 36 Gy to the remaining CS volume, estimated a LYL reduction of 0.90 years (95% CI -0.18-2.41 years). Proton therapy with 36 Gy to the whole CS volume was associated with significantly fewer LYL compared to the risk-adapted photon strategies, with a mean LYL difference of 0.50 years (95% CI 0.25-2.60 years). Conclusions. Optimization of RT prescription strategies considering both late complications and the risk of recurrence, an all-cause mortality dose painting approach, was demonstrated. The risk-adapted techniques compared favorably to the standard, and although in this context, the gain is small compared to estimated uncertainty, this study demonstrates a framework for all-cause mortality risk estimation, rather than evaluates direct clinical applicability of risk-adapted strategies.</p>}},
author = {{Brodin, N. Patrik and Vogelius, Ivan R. and Björk-Eriksson, Thomas and Munck Af Rosenschöld, Per and Maraldo, Maja V. and Aznar, Marianne C. and Specht, Lena and Bentzen, Soren M.}},
issn = {{0284-186X}},
language = {{eng}},
number = {{4}},
pages = {{462--470}},
publisher = {{Taylor & Francis}},
series = {{Acta Oncologica}},
title = {{Optimizing the radiation therapy dose prescription for pediatric medulloblastoma : Minimizing the life years lost attributable to failure to control the disease and late complication risk}},
url = {{http://dx.doi.org/10.3109/0284186X.2013.858824}},
doi = {{10.3109/0284186X.2013.858824}},
volume = {{53}},
year = {{2014}},
}