The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers
Purpose: To understand how verification computed tomography-quality assurance (CTQA) scans influenced clinical decision-making to replan patients with head and neck cancer and identify predictors for replanning to guide intensity-modulated proton therapy (IMPT) clinical practice. Patients and Metho...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-08-01
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| Series: | International Journal of Particle Therapy |
| Subjects: | |
| Online Access: | https://theijpt.org/doi/pdf/10.14338/IJPT-20-00006.1 |
| _version_ | 1827160066631925760 |
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| author | Jaden D. Evans, MD Riley H. Harper, BS Molly Petersen, MS William S. Harmsen, MS Aman Anand, PhD Ashley Hunzeker, CMD Noelle C. Deiter, RTT Heather Schultz, CMD Krishan R. Jethwa, MD Scott C. Lester, MD David M. Routman, MD Daniel J. Ma, MD Yolanda I. Garces, MD Michelle A. Neben-Wittich, MD Nadia N. Laack, MD Chris J. Beltran, PhD Samir H. Patel, MD Lisa A. McGee, MD Jean-Claude M. Rwigema, MD Daniel W. Mundy, PhD Robert L. Foote, MD |
| author_facet | Jaden D. Evans, MD Riley H. Harper, BS Molly Petersen, MS William S. Harmsen, MS Aman Anand, PhD Ashley Hunzeker, CMD Noelle C. Deiter, RTT Heather Schultz, CMD Krishan R. Jethwa, MD Scott C. Lester, MD David M. Routman, MD Daniel J. Ma, MD Yolanda I. Garces, MD Michelle A. Neben-Wittich, MD Nadia N. Laack, MD Chris J. Beltran, PhD Samir H. Patel, MD Lisa A. McGee, MD Jean-Claude M. Rwigema, MD Daniel W. Mundy, PhD Robert L. Foote, MD |
| author_sort | Jaden D. Evans, MD |
| collection | DOAJ |
| description | Purpose: To understand how verification computed tomography-quality assurance (CTQA) scans influenced clinical decision-making to replan patients with head and neck cancer and identify predictors for replanning to guide intensity-modulated proton therapy (IMPT) clinical practice.
Patients and Methods: We performed a quality-improvement study by prospectively collecting data on 160 consecutive patients with head and neck cancer treated using spot-scanning IMPT who underwent weekly verification CT-QA scans. Kaplan-Meier estimates were used to determine the cumulative probability of a replan by week. Predictors for replanning were determined with univariate (UVA) and multivariate (MVA) Cox model hazard ratios (HRs). Logistic regression was used to determine odds ratios (ORs). P < .05 was considered statistically significant.
Results: Of the 160 patients, 79 (49.4%) had verification CT-QA scans, which prompted a replan. The cumulative probability of a replan by week 1 was 13.7% (95% confidence interval [CI], 8.82-18.9), week 2, 25.0% (95% CI, 18.0-31.4), week 3, 33.1% (95% CI, 25.4-40.0), week 4, 45.6% (95% CI, 37.3-52.8), and week 5 and 6, 49.4% (95% CI, 41.0- 56.6). Predictors for replanning were sinonasal disease site (UVA: HR, 1.82, P = .04; MVA: HR, 3.64, P = .03), advanced stage disease (UVA: HR, 4.68, P < .01; MVA: HR, 3.10, P < .05), dose . 60 Gy equivalent (GyE; relative biologic effectiveness, 1.1) (UVA: HR, 1.99, P < .01; MVA: HR, 2.20, P < .01), primary disease (UVA: HR, 2.00 versus recurrent, P = .01; MVA: HR, 2.46, P = .01), concurrent chemotherapy (UVA: HR, 2.05, P < .01; MVA: not statistically significant [NS]), definitive intent treatment (UVA: HR, 1.70 versus adjuvant, P < .02; MVA: NS), bilateral neck treatment (UVA: HR, 2.07, P = .03; MVA: NS), and greater number of beams (5 beam UVA: HR, 5.55 versus 1 or 2 beams, P < .02; MVA: NS). Maximal weight change from baseline was associated with higher odds of a replan (_3 kg: OR, 1.97, P = .04; _ 5 kg: OR, 2.13, P = .02).
Conclusions: Weekly verification CT-QA scans frequently influenced clinical decisionmaking to replan. Additional studies that evaluate the practice of monitoring IMPTtreated patients with weekly CT-QA scans and whether that improves clinical outcomes are warranted. |
| first_indexed | 2024-04-24T08:47:39Z |
| format | Article |
| id | doaj.art-7c82f8da3f5d411aa8efb72d2b1a9052 |
| institution | Directory Open Access Journal |
| issn | 2331-5180 |
| language | English |
| last_indexed | 2025-03-21T00:07:07Z |
| publishDate | 2020-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Particle Therapy |
| spelling | doaj.art-7c82f8da3f5d411aa8efb72d2b1a90522024-08-03T10:14:55ZengElsevierInternational Journal of Particle Therapy2331-51802020-08-0171415310.14338/IJPT-20-00006.12331-5180-7-1-41The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck CancersJaden D. Evans, MD0Riley H. Harper, BS1Molly Petersen, MS2William S. Harmsen, MS3Aman Anand, PhD4Ashley Hunzeker, CMD5Noelle C. Deiter, RTT6Heather Schultz, CMD7Krishan R. Jethwa, MD8Scott C. Lester, MD9David M. Routman, MD10Daniel J. Ma, MD11Yolanda I. Garces, MD12Michelle A. Neben-Wittich, MD13Nadia N. Laack, MD14Chris J. Beltran, PhD15Samir H. Patel, MD16Lisa A. McGee, MD17Jean-Claude M. Rwigema, MD18Daniel W. Mundy, PhD19Robert L. Foote, MD20Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, USADivision of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USADivision of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USADepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USADepartment of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USADepartment of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USADepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, USADepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, USAPurpose: To understand how verification computed tomography-quality assurance (CTQA) scans influenced clinical decision-making to replan patients with head and neck cancer and identify predictors for replanning to guide intensity-modulated proton therapy (IMPT) clinical practice. Patients and Methods: We performed a quality-improvement study by prospectively collecting data on 160 consecutive patients with head and neck cancer treated using spot-scanning IMPT who underwent weekly verification CT-QA scans. Kaplan-Meier estimates were used to determine the cumulative probability of a replan by week. Predictors for replanning were determined with univariate (UVA) and multivariate (MVA) Cox model hazard ratios (HRs). Logistic regression was used to determine odds ratios (ORs). P < .05 was considered statistically significant. Results: Of the 160 patients, 79 (49.4%) had verification CT-QA scans, which prompted a replan. The cumulative probability of a replan by week 1 was 13.7% (95% confidence interval [CI], 8.82-18.9), week 2, 25.0% (95% CI, 18.0-31.4), week 3, 33.1% (95% CI, 25.4-40.0), week 4, 45.6% (95% CI, 37.3-52.8), and week 5 and 6, 49.4% (95% CI, 41.0- 56.6). Predictors for replanning were sinonasal disease site (UVA: HR, 1.82, P = .04; MVA: HR, 3.64, P = .03), advanced stage disease (UVA: HR, 4.68, P < .01; MVA: HR, 3.10, P < .05), dose . 60 Gy equivalent (GyE; relative biologic effectiveness, 1.1) (UVA: HR, 1.99, P < .01; MVA: HR, 2.20, P < .01), primary disease (UVA: HR, 2.00 versus recurrent, P = .01; MVA: HR, 2.46, P = .01), concurrent chemotherapy (UVA: HR, 2.05, P < .01; MVA: not statistically significant [NS]), definitive intent treatment (UVA: HR, 1.70 versus adjuvant, P < .02; MVA: NS), bilateral neck treatment (UVA: HR, 2.07, P = .03; MVA: NS), and greater number of beams (5 beam UVA: HR, 5.55 versus 1 or 2 beams, P < .02; MVA: NS). Maximal weight change from baseline was associated with higher odds of a replan (_3 kg: OR, 1.97, P = .04; _ 5 kg: OR, 2.13, P = .02). Conclusions: Weekly verification CT-QA scans frequently influenced clinical decisionmaking to replan. Additional studies that evaluate the practice of monitoring IMPTtreated patients with weekly CT-QA scans and whether that improves clinical outcomes are warranted.https://theijpt.org/doi/pdf/10.14338/IJPT-20-00006.1ct verificationct quality assuranceimptproton therapyhead and neck cancer |
| spellingShingle | Jaden D. Evans, MD Riley H. Harper, BS Molly Petersen, MS William S. Harmsen, MS Aman Anand, PhD Ashley Hunzeker, CMD Noelle C. Deiter, RTT Heather Schultz, CMD Krishan R. Jethwa, MD Scott C. Lester, MD David M. Routman, MD Daniel J. Ma, MD Yolanda I. Garces, MD Michelle A. Neben-Wittich, MD Nadia N. Laack, MD Chris J. Beltran, PhD Samir H. Patel, MD Lisa A. McGee, MD Jean-Claude M. Rwigema, MD Daniel W. Mundy, PhD Robert L. Foote, MD The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers International Journal of Particle Therapy ct verification ct quality assurance impt proton therapy head and neck cancer |
| title | The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers |
| title_full | The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers |
| title_fullStr | The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers |
| title_full_unstemmed | The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers |
| title_short | The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers |
| title_sort | importance of verification ct qa scans in patients treated with impt for head and neck cancers |
| topic | ct verification ct quality assurance impt proton therapy head and neck cancer |
| url | https://theijpt.org/doi/pdf/10.14338/IJPT-20-00006.1 |
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