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Differences in delineation guidelines for head and neck cancer result in inconsistent reported dose and corresponding NTCP

2014; Elsevier BV; Volume: 111; Issue: 1 Linguagem: Inglês

10.1016/j.radonc.2014.01.019

1879-0887

Charlotte L. Brouwer, Roel J.H.M. Steenbakkers, Elske M. Gort, Marije E. Kamphuis, Hans Paul van der Laan, A.A. van't Veld, Nanna M. Sijtsema, Johannes A. Langendijk,

Esophageal and GI Pathology

PurposeTo test the hypothesis that delineation of swallowing organs at risk (SWOARs) based on different guidelines results in differences in dose–volume parameters and subsequent normal tissue complication probability (NTCP) values for dysphagia-related endpoints.Materials and methodsNine different SWOARs were delineated according to five different delineation guidelines in 29 patients. Reference delineation was performed according to the guidelines and NTCP-models of Christianen et al. Concordance Index (CI), dosimetric consequences, as well as differences in the subsequent NTCPs were calculated.ResultsThe median CI of the different delineation guidelines with the reference guidelines was 0.54 for the pharyngeal constrictor muscles, 0.56 for the laryngeal structures and 0.07 for the cricopharyngeal muscle and esophageal inlet muscle. The average difference in mean dose to the SWOARs between the guidelines with the largest difference (maxΔD) was 3.5 ± 3.2 Gy. A mean ΔNTCP of 2.3 ± 2.7% was found. For two patients, ΔNTCP exceeded 10%.ConclusionsThe majority of the patients showed little differences in NTCPs between the different delineation guidelines. However, large NTCP differences >10% were found in 7% of the patients. For correct use of NTCP models in individual patients, uniform delineation guidelines are of great importance.