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The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers

PURPOSE: To understand how verification computed tomography-quality assurance (CT-QA) scans influenced clinical decision-making to replan patients with head and neck cancer and identify predictors for replanning to guide intensity-modulated proton therapy (IMPT) clinical practice. PATIENTS AND METHO...

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Autores principales: Evans, Jaden D., Harper, Riley H., Petersen, Molly, Harmsen, William S., Anand, Aman, Hunzeker, Ashley, Deiter, Noelle C., Schultz, Heather, Jethwa, Krishan R., Lester, Scott C., Routman, David M., Ma, Daniel J., Garces, Yolanda I., Neben-Wittich, Michelle A., Laack, Nadia N., Beltran, Chris J., Patel, Samir H., McGee, Lisa A., Rwigema, Jean-Claude M., Mundy, Daniel W., Foote, Robert L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Particle Therapy Co-operative Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574830/
https://www.ncbi.nlm.nih.gov/pubmed/33094135
http://dx.doi.org/10.14338/IJPT-20-00006.1
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author Evans, Jaden D.
Harper, Riley H.
Petersen, Molly
Harmsen, William S.
Anand, Aman
Hunzeker, Ashley
Deiter, Noelle C.
Schultz, Heather
Jethwa, Krishan R.
Lester, Scott C.
Routman, David M.
Ma, Daniel J.
Garces, Yolanda I.
Neben-Wittich, Michelle A.
Laack, Nadia N.
Beltran, Chris J.
Patel, Samir H.
McGee, Lisa A.
Rwigema, Jean-Claude M.
Mundy, Daniel W.
Foote, Robert L.
author_facet Evans, Jaden D.
Harper, Riley H.
Petersen, Molly
Harmsen, William S.
Anand, Aman
Hunzeker, Ashley
Deiter, Noelle C.
Schultz, Heather
Jethwa, Krishan R.
Lester, Scott C.
Routman, David M.
Ma, Daniel J.
Garces, Yolanda I.
Neben-Wittich, Michelle A.
Laack, Nadia N.
Beltran, Chris J.
Patel, Samir H.
McGee, Lisa A.
Rwigema, Jean-Claude M.
Mundy, Daniel W.
Foote, Robert L.
author_sort Evans, Jaden D.
collection PubMed
description PURPOSE: To understand how verification computed tomography-quality assurance (CT-QA) scans influenced clinical decision-making to replan patients with head and neck cancer and identify predictors for replanning to guide intensity-modulated proton therapy (IMPT) clinical practice. PATIENTS AND METHODS: We performed a quality-improvement study by prospectively collecting data on 160 consecutive patients with head and neck cancer treated using spot-scanning IMPT who underwent weekly verification CT-QA scans. Kaplan-Meier estimates were used to determine the cumulative probability of a replan by week. Predictors for replanning were determined with univariate (UVA) and multivariate (MVA) Cox model hazard ratios (HRs). Logistic regression was used to determine odds ratios (ORs). P < .05 was considered statistically significant. RESULTS: Of the 160 patients, 79 (49.4%) had verification CT-QA scans, which prompted a replan. The cumulative probability of a replan by week 1 was 13.7% (95% confidence interval [CI], 8.82-18.9), week 2, 25.0% (95% CI, 18.0-31.4), week 3, 33.1% (95% CI, 25.4-40.0), week 4, 45.6% (95% CI, 37.3-52.8), and week 5 and 6, 49.4% (95% CI, 41.0-56.6). Predictors for replanning were sinonasal disease site (UVA: HR, 1.82, P = .04; MVA: HR, 3.64, P = .03), advanced stage disease (UVA: HR, 4.68, P < .01; MVA: HR, 3.10, P < .05), dose > 60 Gy equivalent (GyE; relative biologic effectiveness, 1.1) (UVA: HR, 1.99, P < .01; MVA: HR, 2.20, P < .01), primary disease (UVA: HR, 2.00 versus recurrent, P = .01; MVA: HR, 2.46, P = .01), concurrent chemotherapy (UVA: HR, 2.05, P < .01; MVA: not statistically significant [NS]), definitive intent treatment (UVA: HR, 1.70 versus adjuvant, P < .02; MVA: NS), bilateral neck treatment (UVA: HR, 2.07, P = .03; MVA: NS), and greater number of beams (5 beam UVA: HR, 5.55 versus 1 or 2 beams, P < .02; MVA: NS). Maximal weight change from baseline was associated with higher odds of a replan (≥3 kg: OR, 1.97, P = .04; ≥ 5 kg: OR, 2.13, P = .02). CONCLUSIONS: Weekly verification CT-QA scans frequently influenced clinical decision-making to replan. Additional studies that evaluate the practice of monitoring IMPT-treated patients with weekly CT-QA scans and whether that improves clinical outcomes are warranted.
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spelling pubmed-75748302020-10-21 The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers Evans, Jaden D. Harper, Riley H. Petersen, Molly Harmsen, William S. Anand, Aman Hunzeker, Ashley Deiter, Noelle C. Schultz, Heather Jethwa, Krishan R. Lester, Scott C. Routman, David M. Ma, Daniel J. Garces, Yolanda I. Neben-Wittich, Michelle A. Laack, Nadia N. Beltran, Chris J. Patel, Samir H. McGee, Lisa A. Rwigema, Jean-Claude M. Mundy, Daniel W. Foote, Robert L. Int J Part Ther Original Articles PURPOSE: To understand how verification computed tomography-quality assurance (CT-QA) scans influenced clinical decision-making to replan patients with head and neck cancer and identify predictors for replanning to guide intensity-modulated proton therapy (IMPT) clinical practice. PATIENTS AND METHODS: We performed a quality-improvement study by prospectively collecting data on 160 consecutive patients with head and neck cancer treated using spot-scanning IMPT who underwent weekly verification CT-QA scans. Kaplan-Meier estimates were used to determine the cumulative probability of a replan by week. Predictors for replanning were determined with univariate (UVA) and multivariate (MVA) Cox model hazard ratios (HRs). Logistic regression was used to determine odds ratios (ORs). P < .05 was considered statistically significant. RESULTS: Of the 160 patients, 79 (49.4%) had verification CT-QA scans, which prompted a replan. The cumulative probability of a replan by week 1 was 13.7% (95% confidence interval [CI], 8.82-18.9), week 2, 25.0% (95% CI, 18.0-31.4), week 3, 33.1% (95% CI, 25.4-40.0), week 4, 45.6% (95% CI, 37.3-52.8), and week 5 and 6, 49.4% (95% CI, 41.0-56.6). Predictors for replanning were sinonasal disease site (UVA: HR, 1.82, P = .04; MVA: HR, 3.64, P = .03), advanced stage disease (UVA: HR, 4.68, P < .01; MVA: HR, 3.10, P < .05), dose > 60 Gy equivalent (GyE; relative biologic effectiveness, 1.1) (UVA: HR, 1.99, P < .01; MVA: HR, 2.20, P < .01), primary disease (UVA: HR, 2.00 versus recurrent, P = .01; MVA: HR, 2.46, P = .01), concurrent chemotherapy (UVA: HR, 2.05, P < .01; MVA: not statistically significant [NS]), definitive intent treatment (UVA: HR, 1.70 versus adjuvant, P < .02; MVA: NS), bilateral neck treatment (UVA: HR, 2.07, P = .03; MVA: NS), and greater number of beams (5 beam UVA: HR, 5.55 versus 1 or 2 beams, P < .02; MVA: NS). Maximal weight change from baseline was associated with higher odds of a replan (≥3 kg: OR, 1.97, P = .04; ≥ 5 kg: OR, 2.13, P = .02). CONCLUSIONS: Weekly verification CT-QA scans frequently influenced clinical decision-making to replan. Additional studies that evaluate the practice of monitoring IMPT-treated patients with weekly CT-QA scans and whether that improves clinical outcomes are warranted. The Particle Therapy Co-operative Group 2020-08-03 /pmc/articles/PMC7574830/ /pubmed/33094135 http://dx.doi.org/10.14338/IJPT-20-00006.1 Text en ©Copyright 2020 The Author(s) Distributed under Creative Commons CC-BY (https://creativecommons.org/licenses/cc-by/4.0/)
spellingShingle Original Articles
Evans, Jaden D.
Harper, Riley H.
Petersen, Molly
Harmsen, William S.
Anand, Aman
Hunzeker, Ashley
Deiter, Noelle C.
Schultz, Heather
Jethwa, Krishan R.
Lester, Scott C.
Routman, David M.
Ma, Daniel J.
Garces, Yolanda I.
Neben-Wittich, Michelle A.
Laack, Nadia N.
Beltran, Chris J.
Patel, Samir H.
McGee, Lisa A.
Rwigema, Jean-Claude M.
Mundy, Daniel W.
Foote, Robert L.
The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers
title The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers
title_full The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers
title_fullStr The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers
title_full_unstemmed The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers
title_short The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers
title_sort importance of verification ct-qa scans in patients treated with impt for head and neck cancers
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574830/
https://www.ncbi.nlm.nih.gov/pubmed/33094135
http://dx.doi.org/10.14338/IJPT-20-00006.1
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