Dynamics-Adapted Radiotherapy Dose (DARD) for Head and Neck Cancer Radiotherapy Dose Personalization

Standard of care radiotherapy (RT) doses have been developed as a one-size-fits all approach designed to maximize tumor control rates across a population. Although this has led to high control rates for head and neck cancer with 66–70 Gy, this is done without considering patient heterogeneity. We pr...

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Autores principales:	Mohammad U. Zahid, Abdallah S. R. Mohamed, Jimmy J. Caudell, Louis B. Harrison, Clifton D. Fuller, Eduardo G. Moros, Heiko Enderling
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	radiotherapy dose personalization head and neck cancer mathematical modeling Medicine R
Acceso en línea:	https://doaj.org/article/1ed40d3b5248459d931fd48f0553d810
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spelling	oai:doaj.org-article:1ed40d3b5248459d931fd48f0553d8102021-11-25T18:07:23ZDynamics-Adapted Radiotherapy Dose (DARD) for Head and Neck Cancer Radiotherapy Dose Personalization10.3390/jpm111111242075-4426https://doaj.org/article/1ed40d3b5248459d931fd48f0553d8102021-11-01T00:00:00Zhttps://www.mdpi.com/2075-4426/11/11/1124https://doaj.org/toc/2075-4426Standard of care radiotherapy (RT) doses have been developed as a one-size-fits all approach designed to maximize tumor control rates across a population. Although this has led to high control rates for head and neck cancer with 66–70 Gy, this is done without considering patient heterogeneity. We present a framework to estimate a personalized RT dose for individual patients, based on pre- and early on-treatment tumor volume dynamics—a dynamics-adapted radiotherapy dose (<i>D</i><sub>DARD</sub>). We also present the results of an in silico trial of this dose personalization using retrospective data from a combined cohort of <i>n</i> = 39 head and neck cancer patients from the Moffitt and MD Anderson Cancer Centers that received 66–70 Gy RT in 2–2.12 Gy weekday fractions. This trial was repeated constraining <i>D</i><sub>DARD</sub> between (54, 82) Gy to test more moderate dose adjustment. <i>D</i><sub>DARD</sub> was estimated to range from 8 to 186 Gy, and our in silico trial estimated that 77% of patients treated with standard of care were overdosed by an average dose of 39 Gy, and 23% underdosed by an average dose of 32 Gy. The in silico trial with constrained dose adjustment estimated that locoregional control could be improved by >10%. We demonstrated the feasibility of using early treatment tumor volume dynamics to inform dose personalization and stratification for dose escalation and de-escalation. These results demonstrate the potential to both de-escalate most patients, while still improving population-level control rates.Mohammad U. ZahidAbdallah S. R. MohamedJimmy J. CaudellLouis B. HarrisonClifton D. FullerEduardo G. MorosHeiko EnderlingMDPI AGarticleradiotherapydose personalizationhead and neck cancermathematical modelingMedicineRENJournal of Personalized Medicine, Vol 11, Iss 1124, p 1124 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	radiotherapy dose personalization head and neck cancer mathematical modeling Medicine R
spellingShingle	radiotherapy dose personalization head and neck cancer mathematical modeling Medicine R Mohammad U. Zahid Abdallah S. R. Mohamed Jimmy J. Caudell Louis B. Harrison Clifton D. Fuller Eduardo G. Moros Heiko Enderling Dynamics-Adapted Radiotherapy Dose (DARD) for Head and Neck Cancer Radiotherapy Dose Personalization
description	Standard of care radiotherapy (RT) doses have been developed as a one-size-fits all approach designed to maximize tumor control rates across a population. Although this has led to high control rates for head and neck cancer with 66–70 Gy, this is done without considering patient heterogeneity. We present a framework to estimate a personalized RT dose for individual patients, based on pre- and early on-treatment tumor volume dynamics—a dynamics-adapted radiotherapy dose (<i>D</i><sub>DARD</sub>). We also present the results of an in silico trial of this dose personalization using retrospective data from a combined cohort of <i>n</i> = 39 head and neck cancer patients from the Moffitt and MD Anderson Cancer Centers that received 66–70 Gy RT in 2–2.12 Gy weekday fractions. This trial was repeated constraining <i>D</i><sub>DARD</sub> between (54, 82) Gy to test more moderate dose adjustment. <i>D</i><sub>DARD</sub> was estimated to range from 8 to 186 Gy, and our in silico trial estimated that 77% of patients treated with standard of care were overdosed by an average dose of 39 Gy, and 23% underdosed by an average dose of 32 Gy. The in silico trial with constrained dose adjustment estimated that locoregional control could be improved by >10%. We demonstrated the feasibility of using early treatment tumor volume dynamics to inform dose personalization and stratification for dose escalation and de-escalation. These results demonstrate the potential to both de-escalate most patients, while still improving population-level control rates.
format	article
author	Mohammad U. Zahid Abdallah S. R. Mohamed Jimmy J. Caudell Louis B. Harrison Clifton D. Fuller Eduardo G. Moros Heiko Enderling
author_facet	Mohammad U. Zahid Abdallah S. R. Mohamed Jimmy J. Caudell Louis B. Harrison Clifton D. Fuller Eduardo G. Moros Heiko Enderling
author_sort	Mohammad U. Zahid
title	Dynamics-Adapted Radiotherapy Dose (DARD) for Head and Neck Cancer Radiotherapy Dose Personalization
title_short	Dynamics-Adapted Radiotherapy Dose (DARD) for Head and Neck Cancer Radiotherapy Dose Personalization
title_full	Dynamics-Adapted Radiotherapy Dose (DARD) for Head and Neck Cancer Radiotherapy Dose Personalization
title_fullStr	Dynamics-Adapted Radiotherapy Dose (DARD) for Head and Neck Cancer Radiotherapy Dose Personalization
title_full_unstemmed	Dynamics-Adapted Radiotherapy Dose (DARD) for Head and Neck Cancer Radiotherapy Dose Personalization
title_sort	dynamics-adapted radiotherapy dose (dard) for head and neck cancer radiotherapy dose personalization
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/1ed40d3b5248459d931fd48f0553d810
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Dynamics-Adapted Radiotherapy Dose (DARD) for Head and Neck Cancer Radiotherapy Dose Personalization

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