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• W1991192671 abstract "Dosimetry and quality-of-life (QOL) SDEs for HN cancer patients from our institution are routinely collected and stored in an in-house, analytic database. We hypothesize that retrospective review of such a large clinical data source will elucidate potential avenues for quality improvement. This study aims to assess the relationship between toxicity outcomes and planned dose-volume parameters. From a database of 513 patients treated from 2007 to 2013, 423 patients were identified with various combinations of toxicity outcomes (CTCAE v4.0) and dose-volume histogram (DVH) data (Table). For each combination, the sub-population of DVH curves was modeled by logistic regression at a series of normalized volume thresholds in 1% increments from 1% to 99%. Discriminating DVH regions were identified as having one or more logistic regression analyses predicting a significant increase in toxicity risk of at least 5% per Gy. The threshold dose was calculated at significant volume thresholds as the dose resulting in a 50% probability of toxicity. A total of 29 individual or combined risk structures in the head and neck were assessed in relation to 10 toxicity outcomes. Of particular note, the dose to 90% of the combined parotids was a strong, significant predictor of patients with Grade ≥2 vs <2 xerostomia (p<0.001), demonstrating the potential clinical impact of low doses to all of the parotid tissue. It was also discovered that dysphagia (Grade ≥2 vs <2) and voice changes (Grade ≥1 vs <1) were most strongly and significantly predicted by high doses to 7% and 25% of the larynx, respectively (p<0.001), demonstrating the potential clinical detriment caused by hot spots within the larynx. Routine capture of SDEs facilitates large-scale analysis of toxicity outcomes with respect to planned dose and volume parameters. Despite potential uncertainties in the retrospective data, these results may better reflect our true clinical practice than a controlled prospective effort. The data mining procedure revealed strong relationships between planned dose and recorded toxicity outcomes. In particular, xerostomia rates may be most affected by low doses to the entirety of the combined parotids, whereas dysphagia and voice changes appear to relate more closely to high dose regions in small volumes of the larynx.Scientific Abstract 2923; TableUnique dose-toxicity relationships from a database of 513 irradiated HN cancer patientsToxicityGradeRisk Structure# PatientsThreshold Volume (%)50% Probability Threshold Dose (Gy)P valueXerostomia≥ 2Combined Parotids2109011.5<.001Dysphagia≥ 2Larynx117767.8<.001Voice Changes≥ 1Larynx1122557.6<.001 Open table in a new tab" @default.
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• W1991192671 date "2014-09-01" @default.
• W1991192671 modified "2023-09-26" @default.
• W1991192671 title "Routine Capture of Structured Data Elements (SDEs) Provides Insight Into Unique Dose-Toxicity Relationships in Irradiated Head and Neck (HN) Cancer Patients" @default.
• W1991192671 doi "https://doi.org/10.1016/j.ijrobp.2014.05.1731" @default.
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