Radiation oncology (London, England) · 2026
Normal tissue complication probability modelling and predicting for carbon-ion radiotherapy-induced symptomatic esophageal and tracheobronchial injuries in locally advanced non-small cell lung cancer.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ming Xue, Ma Ningyi, Sheng Yinxiangzi, Chen Jian, Wu Kailiang, Mao Jingfang
Аннотация
BACKGROUND: Radiation-induced injuries (RIs) to the esophagus (ESO) and proximal bronchial tree (PBT) represent one of the most frequently observed symptomatic adverse events in locally advanced non-small cell lung cancer (LA-NSCLC). The establishment of validated normal tissue complication probability (NTCP) models and subsequent dose constraint recommendations are especially essential in carbon-ion radiotherapy (CIRT), owing to its unique physical and biological properties.
PURPOSE: To establish NTCP models and derive corresponding dose constraints for symptomatic or severe RIs in ESO and PBT in LA-NSCLC treated with local effect model (LEM)-I-based CIRT.
METHODS: This retrospective study analyzed 184 LA-NSCLC patients treated with CIRT at a median prescription dose of 77 Gy (RBE) in 3.5 Gy (RBE) per fraction. Lyman-Kutcher-Burman (LKB) NTCP models were developed for acute esophagitis (ARI-ESO), late ESO reaction (LRI-ESO), and late PBT toxicity (LRI-PBT). Predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC-ROC) by comparing single dosimetric parameters versus multivariate nomograms.
RESULTS: For grade ≥ 2 (symptomatic) ARI-ESO and grade ≥ 2/≥3 (severe) LRI-PBT, low n values (0.053±0.097, 0.139 ± 0.085, 0.224 ± 0.135, respectively) indicated predominant dependence on high-dose regions. In contrast, higher n values (0.381/0.362) observed for grade ≥ 2/≥3 late ESO toxicities suggested the use of dual constraints incorporating both maximum dose (Dmax) and mean dose (Dmean). The best equivalent uniform dose (EUD) thresholds (ROC‑derived) defined a low‑risk cohort with an actual incidence of ≤1.9% for each adverse event. The proposed Dmax thresholds of 78 Gy (RBE) for ESO and 80 Gy (RBE) for PBT are expected to limit toxicity risk below 5%. Multivariate nomograms integrating high-dose metrics and Dmean achieved AUC-ROC values of 0.823-0.884.
CONCLUSIONS: The first NTCP models for symptomatic toxicities of ESO and PBT were established in LA-NSCLC patients receiving LEM-I-based CIRT at ~3.5 Gy (RBE) per fraction with sequential systemic therapy. The ROC‑derived optimal EUD thresholds for discriminating NTCP risk were obtained with substantial AUC-ROC values. We also proposed NTCP-derived Dmax constraints and developed multivariate nomograms to facilitate routine clinical use. Further prospective studies in larger cohorts with extended follow-up were warranted.
PURPOSE: To establish NTCP models and derive corresponding dose constraints for symptomatic or severe RIs in ESO and PBT in LA-NSCLC treated with local effect model (LEM)-I-based CIRT.
METHODS: This retrospective study analyzed 184 LA-NSCLC patients treated with CIRT at a median prescription dose of 77 Gy (RBE) in 3.5 Gy (RBE) per fraction. Lyman-Kutcher-Burman (LKB) NTCP models were developed for acute esophagitis (ARI-ESO), late ESO reaction (LRI-ESO), and late PBT toxicity (LRI-PBT). Predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC-ROC) by comparing single dosimetric parameters versus multivariate nomograms.
RESULTS: For grade ≥ 2 (symptomatic) ARI-ESO and grade ≥ 2/≥3 (severe) LRI-PBT, low n values (0.053±0.097, 0.139 ± 0.085, 0.224 ± 0.135, respectively) indicated predominant dependence on high-dose regions. In contrast, higher n values (0.381/0.362) observed for grade ≥ 2/≥3 late ESO toxicities suggested the use of dual constraints incorporating both maximum dose (Dmax) and mean dose (Dmean). The best equivalent uniform dose (EUD) thresholds (ROC‑derived) defined a low‑risk cohort with an actual incidence of ≤1.9% for each adverse event. The proposed Dmax thresholds of 78 Gy (RBE) for ESO and 80 Gy (RBE) for PBT are expected to limit toxicity risk below 5%. Multivariate nomograms integrating high-dose metrics and Dmean achieved AUC-ROC values of 0.823-0.884.
CONCLUSIONS: The first NTCP models for symptomatic toxicities of ESO and PBT were established in LA-NSCLC patients receiving LEM-I-based CIRT at ~3.5 Gy (RBE) per fraction with sequential systemic therapy. The ROC‑derived optimal EUD thresholds for discriminating NTCP risk were obtained with substantial AUC-ROC values. We also proposed NTCP-derived Dmax constraints and developed multivariate nomograms to facilitate routine clinical use. Further prospective studies in larger cohorts with extended follow-up were warranted.