@article{189cd5a82c9a47e38ff3d11d2050fe49,
title = "Dynamics-adapted radiotherapy dose (Dard) for head and neck cancer radiotherapy dose personalization",
abstract = "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 (DDARD). We also present the results of an in silico trial of this dose personalization using retrospective data from a combined cohort of n = 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 DDARD between (54, 82) Gy to test more moderate dose adjustment. DDARD 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 deescalation. These results demonstrate the potential to both de-escalate most patients, while still improving population-level control rates.",
keywords = "Dose personalization, Head and neck cancer, Mathematical modeling, Radiotherapy",
author = "Zahid, {Mohammad U.} and Mohamed, {Abdallah S.R.} and Caudell, {Jimmy J.} and Harrison, {Louis B.} and Fuller, {Clifton D.} and Moros, {Eduardo G.} and Heiko Enderling",
note = "Funding Information: Conflicts of Interest: L.B.H. is Principal Investigator of a ViewRay Research Grant. C.D.F. received funding and salary support unrelated to this project from: the NIDCR Establishing Outcome Measures Award (1R01DE025248/R56DE025248) and National Science Foundation (NSF), Division of Mathematical Sciences, Joint NIH/NSF Initiative on Quantitative Approaches to Biomedical Big Data (QuBBD) Grant (NSF 1557679); NSF Division of Civil, Mechanical, and Manufacturing Innovation (CMMI) standard grant (NSF 1933369) a National Institute of Biomedical Imaging and Bioengineering (NIBIB) Research Education Programs for Residents and Clinical Fellows Grant (R25EB025787-01); the NIH Big Data to Knowledge (BD2K) Program of the NCI Early Stage Development of Technologies in Biomedical Computing, Informatics, and Big Data Science Award (1R01CA214825), and the MD Anderson Sister Institution Network Fund. Direct infrastructure support was provided by the multidisciplinary Stiefel Oropharyngeal Research Fund of the University of Texas MD Anderson Cancer Center Charles and Daneen Stiefel Center for Head and Neck Cancer and the Cancer Center Support Grant (P30CA016672) and the MD Anderson Program in Image-guided Cancer Therapy. C.D.F. has received direct industry grant support, honoraria, and travel funding from Elekta AB. J.J.C. has received unrelated research grant support and honoraria from, and consulted for, Varian Medical Systems. H.E. receives funding and salary support related to this project from: NIH/NCI Physical Sciences in Oncology Network (1 U01 CA244100-01), and unrelated to this project from: NIH/NCI grant (1R21CA234787-01A1). No potential conflicts of interest were disclosed by the other authors. Funding Information: C.D.F. received funding and salary support related to this project from the National Institutes of Health (NIH), including: the National Institute for Dental and Craniofacial Research (NIDCR) Academic Industrial Partnership Grant (R01DE028290); National Cancer Institute (NCI) Early Phase Clinical Trials in Imaging and Image-Guided Interventions Program (1R01CA218148); an NIH/NCI Cancer Center Support Grant (CCSG) Pilot Research Program Award from the UT MD Anderson CCSG Radiation Oncology and Cancer Imaging Program (P30CA016672) and an NIH/NCI Head and Neck Specialized Programs of Research Excellence (SPORE) Developmental Research Program Award (P50 CA097007). Funding Information: Funding: C.D.F. received funding and salary support related to this project from the National Institutes of Health (NIH), including: the National Institute for Dental and Craniofacial Research (NIDCR) Academic Industrial Partnership Grant (R01DE028290); National Cancer Institute (NCI) Early Phase Clinical Trials in Imaging and Image-Guided Interventions Program (1R01CA218148); an NIH/NCI Cancer Center Support Grant (CCSG) Pilot Research Program Award from the UT MD Anderson CCSG Radiation Oncology and Cancer Imaging Program (P30CA016672) and an NIH/NCI Publisher Copyright: {\textcopyright} 2021 by the authors. Licensee MDPI, Basel, Switzerland.",
year = "2021",
month = nov,
doi = "10.3390/jpm11111124",
language = "English (US)",
volume = "11",
journal = "Journal of Personalized Medicine",
issn = "2075-4426",
publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",
number = "11",
}