Incidence of alopecia in brain tumour patients treated with pencil scanning proton therapy and validation of existing NTCP models
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Authors
Gaito, SimonaCella, L.
France, Anna
Monti, S.
Whitfield, Gillian
Sitch, Peter
Burnet, Neil
Smith, Ed
Palma, G.
Aznar, M.
Affiliation
Proton Clinical Outcomes Unit, The Christie Proton Beam Therapy Center, Manchester, United Kingdom; Division of Cancer Sciences, School of Medical Science, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom. Division of Cancer Sciences, School of Medical Science, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom; Proton Beam Therapy Centre. The Christie NHS Foundation Trust, Manchester, United Kingdom.Issue Date
2024
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BACKGROUND AND PURPOSE: Radiation-induced alopecia (RIA) is one of the most frequent and upsetting cosmetic side effects after radiotherapy (RT) for brain cancer. We report the incidence of RIA in a cohort of brain tumours patients treated with Proton Therapy (PT) and externally validate published NTCP models of grade 2 (G2) RIA for their implementation in clinical practice. METHODS: Data for patients treated for brain tumours with scanning beam PT between 2018 and 2022 were extracted. Acute, late and permanent RIA events were evaluated according to CTCAE 5.0. Lyman-Kutcher-Burman (LKB) and multivariable logistic regression (MLR) published models were computed from the relative dose-surface histogram of the scalp. External validity of models was assessed in terms of discrimination and calibration. RESULTS: In the 264 patients analysed, rates of any grade acute (≤90 days after PT completion), late (>90 days) and permanent RIA (persisting for> 12 months) were 61.8 %, 24.7 % and 14.4 %, respectively. In our independent cohort, LKB- and MLR-NTCP showed a good discrimination for G2 RIA (0.71≤ROC-AUC≤0.83) while model calibration was unsatisfactory possibly due to a different outcome evaluation between training and validation cohorts, as well as differences in clinical and treatment related variables between the two groups. CONCLUSIONS: Despite the reasonable sensitivity and specificity of the NTCP models for RIA in the validation cohort, our study emphasizes the significance of differences between the cohorts utilized for model development and validation. Specifically, variations in the reporting of clinical outcomes inevitably jeopardize the validation of NTCP models. A standardize and objective RIA scoring system is essential.Citation
Gaito S, Cella L, France A, Monti S, Whitfield G, Sitch P, et al. Incidence of alopecia in brain tumour patients treated with pencil scanning proton therapy and validation of existing NTCP models. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2024 Oct;199:110462. PubMed PMID: 39069083. Epub 2024/07/29. eng.Journal
Radiotherapy OncologyPubMed ID
39069083Language
enCollections
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