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Yeap PL, Noble DJ, Harrison K, Bates AM, Burnet NG, Jena R, Romanchikova M, Sutcliffe MPF, Thomas SJ, Barnett GC, Benson RJ, Jefferies SJ, Parker MA. Automatic contour propagation using deformable image registration to determine delivered dose to spinal cord in head-and-neck cancer radiotherapy. Phys Med Biol 2017; 62:6062-6073. [PMID: 28573978 PMCID: PMC5952263 DOI: 10.1088/1361-6560/aa76aa] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To determine delivered dose to the spinal cord, a technique has been developed to propagate manual contours from kilovoltage computed-tomography (kVCT) scans for treatment planning to megavoltage computed-tomography (MVCT) guidance scans. The technique uses the Elastix software to perform intensity-based deformable image registration of each kVCT scan to the associated MVCT scans. The registration transform is then applied to contours of the spinal cord drawn manually on the kVCT scan, to obtain contour positions on the MVCT scans. Different registration strategies have been investigated, with performance evaluated by comparing the resulting auto-contours with manual contours, drawn by oncologists. The comparison metrics include the conformity index (CI), and the distance between centres (DBC). With optimised registration, auto-contours generally agree well with manual contours. Considering all 30 MVCT scans for each of three patients, the median CI is \documentclass[12pt]{minimal}
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}{}$0.759 \pm 0.003$ \end{document}0.759±0.003, and the median DBC is (\documentclass[12pt]{minimal}
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}{}$0.87 \pm 0.01$ \end{document}0.87±0.01) mm. An intra-observer comparison for the same scans gives a median CI of \documentclass[12pt]{minimal}
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}{}$0.820 \pm 0.002$ \end{document}0.820±0.002 and a DBC of (\documentclass[12pt]{minimal}
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}{}$0.64 \pm 0.01$ \end{document}0.64±0.01) mm. Good levels of conformity are also obtained when auto-contours are compared with manual contours from one observer for a single MVCT scan for each of 30 patients, and when they are compared with manual contours from six observers for two MVCT scans for each of three patients. Using the auto-contours to estimate organ position at treatment time, a preliminary study of 33 patients who underwent radiotherapy for head-and-neck cancers indicates good agreement between planned and delivered dose to the spinal cord.
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Affiliation(s)
- P L Yeap
- Cavendish Laboratory, University of Cambridge, JJ Thomson Avenue, Cambridge, CB3 0HE, United Kingdom
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Lonkvist CK, Lønbro S, Vinther A, Zerahn B, Rosenbom E, Primdahl H, Hojman P, Gehl J. Progressive resistance training in head and neck cancer patients during concomitant chemoradiotherapy -- design of the DAHANCA 31 randomized trial. BMC Cancer 2017; 17:400. [PMID: 28578654 PMCID: PMC5457597 DOI: 10.1186/s12885-017-3388-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 05/25/2017] [Indexed: 02/06/2023] Open
Abstract
Background Head and neck cancer patients undergoing concomitant chemoradiotherapy (CCRT) frequently experience loss of muscle mass and reduced functional performance. Positive effects of exercise training are reported for many cancer types but biological mechanisms need further elucidation. This randomized study investigates whether progressive resistance training (PRT) may attenuate loss of muscle mass and functional performance. Furthermore, biochemical markers and muscle biopsies will be investigated trying to link biological mechanisms to training effects. Methods At the Departments of Oncology at Herlev and Aarhus University Hospitals, patients with stage III/IV squamous cell carcinoma of the head and neck, scheduled for CCRT are randomized 1:1 to either a 12-week PRT program or control group, both with 1 year follow-up. Planned enrollment is 72 patients, and stratification variables are study site, sex, p16-status, and body mass index. Primary endpoint is difference in change in lean body mass (LBM) after 12 weeks of PRT, assessed by dual-energy X-ray absorptiometry (DXA). The hypothesis is that 12 weeks of PRT can attenuate the loss of LBM by at least 25%. Secondary endpoints include training adherence, changes in body composition, muscle strength, functional performance, weight, adverse events, dietary intake, self-reported physical activity, quality of life, labor market affiliation, blood biochemistry, plasma cytokine concentrations, NK-cell frequency in blood, sarcomeric protein content in muscles, as well as muscle fiber type and fiber size in muscle biopsies. Muscle biopsies are optional. Discussion This randomized study investigates the impact of a 12-week progressive resistance training program on lean body mass and several other physiological endpoints, as well as impact on adverse events and quality of life. Furthermore, a translational approach is integrated with extensive biological sampling and exploration into cytokines and mechanisms involved. The current paper discusses decisions and methods behind exercise in head and neck cancer patients undergoing concomitant chemoradiotherapy. Trial registration Approved by the Regional Ethics Committee for the Capital Region of Denmark (protocol id: H-15003725) and registered retrospectively at ClinicalTrials.gov (NCT02557529) September 11th 2015. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3388-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Camilla K Lonkvist
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Simon Lønbro
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Section for Sports Science, Aarhus University, Aarhus, Denmark
| | - Anders Vinther
- Department of Rehabilitation, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Eva Rosenbom
- Nutritional Research Unit, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Hanne Primdahl
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Pernille Hojman
- Centre of Inflammation and Metabolism (CIM) and Centre for Physical Activity Research (CFAS), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Julie Gehl
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark.
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Lim WS, Roh JL, Kim SB, Choi SH, Nam SY, Kim SY. Pretreatment albumin level predicts survival in head and neck squamous cell carcinoma. Laryngoscope 2017; 127:E437-E442. [PMID: 28561532 DOI: 10.1002/lary.26691] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/13/2017] [Accepted: 04/18/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Poor nutritional status in patients with head and neck squamous cell carcinoma (HNSCC) is associated with tumor progression and survival. This study examined the prognostic value of nutritional and hematological markers in patients with HNSCC who received definitive treatments. STUDY DESIGN A prospective observational cohort study. METHODS This study included 338 consecutive patients who underwent surgery and/or radiotherapy/chemoradiotherapy for treatment-naïve HNSCC. Body weight and nutritional and hematological parameters were regularly measured before and after treatment. Univariate and multivariate analyses using Cox proportional hazards models were performed to identify factors associated with disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS Body weight, serum total protein and albumin levels, and hematological variables significantly decreased after treatment. Univariate analyses illustrated that age, tumor site, T and N classifications, overall stage, pretreatment serum albumin (<3.5 g/dL) and hemoglobin (<12 g/dL) levels, and neutrophil-lymphocyte ratio were significantly associated with DFS, CSS, and OS (all P < .05). Multivariate analyses identified age, tumor site, N classification, and pretreatment albumin levels as independent predictors of DFS, CSS, and OS (all P < .05). Patients with low serum albumin levels prior to treatment experienced approximately sixfold increases in the risks of tumor progression and cancer-specific and overall mortality compared to the findings in their counterparts. CONCLUSIONS Our results suggest that pretreatment serum albumin levels predict DFS, CSS, and OS in patients who received definitive treatment for HNSCC. These findings might help to predict treatment outcome and guide nutritional intervention in patients with HNSCC. LEVEL OF EVIDENCE 2b. Laryngoscope, 127:E437-E442, 2017.
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Affiliation(s)
- Won Sub Lim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Bae Kim
- Internal Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Predictors for Weight Loss in Head and Neck Cancer Patients Undergoing Radiotherapy: A Systematic Review. Cancer Nurs 2017; 38:E37-45. [PMID: 25730590 DOI: 10.1097/ncc.0000000000000231] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Head and neck cancer patients are at high risk of weight loss because of their disease process and the treatment of their disease. Recognition of predictors for weight loss may be able to give proactive or reactive nutritional treatment to patients at risk. OBJECTIVE The aim of this study is to identify the independent risk factors for head and neck cancer patients developing weight loss undergoing radiotherapy. METHODS A comprehensive literature search was performed on January 2014. Articles reporting studies of the predictors for weight loss in head and neck cancer patients undergoing radiotherapy were included. These studies were published between 1982 and 2014. Study quality was assessed using a modified quality assessment tool that was designed previously for an observational study. The effects of studies were combined with the study quality score using a best-evidence synthesis model. RESULTS Twenty-two observational studies involving 6159 patients were included. There was strong evidence for 3 predictors, including advanced tumor stage, a higher body mass index before treatment, and the use of concurrent chemoradiotherapy. We also identified 8 moderate evidence predictors and 30 limited evidence predictors. CONCLUSION The scientific literature to date indicates that patients with advanced tumor stage, or a higher body mass index before treatment, or the use of concurrent chemotherapy are at high risk to have weight loss during radiotherapy. IMPLICATIONS FOR PRACTICE These data provide evidence to guide healthcare professionals in admitting patients who will have weight loss and choosing an optimal prophylactic strategy.
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Dysphagia and Head and Neck Cancer. Dysphagia 2016. [DOI: 10.1016/b978-0-323-18701-5.00004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Zhang Z, Brown JC, O'Malley BW, Troxel AB, Bauml JM, Rubnitz KR, Grosso CM, Weinstein GS, Schmitz KH. Post-treatment weight change in oral cavity and oropharyngeal squamous cell carcinoma. Support Care Cancer 2015; 24:2333-2340. [PMID: 26619995 DOI: 10.1007/s00520-015-3029-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 11/15/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE Incidence of head and neck cancer (HNC) due to human papillomavirus (HPV) infection has been increasing. Treatment regimens have evolved. These changes might result in alterations of assumed treatment-related weight changes for HNC patients. We aimed to compare the trajectory of pre- to post-treatment weight changes of oropharyngeal squamous cell carcinoma (OPSCC) versus oral cavity squamous cell carcinoma (OCSCC) patients and to compare weight changes between patients with primary surgery ± adjuvant therapy to patients with primary radiation and/or chemotherapy. METHODS This retrospective cohort study examined adult OPSCC and OCSCC patients with initial definitive treatment at the University of Pennsylvania from January 1, 2009 to December 31, 2010. Patient demographics, medical history, treatments, and pre- and post-treatment body weight data were collected from electronic medical records. Mixed-effects modeling was performed. RESULTS Among 354 patients who met the inclusion criteria, 290 (82 %) survivors were available for inclusion by 24-month follow-up. More than 70 % OPSCC and OCSCC patients were overweight or obese at all pre- and post-treatment time points. The average weight among OPSCC patients was 6.63 kg higher than OCSCC patients at all time points (mean = 6.63, 95 % confidence interval (CI), 2.46-10.79, p = 0.002). After adjusting for potential confounders, patients with primary surgery had significantly more weight gain from pre-treatment to 12-18 month post-treatment follow-up as compared to patients with primary radiation and/or chemotherapy (adjusted mean = 4.01, 95 % CI, 0.16-7.87, p = 0.041). CONCLUSION Overweight and obesity may be a new challenge in OPSCC and OCSCC patient care. Further study is needed to evaluate whether exercise and nutritional interventions can improve their survivorship.
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Affiliation(s)
- Zi Zhang
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 8th Floor, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA
| | - Justin C Brown
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 8th Floor, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA
| | - Bert W O'Malley
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea B Troxel
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 8th Floor, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA
| | - Joshua M Bauml
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kaitlyn R Rubnitz
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 8th Floor, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA
| | - Colleen M Grosso
- Cancer Registry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory S Weinstein
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn H Schmitz
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 8th Floor, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA.
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Lønbro S, Petersen GB, Andersen JR, Johansen J. Prediction of critical weight loss during radiation treatment in head and neck cancer patients is dependent on BMI. Support Care Cancer 2015; 24:2101-2109. [PMID: 26553031 DOI: 10.1007/s00520-015-2999-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/26/2015] [Indexed: 01/19/2023]
Abstract
PURPOSE The aims of the present study were to explore pre-treatment predictors of weight loss during radiation treatment only in head and neck cancer (HNSCC) patients and investigate the weight loss in patients with or without a feeding tube. METHODS Retrospectively, weight change during curative radiotherapy was investigated in 476 consecutive HNSCC patients. Independent predictors were identified using multivariate regression analysis with weight loss below or above 5 % as the primary dependent variable. RESULTS Baseline BMI, tumor site, and stage predicted weight loss above 5 %. The odds of weight loss above 5 % in patients with BMI >25 were 3.00 ± 0.64 times higher compared with patients with BMI <25 (p < 0.0001). Patients with pharyngeal, oral cavity, or supraglottic tumors had 3.12 ± 0.80 times higher odds of weight loss above 5 % compared with glottic cancer patients (p < 0.0001), and the odds were 1.68 ± 0.40 times higher in stage III-IV patients compared with stage I-II patients (p = 0.03). Seperate analyses revealed that tumor site and stage only predicted weight loss in patients with BMI >25 but not in patients with BMI <25. Patients receiving a feeding tube weighed less than patients without (73.8 vs 78.3 kg) and feeding tube reduced, but did not prevent, weight loss which averaged 6.7 ± 4.7 kg (7.4 ± 4.7 %) compared with 4.7 ± 5.9 kg (5.5 ± 6.0 %) in patients without a feeding tube (P < 0.0001). CONCLUSION Pre-treatment BMI, tumor site and stage predicted weight loss above 5 % in HNSCC patients during radiotherapy. BMI should be considered when analyzing weight loss in HNSCC patients receiving curative radiotherapy.
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Affiliation(s)
- Simon Lønbro
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
- Department of Public Health, Section for Sports Science, Aarhus University, Aarhus, Denmark
| | - Gry Bjerg Petersen
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
| | - Jens Rikardt Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
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McKibbin T, Cheng LL, Kim S, Steuer CE, Owonikoko TK, Khuri FR, Shin DM, Saba NF. Mannitol to prevent cisplatin-induced nephrotoxicity in patients with squamous cell cancer of the head and neck (SCCHN) receiving concurrent therapy. Support Care Cancer 2015; 24:1789-93. [PMID: 26446698 DOI: 10.1007/s00520-015-2978-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/28/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study is to compare the incidence and severity of nephrotoxicity in patients receiving cisplatin with saline hydration vs. saline hydration with mannitol. METHODS Retrospective chart review of all patients receiving a starting dose of cisplatin 100 mg/m(2) with concurrent radiation for SCCHN between January 1, 2009 and March 1, 2013. All patients received pre and post hydration each with 1 l of 0.9 % saline. The mannitol group received 12.5 g of mannitol in the prehydration fluid. The primary outcome was to compare the rate of grade 3 or greater serum creatinine (SCr) increase in patients receiving saline hydration vs. the addition of mannitol; additional parameters of interest included creatinine clearance, electrolyte disturbances, dose changes, and discontinuation of cisplatin. RESULTS Data from 139 patients (80 % male) with a median age of 56 years (range 22 to 75 years) were collected; 88 received mannitol and 51 received saline alone. On multivariable analysis, the mannitol group was less likely to have grade 3 SCr increase than saline only group (OR 0.16; 95 % CI 0.04-0.65; p value = 0.01). There were no grade 4 SCr increase events. Rates of hypomagnesemia and hypokalemia were similar across groups. Grade 3 hyponatremia was more likely to occur in the mannitol group as compared to saline alone group (41 vs 22 %; p = 0.026). CONCLUSION The addition of mannitol to saline hydration decreased the incidence of grade 3 increases in SCr in this cohort of patients and may increase rates of hyponatremia. Further investigations of methods to lessen cisplatin-induced nephrotoxicity are needed.
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Affiliation(s)
- Trevor McKibbin
- Department of Hematology and Medical Oncology, School of Medicine, Emory University, Atlanta, GA, USA. .,Winship Cancer Institute of Emory University, 1365 Clifton Rd., Atlanta, GA, 30322, USA.
| | - Linda L Cheng
- Department of Pharmacy, Albany Medical Center, Albany, NY, USA
| | - Sungjin Kim
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Conor E Steuer
- Department of Hematology and Medical Oncology, School of Medicine, Emory University, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, 1365 Clifton Rd., Atlanta, GA, 30322, USA
| | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, School of Medicine, Emory University, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, 1365 Clifton Rd., Atlanta, GA, 30322, USA
| | - Fadlo R Khuri
- Department of Hematology and Medical Oncology, School of Medicine, Emory University, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, 1365 Clifton Rd., Atlanta, GA, 30322, USA
| | - Dong M Shin
- Department of Hematology and Medical Oncology, School of Medicine, Emory University, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, 1365 Clifton Rd., Atlanta, GA, 30322, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, School of Medicine, Emory University, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, 1365 Clifton Rd., Atlanta, GA, 30322, USA
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Mature results from a Swedish comparison study of conventional versus accelerated radiotherapy in head and neck squamous cell carcinoma - The ARTSCAN trial. Radiother Oncol 2015; 117:99-105. [PMID: 26427805 DOI: 10.1016/j.radonc.2015.09.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/10/2015] [Accepted: 09/18/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE This report contains the mature five-year data from the Swedish ARTSCAN trial including information on the influence of p16 positivity (p16+) for oropharyngeal cancers. MATERIAL AND METHODS Patients with previously untreated squamous cell carcinoma without distant metastases of the oral cavity, oropharynx, larynx (except T1-2, N0 glottic cancers) and hypopharynx were included. Patients were randomised between accelerated fractionation (AF) (1.1Gy+2Gy per day, 5days/week for 4.5weeks, total dose 68Gy) and conventional fractionation (CF) (2Gy per day, 5days/week for 7weeks, total dose 68Gy). Human papillomavirus (HPV)-associated p16-expression was assessed retrospectively in tumour tissues from patients with oropharyngeal carcinoma. RESULTS There was no significant difference in loco-regional control (LRC) between AF and CF (log-rank test p=0.75). LRC at 5years was 65.5% for AF and 64.9% for CF. Overall survival (OS) was similar in both arms (p=0.99). The estimated cancer specific survival (CSS) at 5years was 62.2% (AF) and 63.3% (CF) (p=0.99). 206 specimens were analysed for p16 with 153 specimens (74%) identified as p16+. P16 status did not discriminate for response to AF vs. CF with regard to LRC, OS or CSS. Patients with p16+ tumours had a statistically significant better overall prognosis compared with p16- tumours. CONCLUSION This update confirms the results of the 2-year report. We failed to identify a positive effect resulting from AF with regards to LRC, OS and CSS. The addition of information on the HPV-associated p16 overexpression did not explain this lack of effect.
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Vlooswijk CP, van Rooij PHE, Kruize JC, Schuring HA, Al-Mamgani A, de Roos NM. Dietary counselling and nutritional support in oropharyngeal cancer patients treated with radiotherapy: persistent weight loss during 1-year follow-ups. Eur J Clin Nutr 2015. [PMID: 26197875 DOI: 10.1038/ejcn.2015.102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES The need for dietary counselling and nutritional support in oropharyngeal cancer patients is generally accepted. However, evidence for the effectiveness is sparse. The aim of this study was to describe dietary counselling, nutritional support, body weight and toxicity during and after treatment, and investigate the effect of pre-treatment body mass index (BMI) on survival in oropharyngeal cancer patients. SUBJECTS/METHODS A retrospective chart review was made in 276 oropharyngeal cancer patients treated with radiotherapy (RT). End points were dietary consultations, weight loss, toxicity, overall survival and disease-free survival. RESULTS Almost all oropharyngeal cancer patients received dietary counselling (94%) and nutritional support (99%). Dietary counselling decreased sharply shortly after treatment to 38% at 1 year after treatment. Overall weight loss increased during the first year of follow-up and ranged from 3% at start of RT, until 11% at 1 year after RT. Overall survival was significantly longer for patients with a BMI above average (P=0.01). Acute dysphagia (P=0.001), mucositis (P=0.000) and toxicity grade 3 (P=0.002) were significantly more prevalent in patients who had lost 10% or more of their body weight. CONCLUSIONS This study showed that patients continue to lose body weight during and until 1 year after treatment, despite nutrition support and frequent dietetic consultation. A BMI above average appears to increase survival time. Future studies, preferably randomized trials, are needed to compare standard dietary counselling with more intensive dietary counselling that consists of earlier and/or prolonged treatment.
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Affiliation(s)
- C P Vlooswijk
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - P H E van Rooij
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - J C Kruize
- Department of Dietetics, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - H A Schuring
- Department of Dietetics, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - A Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - N M de Roos
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
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Exploration of risk factors for weight loss in head and neck cancer patients. JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s146039691500031x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroductionHead and neck cancer patients receiving radiotherapy can experience a number of toxicities, including weight loss and malnutrition, which can impact upon the quality of treatment. The purpose of this retrospective cohort study is to evaluate weight loss and identify predictive factors for this patient group.Materials and methodsA total of 40 patients treated with radiotherapy since 2012 at the study centre were selected for analysis. Data were collected from patient records. The association between potential risk factors and weight loss was investigated.ResultsMean weight loss was 5 kg (6%). In all, 24 patients lost >5% starting body weight. Age, T-stage, N-stage, chemotherapy and starting body weight were individually associated with significant differences in weight loss. On multiple linear regression analysis age and nodal status were predictive.ConclusionYounger patients and those with nodal disease were most at risk of weight loss. Other studies have identified the same risk factors along with several other variables. The relative significance of each along with a number of other potential factors is yet to be fully understood. Further research is required to help identify patients most at risk of weight loss; and assess interventions aimed at preventing weight loss and malnutrition.
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Isaksson J, Wilms T, Laurell G, Fransson P, Ehrsson YT. Meaning of work and the process of returning after head and neck cancer. Support Care Cancer 2015; 24:205-213. [PMID: 26003423 DOI: 10.1007/s00520-015-2769-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/12/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The purposes of this study were (1) to investigate employment status at diagnosis, sick leave, and returning to work patterns in correlation to quality of life, anxiety, and depression in patients treated for head and neck cancer (HNC) and (2) to explore patients' experiences of the process of returning to work. METHODS Sixty-six patients with HNC (aged 34-66 years) were repeatedly interviewed over a period of 24 months. Interview responses that concerned the patients' experiences and ideas about work were categorised using the similarities-differences technique. Questionnaires on quality of life, anxiety, and depression were used to describe the patient characteristics and the differences between groups. RESULTS In total, 53% of the patients had returned to work at 24 months after treatment, and 17% were deceased. Several quality of life parameters were significantly worse for patients not working at 24 months after treatment. Nine categories were found to describe the return-to-work process starting with symptoms causing sick leave, thoughts about the sick leave, and ending with the return to work and/or retirement. CONCLUSIONS Returning to work is an important part of life because it structures everyday life and strengthens the individual's identity. The quality of life results showed significant differences between workers and non-workers at the 24-month follow-up. The patients need to be both physically and mentally prepared for the process of returning to work. It is important to take an individual rehabilitation approach to guide and support the patients in returning to work and regaining an important aspect of their everyday life. In such an approach, it is vital to understand the patients' overall life context and the patients' own perspective on the process and meaning associated with work.
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Affiliation(s)
- Joakim Isaksson
- Department of Social Work, Umeå University, SE-901 87, Umeå, Sweden.
| | - Torben Wilms
- Department of Medical Biosciences, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Göran Laurell
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Per Fransson
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Ylva Tiblom Ehrsson
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
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63
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Jackson SE, Williams K, Steptoe A, Wardle J. The impact of a cancer diagnosis on weight change: findings from prospective, population-based cohorts in the UK and the US. BMC Cancer 2014; 14:926. [PMID: 25487996 PMCID: PMC4265482 DOI: 10.1186/1471-2407-14-926] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 11/21/2014] [Indexed: 12/05/2022] Open
Abstract
Background Obesity is a risk factor for cancer incidence and survival, but data on patterns of weight change in cancer survivors are scarce and few stratify by pre-diagnosis weight status. In two population-based cohorts of older adults, we examined weight change in cancer survivors and cancer-free controls in relation to baseline weight status. Methods In the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS), we identified participants diagnosed with cancer who had pre- and post-diagnosis BMI data (ELSA n = 264; HRS n = 2553), and cancer-free controls (ELSA n = 1538; HRS n = 4946). Repeated-measures ANOVAs tested three-way interactions by group (cancer/control), time (pre-/post-diagnosis), and pre-diagnosis weight status (normal-weight/overweight/obese). Results Mean BMI change was -0.07 (SD = 2.22) in cancer survivors vs. +0.14 (SD = 1.11) in cancer-free controls in ELSA, and -0.20 (SD = 2.84) vs. +0.11 (SD = 0.93) respectively in HRS. Three-way interactions were significant in both cohorts (ELSA p = .015; HRS p < .001). In ELSA, mean BMI change in normal-weight cancer survivors was +0.19 (SD = 1.53) compared with -0.33 (SD = 3.04) in obese survivors. In ELSA controls, the respective figures were +0.09 (SD = 0.81) and +0.16 (SD = 1.50). In HRS, mean change in normal-weight cancer survivors was +0.07 (SD = 2.30) compared with -0.72 (SD = 3.53) in obese survivors. In HRS controls, the respective figures were +0.003 (SD = 0.66) and +0.27 (SD = 1.27). Conclusion Over a four-year period, in two cohorts of older adults, cancer survivors lost weight relative to cancer-free controls. However, cancer survivors who were obese pre-diagnosis were more likely to lose weight than healthy-weight survivors or obese adults without a cancer diagnosis. Whether this was due to differences in clinical status or deliberate lifestyle change triggered by the cancer diagnosis is not known. Further research is needed to establish why weight loss occurs more frequently in cancer survivors who were obese at diagnosis, and whether this has favourable effects on mortality. Electronic supplementary material The online version of this article (doi:10.1186/1471-2407-14-926) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
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64
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Référentiel de pratiques professionnelles : prise en charge nutritionnelle des cancers des voies aérodigestives supérieures. NUTR CLIN METAB 2014. [DOI: 10.1016/j.nupar.2014.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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65
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Ottosson S, Söderström K, Kjellén E, Nilsson P, Zackrisson B, Laurell G. Weight and body mass index in relation to irradiated volume and to overall survival in patients with oropharyngeal cancer: a retrospective cohort study. Radiat Oncol 2014; 9:160. [PMID: 25052587 PMCID: PMC4112828 DOI: 10.1186/1748-717x-9-160] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 07/12/2014] [Indexed: 01/04/2023] Open
Abstract
Background Weight loss is a common problem in patients with Squamous Cell Carcinoma of the Head and Neck (SCCHN) treated with radiotherapy (RT). The aims of the present study were to determine if treated volume (TV), as a measure of the radiation dose burden, can predict weight loss in patients with oropharyngeal cancer and to analyze weight loss and body mass index (BMI) in the same patient group in relation to 5-year overall survival. Methods The ARTSCAN trial is a prospective, randomized, multicenter trial in patients with SCCHN. Nutritional data from the ARTSCAN trial were analyzed retrospectively using univariate and multivariate statistical methods based on information on percentage weight loss from the start of RT up to five months after the termination of RT (study cohort 1, n = 232) and information on patients’ BMI at the start of RT (study cohort 2, n = 203). TV was defined as the volume of the patient receiving at least 95% of the prescribed dose. TV64.6 Gy encompasses macroscopic tumor and TV43.7 Gy elective lymph nodes of the neck. Results TV64.6 Gy and TV43.7 Gy were both significantly correlated with higher weight loss up to five months after the termination of RT in study cohort 1 (p < 0.001 for both). BMI at the start of RT was shown to be a prognostic factor for 5-year overall survival in study cohort 2 but weight loss was not. The hazard ratios and 95% confidence intervals were 3.78 (1.46–9.75) and 2.57 (1.43–4.62) in patients with underweight and normal weight, respectively. Conclusions TV can predict weight loss during RT in patients with oropharyngeal cancer regardless of clinical stage. A high BMI (>25 kg/m2) at the start of RT is positively associated with survival in patients with oropharyngeal cancer.
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Affiliation(s)
- Sandra Ottosson
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden.
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66
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Ottosson S, Lindblom U, Wahlberg P, Nilsson P, Kjellén E, Zackrisson B, Levring Jäghagen E, Laurell G. Weight loss and body mass index in relation to aspiration in patients treated for head and neck cancer: a long-term follow-up. Support Care Cancer 2014; 22:2361-9. [DOI: 10.1007/s00520-014-2211-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 03/09/2014] [Indexed: 11/28/2022]
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67
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Gobbo M, Ottaviani G, Perinetti G, Ciriello F, Beorchia A, Giacca M, Di Lenarda R, Rupel K, Tirelli G, Zacchigna S, Biasotto M. Evaluation of nutritional status in head and neck radio-treated patients affected by oral mucositis: efficacy of class IV laser therapy. Support Care Cancer 2014; 22:1851-6. [DOI: 10.1007/s00520-014-2155-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 01/28/2014] [Indexed: 01/09/2023]
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Lønbro S, Dalgas U, Primdahl H, Johansen J, Nielsen JL, Overgaard J, Overgaard K. Lean body mass and muscle function in head and neck cancer patients and healthy individuals--results from the DAHANCA 25 study. Acta Oncol 2013; 52:1543-51. [PMID: 23964657 DOI: 10.3109/0284186x.2013.822553] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Loss of lean body mass is common following radiotherapy in patients with head and neck squamous cell carcinoma (HNSCC) and may reduce maximal muscle strength and functional performance. However, the associations between lean body mass, muscle strength and functional performance are unclear and no studies in HNSCC patients have compared the levels of these variables to the levels seen in healthy individuals. PURPOSE The purpose of the present study was to investigate the associations between lean body mass, maximal muscle strength and functional performance in HNSCC patients and to compare the levels of these variables after radiotherapy and after progressive resistance training with the levels in healthy individuals. MATERIAL AND METHODS Lean body mass (dual energy X-ray absorptiometry), maximal muscle strength (isokinetic dynamometry) and functional performance (10 m max gait speed, 30 s chair rise, 30 s arm curl, stair climb) from HNSCC patients from the DAHANCA 25 trials and data from 24 healthy individuals were included. RESULTS Lean body mass and maximal muscle strength were significantly associated according to the gender and age-adjusted linear regression model (p < 0.0001). In addition, maximal muscle strength were associated with 30 s arm curl performance, 10 m max gait speed and 30 s chair rise (p < 0.0001). Multiple regression analyses showed that HNSCC patients expressed significant lower levels of the investigated variables after radiotherapy than healthy individuals (p < 0.0001), and that all differences were evened out after training. CONCLUSIONS Significant associations were found between lean body mass, maximal muscle strength and functional performance in HNSCC patients. Patients expressed lower levels of these variables compared with healthy individuals, suggesting that lean body mass is a clinically relevant health factor in HNSCC patients.
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Affiliation(s)
- Simon Lønbro
- Department of Experimental Clinical Oncology, Aarhus University Hospital , Aarhus , Denmark
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Mortensen HR, Overgaard J, Jensen K, Specht L, Overgaard M, Johansen J, Evensen JF, Andersen E, Andersen LJ, Hansen HS, Grau C. Factors associated with acute and late dysphagia in the DAHANCA 6 & 7 randomized trial with accelerated radiotherapy for head and neck cancer. Acta Oncol 2013; 52:1535-42. [PMID: 24047339 DOI: 10.3109/0284186x.2013.824609] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Dysphagia is a common and debilitating side effect in head and neck radiotherapy (RT). Prognostic factors are numerous and their interrelationship not well understood. The aim of this study was to establish a multivariate prognostic model for acute and late dysphagia after RT, based on information from a prospective trial. MATERIAL AND METHODS The DAHANCA 6&7 randomized study included 1476 patients with head and neck cancer eligible for primary RT alone. Patients were randomized between 5 and 6 weekly fractions of conventional RT, and received 62-70 Gy in 31-35 fractions. Patients were scored for dysphagia weekly during treatment and at regular intervals until five years after treatment. Dysphagia scores were available from 1461 patients. RESULTS Acute dysphagia according to DAHANCA grades 1, 2, 3 and 4 occurred in 83%, 71%, 43% and 23%, respectively. Severe dysphagia occurred in 47% and 38% of patients receiving accelerated or conventional radiotherapy, respectively (p = 0.001). At one, two, three, four and five years the prevalence of chronic dysphagia above grade 0, was 46%, 32%, 29%, 24%, 23%, respectively with no difference between 5 and 6 fractions. In multivariate analysis, the following parameters were independent factors for severe acute dysphagia: T3-T4 tumors, N-positive disease, non-glottic cancer, age> median, baseline dysphagia > 1 and accelerated radiotherapy. The following factors were prognostic factors for late dysphagia: non-glottic cancer, T3-T4, N-positive disease and baseline dysphagia > 1. The data confirmed previously published predictive models, as it was possible to separate patients in groups with low, medium and high risk of dysphagia, respectively, based on pre-treatment risk scores. CONCLUSION Prognostic models were established to characterize patients at risk of developing acute or late dysphagia in the DAHANCA 6&7 trial. The results may be useful to identify patients at risk of dysphagia and thus candidates for prophylactic measures against swallowing dysfunction.
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Mattiucci GC, Boldrini L, Chiloiro G, D'Agostino GR, Chiesa S, De Rose F, Azario L, Pasini D, Gambacorta MA, Balducci M, Valentini V. Automatic delineation for replanning in nasopharynx radiotherapy: what is the agreement among experts to be considered as benchmark? Acta Oncol 2013; 52:1417-22. [PMID: 23957565 DOI: 10.3109/0284186x.2013.813069] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE Anatomic changes during head and neck radiotherapy require replanning. The primary aim of this study is the definition of the agreement among experts in the head and neck automatic delineation frame to use as benchmark. The secondary goal is to assess the reliability of automatic delineation for nasopharynx radiotherapy and time saving. MATERIAL AND METHODS A computed tomography (CT) scan was acquired in 10 nasopharynx patients along intensity-modulated radiotherapy (IMRT) treatment for replanning. Deformable registration with replanning autocontouring of the structures was performed using VelocityAI 2.3© software defining Structure Set A. The optimization of these contours was obtained through revision by a skilled operator, drawing Structure Set B. An ex novo Structure Set C was segmented on the replanning CT-scan by an expert delineation team. The mean Dice's Similarity Index (mDSI) was calculated between Structure Set A and B, A and C, and between B and C for each volume. All segmentation times for organs at risk (OARs) and clinical target volume (CTV) were recorded and compared. RESULTS We validated the replanning autocontoured Structure Sets for 10 patients. For volumetric analysis we observed mDSI values of 0.87 for the OARs, 0.70 for nodes, 0.90 for CTV in the Structure Set A-B comparison and respectively of 0.74, 0.63 and 0.78 for the Structure Set A-C one, and 0.78, 0.78 and 0.85 for Structure Set B-C, which represents the existing expert based benchmark. We calculated a mean saved time in Structure Set B of 30 minutes. CONCLUSIONS Autocontouring procedures offer considerable segmentation time saving with acceptable reliability of the contours, even if an independent check procedure for their optimization is still required to increase their adherence to referential benchmark gold standard among experts, which stands at a 0.80 DSI value.
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Affiliation(s)
- Gian Carlo Mattiucci
- Radiation Oncology Department, Università Cattolica del Sacro Cuore , Rome , Italy
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