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.firstpage684en_US
dc.citation.issueNumber3en_US
dc.citation.journalTitleInternational Journal of Radiation Oncology*Biology*Physicsen_US
dc.citation.lastpage692en_US
dc.citation.volumeNumber111en_US
dc.contributor.authorEngeseth, Grete Mayen_US
dc.contributor.authorHe, Renjieen_US
dc.contributor.authorMirkovic, Draganen_US
dc.contributor.authorYepes, Pabloen_US
dc.contributor.authorMohamed, Abdallah Sherif Radwanen_US
dc.contributor.authorStieb, Sonjaen_US
dc.contributor.authorFuller, Clifton Daveen_US
dc.contributor.authorWu, Richarden_US
dc.contributor.authorZhang, Xiadongen_US
dc.contributor.authorHysing, Liv Bolstaden_US
dc.contributor.authorPettersen, Helge Egil Seimeen_US
dc.contributor.authorStokkevåg, Camilla Hanquisten_US
dc.contributor.authorMohan, Radheen_US
dc.contributor.authorFrank, Steven Jayen_US
dc.contributor.authorGunn, Gary Brandonen_US
dc.date.accessioned2021-09-30T17:34:44Zen_US
dc.date.available2021-09-30T17:34:44Zen_US
dc.date.issued2021en_US
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.en_US
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.en_US
dc.identifier.digital1-s2-0-S0360301621007343-mainen_US
dc.identifier.doihttps://doi.org/10.1016/j.ijrobp.2021.06.016en_US
dc.identifier.urihttps://hdl.handle.net/1911/111411en_US
dc.language.isoengen_US
dc.publisherElsevieren_US
dc.rightsThis is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)en_US
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/)en_US
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 Canceren_US
dc.typeJournal articleen_US
dc.type.dcmiTexten_US
dc.type.publicationpublisher versionen_US
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