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Can the Risk of Dysphagia in Head and Neck Radiation Therapy Be Predicted by an Automated Transit Fluence Monitoring Process During Treatment? A First Comparative Study of Patient Reported Quality of Life and the Fluence-Based Decision Support Metric

PURPOSE/OBJECTIVE(S): The additional personnel and imaging procedures required for Adaptive Radiation Therapy (ART) pose a challenge for a broad implementation. We hypothesize that a change in transit fluence during the treatment course is correlated with the change of quality of life and thus can b...

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Autores principales: Lim, Seng Boh, Lee, Nancy, Zakeri, Kaveh, Greer, Peter, Fuangrod, Todsaporn, Coffman, Frederick, Cerviño, Laura, Lovelock, D. Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252347/
https://www.ncbi.nlm.nih.gov/pubmed/34190006
http://dx.doi.org/10.1177/15330338211027906
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author Lim, Seng Boh
Lee, Nancy
Zakeri, Kaveh
Greer, Peter
Fuangrod, Todsaporn
Coffman, Frederick
Cerviño, Laura
Lovelock, D. Michael
author_facet Lim, Seng Boh
Lee, Nancy
Zakeri, Kaveh
Greer, Peter
Fuangrod, Todsaporn
Coffman, Frederick
Cerviño, Laura
Lovelock, D. Michael
author_sort Lim, Seng Boh
collection PubMed
description PURPOSE/OBJECTIVE(S): The additional personnel and imaging procedures required for Adaptive Radiation Therapy (ART) pose a challenge for a broad implementation. We hypothesize that a change in transit fluence during the treatment course is correlated with the change of quality of life and thus can be used as a replanning trigger. MATERIALS/METHODS: Twenty-one head and neck cancer (HNC) patients filled out an MD Anderson Dysphagia Inventory (MDADI) questionnaire, before-and-after the radiotherapy treatment course. The transit fluence was measured by the Watchdog (WD) in-vivo portal dosimetry system. The patients were monitored with daily WD and weekly CBCTs. The region of interest (ROI) of each patient was defined as the outer contour of the patient between approximate spine levels C1 to C4, essentially the neck and mandible inside the beam’s eye view. The nth day integrated transit fluence change, Δϕ(n), and the volume change, ΔV(ROI), of the ROI of each patient was calculated from the corresponding WD and CBCT measurements. The correlation between MDADI scores and age, gender, planning mean dose to salivary glands <D(sg)>, weight change ΔW, ΔV(ROI), and Δϕ(n), were analyzed using the ranked-Pearson correlation. RESULTS: No statistically significant correlation was found for age, gender and ΔW. <D(sg)> was found to have clinically important correlation with functional MDADI (ρ = −0.39, P = 0.081). ΔV(ROI) was found to have statistically significant correlation of 0.44, 0.47 and 0.44 with global, physical and functional MDADI (P-value < 0.05). Δϕ(n) was found to have statistically significant ranked-correlation (−0.46, −0.46 and −0.45) with physical, functional and total MDADI (P-value < 0.05). CONCLUSION: A transit fluence based decision support metric (DSM) is statistically correlated with the dysphagia risk. It can not only be used as an early signal in assisting clinicians in the ART patient selection for replanning, but also lowers the resource barrier of ART implementation.
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spelling pubmed-82523472021-07-13 Can the Risk of Dysphagia in Head and Neck Radiation Therapy Be Predicted by an Automated Transit Fluence Monitoring Process During Treatment? A First Comparative Study of Patient Reported Quality of Life and the Fluence-Based Decision Support Metric Lim, Seng Boh Lee, Nancy Zakeri, Kaveh Greer, Peter Fuangrod, Todsaporn Coffman, Frederick Cerviño, Laura Lovelock, D. Michael Technol Cancer Res Treat Original Article PURPOSE/OBJECTIVE(S): The additional personnel and imaging procedures required for Adaptive Radiation Therapy (ART) pose a challenge for a broad implementation. We hypothesize that a change in transit fluence during the treatment course is correlated with the change of quality of life and thus can be used as a replanning trigger. MATERIALS/METHODS: Twenty-one head and neck cancer (HNC) patients filled out an MD Anderson Dysphagia Inventory (MDADI) questionnaire, before-and-after the radiotherapy treatment course. The transit fluence was measured by the Watchdog (WD) in-vivo portal dosimetry system. The patients were monitored with daily WD and weekly CBCTs. The region of interest (ROI) of each patient was defined as the outer contour of the patient between approximate spine levels C1 to C4, essentially the neck and mandible inside the beam’s eye view. The nth day integrated transit fluence change, Δϕ(n), and the volume change, ΔV(ROI), of the ROI of each patient was calculated from the corresponding WD and CBCT measurements. The correlation between MDADI scores and age, gender, planning mean dose to salivary glands <D(sg)>, weight change ΔW, ΔV(ROI), and Δϕ(n), were analyzed using the ranked-Pearson correlation. RESULTS: No statistically significant correlation was found for age, gender and ΔW. <D(sg)> was found to have clinically important correlation with functional MDADI (ρ = −0.39, P = 0.081). ΔV(ROI) was found to have statistically significant correlation of 0.44, 0.47 and 0.44 with global, physical and functional MDADI (P-value < 0.05). Δϕ(n) was found to have statistically significant ranked-correlation (−0.46, −0.46 and −0.45) with physical, functional and total MDADI (P-value < 0.05). CONCLUSION: A transit fluence based decision support metric (DSM) is statistically correlated with the dysphagia risk. It can not only be used as an early signal in assisting clinicians in the ART patient selection for replanning, but also lowers the resource barrier of ART implementation. SAGE Publications 2021-06-30 /pmc/articles/PMC8252347/ /pubmed/34190006 http://dx.doi.org/10.1177/15330338211027906 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Article
Lim, Seng Boh
Lee, Nancy
Zakeri, Kaveh
Greer, Peter
Fuangrod, Todsaporn
Coffman, Frederick
Cerviño, Laura
Lovelock, D. Michael
Can the Risk of Dysphagia in Head and Neck Radiation Therapy Be Predicted by an Automated Transit Fluence Monitoring Process During Treatment? A First Comparative Study of Patient Reported Quality of Life and the Fluence-Based Decision Support Metric
title Can the Risk of Dysphagia in Head and Neck Radiation Therapy Be Predicted by an Automated Transit Fluence Monitoring Process During Treatment? A First Comparative Study of Patient Reported Quality of Life and the Fluence-Based Decision Support Metric
title_full Can the Risk of Dysphagia in Head and Neck Radiation Therapy Be Predicted by an Automated Transit Fluence Monitoring Process During Treatment? A First Comparative Study of Patient Reported Quality of Life and the Fluence-Based Decision Support Metric
title_fullStr Can the Risk of Dysphagia in Head and Neck Radiation Therapy Be Predicted by an Automated Transit Fluence Monitoring Process During Treatment? A First Comparative Study of Patient Reported Quality of Life and the Fluence-Based Decision Support Metric
title_full_unstemmed Can the Risk of Dysphagia in Head and Neck Radiation Therapy Be Predicted by an Automated Transit Fluence Monitoring Process During Treatment? A First Comparative Study of Patient Reported Quality of Life and the Fluence-Based Decision Support Metric
title_short Can the Risk of Dysphagia in Head and Neck Radiation Therapy Be Predicted by an Automated Transit Fluence Monitoring Process During Treatment? A First Comparative Study of Patient Reported Quality of Life and the Fluence-Based Decision Support Metric
title_sort can the risk of dysphagia in head and neck radiation therapy be predicted by an automated transit fluence monitoring process during treatment? a first comparative study of patient reported quality of life and the fluence-based decision support metric
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252347/
https://www.ncbi.nlm.nih.gov/pubmed/34190006
http://dx.doi.org/10.1177/15330338211027906
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