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Robust maximization of tumor control probability for radicality constrained dose painting by numbers of head and neck cancer
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medical Radiation Science.ORCID iD: 0000-0002-4603-6338
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medical Radiation Science. The Skandion Clinic, Uppsala, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
RaySearch Laboratories AB, Sweden.
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(English)In: Article in journal (Refereed) Submitted
Abstract [en]

Background and Purpose The aim of this study was to evaluate the potential and robustness to increase the tumor control probability (TCP) for robustly optimized dose painting plans compared to conventional homogeneous dose plans for head and neck cancers.

Material and Methods We optimized a set of dose painting plans with a robust TCP maximizing objective under different mean dose constraints for the primary clinical target volume (CTVT). These plans were optimized with the robust mini-max algorithm together with dose-responses driven by standardized uptake values (SUV) from 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). The robustness in TCP was evaluated through sampling treatment scenarios with iso-center displacements. We also analyzed the impact on TCP predictions by considering dose-response uncertainties.

Results The average increase in TCP with dose painting ranged between 3 to 20 percentage points (p.p.) which depended on the allowed integral CTVT dose. The median deviation in TCP increase was below 1p.p. for all sampled treatment scenarios versus the nominal plans. Patients with large tumors and large spread of SUV gained the greatest TCP increases. By considering dose-response uncertainties, a decrease of the TCP for a homogeneous dose yielded an increasing dose painting potential.

Conclusions We have found that it is feasible to optimize FDG-PET driven dose painting plans that robustly increase the TCP compared to homogeneous dose treatments for head and neck cancers. The greatest potential TCP increases were found for patients with larger and more SUV heterogeneous tumors, which may give guidance for patient selection to further test the presented dose painting formalism.

Keywords [en]
Dose painting; Dose painting by numbers; Head and neck cancer; 18F-FDG PET/CT
National Category
Cancer and Oncology
Research subject
Medical Radiophysics
Identifiers
URN: urn:nbn:se:uu:diva-395142OAI: oai:DiVA.org:uu-395142DiVA, id: diva2:1360489
Funder
Swedish Cancer Society, 130632Available from: 2019-10-14 Created: 2019-10-14 Last updated: 2019-10-18Bibliographically approved

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Grönlund, EricAlmhagen, ErikJohansson, SilviaAhnesjö, Anders

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