Mixed Effect Modeling of Dose and Linear Energy Transfer Correlations With Brain Image Changes After Intensity Modulated Proton Therapy for Skull Base Head and Neck Cancer

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dc.citation.firstpage684
dc.citation.issueNumber3
dc.citation.journalTitleInternational Journal of Radiation Oncology*Biology*Physics
dc.citation.lastpage692
dc.citation.volumeNumber111
dc.contributor.authorEngeseth, Grete May
dc.contributor.authorHe, Renjie
dc.contributor.authorMirkovic, Dragan
dc.contributor.authorYepes, Pablo
dc.contributor.authorMohamed, Abdallah Sherif Radwan
dc.contributor.authorStieb, Sonja
dc.contributor.authorFuller, Clifton Dave
dc.contributor.authorWu, Richard
dc.contributor.authorZhang, Xiadong
dc.contributor.authorHysing, Liv Bolstad
dc.contributor.authorPettersen, Helge Egil Seime
dc.contributor.authorStokkevåg, Camilla Hanquist
dc.contributor.authorMohan, Radhe
dc.contributor.authorFrank, Steven Jay
dc.contributor.authorGunn, Gary Brandon
dc.date.accessioned2021-09-30T17:34:44Z
dc.date.available2021-09-30T17:34:44Z
dc.date.issued2021
dc.description.abstractPurpose: Intensity modulated proton therapy (IMPT) could yield high linear energy transfer (LET) in critical structures and increased biological effect. For head and neck cancers at the skull base this could potentially result in radiation-associated brain image change (RAIC). The purpose of the current study was to investigate voxel-wise dose and LET correlations with RAIC after IMPT. Methods and Materials: For 15 patients with RAIC after IMPT, contrast enhancement observed on T1-weighted magnetic resonance imaging was contoured and coregistered to the planning computed tomography. Monte Carlo calculated dose and dose-averaged LET (LETd) distributions were extracted at voxel level and associations with RAIC were modelled using uni- and multivariate mixed effect logistic regression. Model performance was evaluated using the area under the receiver operating characteristic curve and precision-recall curve. Results: An overall statistically significant RAIC association with dose and LETd was found in both the uni- and multivariate analysis. Patient heterogeneity was considerable, with standard deviation of the random effects of 1.81 (1.30-2.72) for dose and 2.68 (1.93-4.93) for LETd, respectively. Area under the receiver operating characteristic curve was 0.93 and 0.95 for the univariate dose-response model and multivariate model, respectively. Analysis of the LETd effect demonstrated increased risk of RAIC with increasing LETd for the majority of patients. Estimated probability of RAIC with LETd = 1 keV/µm was 4% (95% confidence interval, 0%, 0.44%) and 29% (95% confidence interval, 0.01%, 0.92%) for 60 and 70 Gy, respectively. The TD15 were estimated to be 63.6 and 50.1 Gy with LETd equal to 2 and 5 keV/µm, respectively. Conclusions: Our results suggest that the LETd effect could be of clinical significance for some patients; LETd assessment in clinical treatment plans should therefore be taken into consideration.
dc.identifier.citationEngeseth, Grete May, He, Renjie, Mirkovic, Dragan, et al.. "Mixed Effect Modeling of Dose and Linear Energy Transfer Correlations With Brain Image Changes After Intensity Modulated Proton Therapy for Skull Base Head and Neck Cancer." <i>International Journal of Radiation Oncology*Biology*Physics,</i> 111, no. 3 (2021) Elsevier: 684-692. https://doi.org/10.1016/j.ijrobp.2021.06.016.
dc.identifier.digital1-s2-0-S0360301621007343-main
dc.identifier.doihttps://doi.org/10.1016/j.ijrobp.2021.06.016
dc.identifier.urihttps://hdl.handle.net/1911/111411
dc.language.isoeng
dc.publisherElsevier
dc.rightsThis is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/)
dc.titleMixed Effect Modeling of Dose and Linear Energy Transfer Correlations With Brain Image Changes After Intensity Modulated Proton Therapy for Skull Base Head and Neck Cancer
dc.typeJournal article
dc.type.dcmiText
dc.type.publicationpublisher version
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