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Nowicka-Matus K, Friborg J, Hansen C, Bernsdorf M, Elstrøm U, Farhadi M, Grau C, Eriksen J, Johansen J, Nielsen M, Holm A, Samsøe E, Sibolt P, Smulders B, Jensen K. Acute toxicities in proton therapy for head and neck cancer - A matched analysis of the DAHANCA 35 feasibility study. Clin Transl Radiat Oncol 2024; 48:100835. [PMID: 39189000 PMCID: PMC11345689 DOI: 10.1016/j.ctro.2024.100835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 07/30/2024] [Accepted: 07/30/2024] [Indexed: 08/28/2024] Open
Abstract
Background and purpose As preparation for a national randomized study comparing proton radiotherapy to photon radiotherapy, DAHANCA 35, we performed a non-randomized pilot study to investigate patient selection, logistics, planning, and treatment delivery. With the present study, as a comprehensive safety analysis, we want to compare toxicity during and up to two months after therapy to a historically matched group of patients treated with photon radiotherapy. Materials and methods 62 patients treated with protons were matched to 124 patients who received photon treatment outside a protocol. Available data were retrieved from the DAHANCA database. Patients were matched on treatment centre, concurrent chemotherapy, tumour site, stage, p16 status for oropharynx cancers. Selection of patients for proton therapy was based on comparative treatment plans with a NTCP reduction for dysphagia and xerostomia at six months. Results Baseline characteristics between groups were well balanced, except for the type of drug used concurrently; more photon patients received Carboplatin (21.2 % vs 5.8 %, p = 0.01). Proton therapy was associated with significantly less weight loss at the end of treatment, mean weight loss of 3 % for protons and 5 % for photons (p < 0.001). There were more grade 3 skin reactions and grade 3 mucositis after proton treatment compared with photons at the end of treatment, Risk Ratio (RR) 1.9 (95 % CI: 1.01-3.5, p = 0.04) and RR 1.5 (95 % CI: 1.3-1.7, p < 0.001), respectively. All differences resolved at follow up two months after treatment. There were no significant differences between groups on opioid use, use of feeding tubes, or hospitalization during the observation period. Conclusion Proton treatment resulted in excess objective mucositis and dermatitis, which was transient and did not seem to negatively influence weight or treatment compliance and intensity. Selection bias was likely especially since NTCP models were used for selection of proton treatment and photon treated patients were matched manually. We are currently including patients in a randomized controlled trial.
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Friborg J, Jensen K, Grau C, Hansen CR. Response to the letter by Boon and colleagues. Radiother Oncol 2024; 195:110233. [PMID: 38537679 DOI: 10.1016/j.radonc.2024.110233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 03/14/2024] [Indexed: 05/18/2024]
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Mortensen HR, Populaire P, Hoffmann L, Moeller DS, Appelt A, Nafteux P, Muijs CT, Grau C, Hawkins MA, Troost EGC, Defraene G, Canters R, Clarke CS, Weber DC, Korevaar EW, Haustermans K, Nordsmark M, Gebski V, Achiam MP, Markar SR, Radhakrishna G, Berbee M, Scartoni D, Orlandi E, Doyen J, Gregoire V, Crehange G, Langendijk J, Lorgelly P, Blommenstein HM, Byskov CS, Ehmsen ML, Jensen MF, Freixas GV, Bütof R. Proton versus photon therapy for esophageal cancer - A trimodality strategy (PROTECT) NCT050555648: A multicenter international randomized phase III study of neoadjuvant proton versus photon chemoradiotherapy in locally advanced esophageal cancer. Radiother Oncol 2024; 190:109980. [PMID: 37935284 DOI: 10.1016/j.radonc.2023.109980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/29/2023] [Accepted: 10/29/2023] [Indexed: 11/09/2023]
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Friborg J, Jensen K, Eriksen JG, Samsøe E, Maare C, Farhadi M, Sibolt P, Nielsen M, Andersen M, Holm AIS, Skyt P, Smulders B, Johansen J, Overgaard J, Grau C, Hansen CR. Considerations for study design in the DAHANCA 35 trial of protons versus photons for head and neck cancer. Radiother Oncol 2024; 190:109958. [PMID: 37871751 DOI: 10.1016/j.radonc.2023.109958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 08/10/2023] [Accepted: 09/26/2023] [Indexed: 10/25/2023]
Abstract
Proton radiotherapy offers a dosimetric advantage compared to photon therapy in sparing normal tissue, but the clinical evidence for toxicity reductions in the treatment of head and neck cancer is limited. The Danish Head and Neck Cancer Group (DAHANCA) has initiated the DAHANCA 35 randomised trial to clarify the value of proton therapy (NCT04607694). The DAHANCA 35 trial is performed in an enriched population of patients selected by an anticipated benefit of proton therapy to reduce the risk of late dysphagia or xerostomia based on normal tissue complication probability (NTCP) modelling. We present our considerations on the trial design and a test of the selection procedure conducted before initiating the randomised study.
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Tvilum M, Lutz C, Hoffmann L, Khalil A, Appelt A, Alber M, Grau C, Schmidt H, Kandi M, Haraldsen A, Mortensen L, Holt M, Knap M, Moller D. Prognostic Image Biomarkers in the Treatment of Patients with Locally Advanced NSCLC. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Argota-Perez R, Sharma MB, Elstrøm UV, Møller DS, Grau C, Jensen K, Holm AIS, Korreman SS. Dose and robustness comparison of nominal, daily and accumulated doses for photon and proton treatment of sinonasal cancer. Radiother Oncol 2022; 173:102-108. [PMID: 35667574 DOI: 10.1016/j.radonc.2022.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim was to evaluate and compare the dosimetric effect and robustness towards day-to-day anatomical and setup variations in the delivered dose for photon and proton treatments of sinonasal cancer (SNC) patients. MATERIALS AND METHODS Photon (VMAT) and proton (IMPT) plans were optimized retrospectively for 24 SNC patients. Synthetic CTs (synCT) were obtained by deforming the planning CT (pCT) to the anatomy of every daily cone-beam CT. Both VMAT and IMPT plans were recalculated on the synCTs. The recalculated daily dose was accumulated over the whole treatment on the pCT. Target coverage and dose to organs and risk (OARs) were evaluated for all patients for the nominal, daily and accumulated dose distribution. RESULTS In general, dose to OARs farther away from the target, including brain, chiasm and contralateral optic nerve, was lower for proton plans than photon plans. Whereas, OARs in proximity of the target received a lower dose for photon plans. For proton plans, the target coverage (volume of CTV receiving 95% of prescribed dose), V95%, fell below 99% for 9/24 patients in one or more fractions. For photon plans, 4/24 patients had one or more fractions where V95% fell below 99%. For accumulated doses, V95% was below 99% only in two cases, but above 98% for all patients. CONCLUSION Photon and proton treatment have different strengths regarding OAR sparing. The robustness was high for both treatment modalities. Patient selection for either proton or photon radiation therapy of SNC patients should be based on a case-by-case comparison.
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Sørensen B, Sitarz M, Ankjærgaard C, Johansen J, Andersen C, Kanouta E, Grau C, Poulsen P. OC-0507 Differential effect of PBS Proton FLASH on tumor control and skin toxicity in a mouse leg model. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02607-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zukauskaite R, Grau Eriksen J, Andersen E, Johansen J, Samsøe E, Long Krogh S, Overgaard J, Grau C, Rønn Hansen C. MO-0480 Risk of acute mucositis following an increase in high dose CTV1 in HNSCC patients. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02374-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nowicka-Matus K, Friborg J, Hansen C, Andersen E, Bernsdorf M, Elstrøm U, Farhadi M, Grau C, Eriksen J, Johansen J, Nielsen M, Petersen J, Samsøe E, Sibolt P, Smulders B, Jensen K. OC-0089 Acute toxicities in proton therapy of head-neck cancer – a matched analysis of DAHANCA 35 pilot data. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02465-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tvilum M, Knap M, Lutz C, Hoffmann L, Khalil A, Haraldsen A, Alber M, Grau C, Schmidt H, Kandi M, Mortensen L, Holt M, Appelt A, Moeller D. PO-1262 Early response to chemotherapy as predictor of locoregional and distant failure in NSCLC. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03226-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sørensen B, Sitarz M, Ankjærgaard C, Johansen J, Andersen C, Kanouta E, Overgaard C, Grau C, Poulsen P. FLASH Modalities Track (Oral Presentations) THE EFFECT OF PBS PROTON FLASH ON ACUTE SKIN TOXICITY AND TUMOR CONTROL IN A MOUSE MODEL. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01531-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Hansen C, Friborg J, Skyt P, Smulders B, Sibolt P, Nielsen M, Samsøe E, Petersen J, Johansen J, Zukauskaite R, Andersen E, Andersen M, Farhadi M, Eriksen J, Overgaard J, Grau C, Jensen K. Photon-proton dose plan comparison in the pilot phase of the randomized clinical DAHANCA 35 trial. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00106-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Argota Perez R, Sharma M, Elstroem U, Moeller D, Grau C, Jensen K, Korreman S, Holm A. OC-0203 Nominal, daily and accumulated target coverage for photon and proton treatment of sinonasal cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06818-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Prades J, Borras J, Bibault J, Grau C, Jereczek-Fossa B, Lambrecht M, Slotman B, Troost E, Lievens Y. PO-1493 Opening the angle: the role played by National Societies for Radiation Oncology during the COVID-19. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07944-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sørensen B, Sitarz M, Ankjærgaard C, Johansen J, Andersen C, Kanouta E, Overgaard C, Grau C, Poulsen P. OC-0561 In vivo validation and tissue sparing factor for acute damage of pencil beam scanning proton FLASH. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06968-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Overgaard C, Sitarz M, Bassler N, Spejlborg H, Johansen J, Kanouta E, Grau C, Overgaard J, Poulsen P, Sørensen B. OC-0283 LET dependence of proton RBE in early normal tissue damage in vivo. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06833-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Zukauskaite R, Grau Eriksen J, Andersen E, Johansen J, Samsøe Hinsby E, Long Krogh S, Overgaard J, Grau C, Rønn Hansen C. OC-0516 Local control in HNSCC after introduction of geometric margins in DAHANCA radiotherapy guidelines. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06942-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gerlach S, Pinto M, Kurichiyanil N, Grau C, Hérault J, Hillbrand M, Poulsen PR, Safai S, Schippers JM, Schwarz M, Søndergaard CS, Tommasino F, Verroi E, Vidal M, Yohannes I, Schreiber J, Parodi K. Corrigendum: Beam characterization and feasibility study for a small animal irradiation platform at clinical proton therapy facilities (2020 Phys. Med. Biol.65 245045). Phys Med Biol 2021; 66. [PMID: 34037545 DOI: 10.1088/1361-6560/abf00e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/18/2021] [Indexed: 11/11/2022]
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Nyeng TB, Møller DS, Farr K, Kramer S, Khalil AA, Grau C, Hoffmann L. A comparison of two methods for segmentation of functional volumes in radiotherapy planning of lung cancer patients. Acta Oncol 2021; 60:353-360. [PMID: 33522851 DOI: 10.1080/0284186x.2021.1877811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND In radiotherapy (RT) of lung cancer, dose to functional lung (FL) volumes segmented with two different methods (perfusion SPECT (Q-SPECT) and 4D-CT (4D) ventilation (V)) have been shown to correlate with the incidence of radiation pneumonitis (RP). This study aims to compare the FL volumes identified by both methods. MATERIAL AND METHODS Thirty lung cancer patients had a 4D and Q-SPECT prior to treatment. Seventeen of these patients also had a ventilation SPECT (V-SPECT). FL sub-volumes were segmented automatically, using cut-off values. The volumes were compared in terms of overlap fraction (OF) relative to the minimal volume, and intersection fraction (IF) of the FL volume relative to the total lung volume (VLung). RESULTS Cut-off values suggested in literature for Q-SPECT and 4D-V resulted in volumes differing in size by a median 18% [6%;31%], and a median OF and IF of 0.48 [0.23;0.70] and 0.09 [0.02;0.25], respectively. Segmenting volumes of comparable size of about 1/3 of VLung (FL-m(1/3), m = method) resulted in a median OF and IF of 0.43 [0.23;0.58] and 0.12 [0.06;0.19], respectively. Twenty-five patients (83%) had a reasonable overlap between FL-Q(1/3) and FL-4D-V(1/3) volumes, with OF values above 0.33. IF increased significantly (p = .036) compared to using fixed cut-off values. Similarly, volumes of comparable size of about 1/3 VLung were produced for V-SPECT, and FL-Q(1/3), FL-V(1/3), and FL-4D-V(1/3) were compared. The overlaps and intersections of FL-V(1/3) with FL-Q(1/3) volumes were significantly (p<.001) larger than the corresponding overlaps and intersections of FL-Q(1/3) with FL-4D(1/3) and FL-V(1/3) with FL-4D(1/3). CONCLUSION The Q-SPECT and 4D-V methods do not segment entirely the same FL volumes. A reasonable overlap of the volumes along with the findings of other studies that both correlate to RP incidence, suggests that a combination of both volumes, e.g. using the IF, may be useful in RT treatment planning.
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Sharma M, Argota Perez R, Holm A, Korreman S, Jensen K, Elstrøm U, Grau C. Air variability in maxillary sinus during radiotherapy for sinonasal carcinoma. Clin Transl Radiat Oncol 2021; 27:36-43. [PMID: 33490653 PMCID: PMC7809099 DOI: 10.1016/j.ctro.2020.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/26/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The aim was to characterise patterns and predictability of aeration changes in the ipsilateral maxillary sinus during intensity-modulated radiotherapy (IMRT) for sinonasal cancer (SNC), and in a sample evaluate the dosimetric effects of aeration changes for both photon and proton therapy. MATERIALS AND METHODS The study included patients treated with IMRT for SNC in a single institution in 2009-2017. The volume of air in the ipsilateral maxillary sinus was recorded in 1578 daily cone beam computer tomography (CBCT) from 53 patients. Patterns of changing air volumes were categorised as 'stable', increasing', 'decreasing', or 'erratic'. For the prediction analysis, categorisation was performed based both on the entire treatment course and the first five fractions (F1-5). Photon and proton therapy plans were generated for four patients, the one from each category with the largest aeration variation. Synthetic CT images were generated for each CBCT and all plans were recalculated on the daily synthetic CTs. RESULTS The absolute volume of air varied considerably during the treatment course, ranging from 0 to 25.9 cm3. Changes within a single participant varied in the range of 0-18.7 cm3. In the categorisation of patterns, most patients had increasing aeration of the sinus. Generally, patterns of aeration could not be predicted from F1-5. Patients categorised as increasing in F1-5 had the best prediction, with 78% predicted correctly as increasing for the entire treatment course. The numeric correlation coefficients for target coverage and air volume were low for 3/4 scenarios (photons 0.03-0.23, protons 0.26-0.48). No straightforward correlation between the dosimetric effect and the volume changes could be detected in the sample test of four patients for neither photon nor proton therapy. CONCLUSION The variation of aeration was large and unpredictable. No clear dosimetric consequences of the aeration variation were evident for neither IMRT nor proton therapy for the patients investigated.
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Gerlach S, Pinto M, Kurichiyanil N, Grau C, Hérault J, Hillbrand M, Poulsen PR, Safai S, Schippers JM, Schwarz M, Søndergaard CS, Tommasino F, Verroi E, Vidal M, Yohannes I, Schreiber J, Parodi K. Beam characterization and feasibility study for a small animal irradiation platform at clinical proton therapy facilities. Phys Med Biol 2020; 65:245045. [DOI: 10.1088/1361-6560/abc832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Machiels JP, René Leemans C, Golusinski W, Grau C, Licitra L, Gregoire V. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2020; 31:1462-1475. [PMID: 33239190 DOI: 10.1016/j.annonc.2020.07.011] [Citation(s) in RCA: 351] [Impact Index Per Article: 87.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 12/25/2022] Open
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Chan J, Friborg J, Zubizarreta E, van Eck J, Hanna T, Bourque J, Gaudet M, Dennis K, Olson R, Coleman C, Petersen A, Grau C, Abdel-Wahab M, Brundage M, Slotman B, Polo A. Geographic Accessibility to Radiotherapy in Canada and Greenland for Indigenous Populations: A Quantitative Approach to Highlighting Inequities and Exploring Solutions. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kaplan L, Hansen C, Jensen K, Friborg J, Samsøe E, Johansen J, Andersen M, Smulders B, Andersen E, Nielsen M, Eriksen J, Petersen J, Elstrøm U, Holm A, Skyt P, Vestergaard A, Lorenzen E, Nielsen M, Marseguerra R, Morthorst M, Grau C, Korreman S. OC-0107: Quantitative metrics to analyze variations and support best practices in head and neck dose plans. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hansen C, Van den Bosch L, Van der Laan H, Friborg J, Jensen K, Samsøe E, Johnsen L, Zukauskaite R, Grau C, Maare C, Johansen J, Primdahl H, Bratland Å, Kristensen C, Andersen M, Eriksen J, Langendijk J, Overgaard J, Van der Schaaf A. OC-0575: Type 4 validation of dysphagia NTCP model for selection of HNC patients to the RCT, DAHANCA35. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00597-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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