头颈部放疗中随着摆位变异性增加，针对备选危及器官勾画的DVH与NTCP指标得出的临床等效性结论存在差异
Divergent Clinical Equivalence Findings from DVH and NTCP Metrics for Alternative OAR Delineations with Increasing Setup Variability in Head-and-Neck Radiotherapy
AI总结：
本研究针对209名头颈部癌症患者，探究不同OAR勾画、治疗技术与摆位变异性对DVH和NTCP指标的影响，发现摆位变异升高会缩小DVH差异却增大NTCP差异，提出需结合剂量学与几何评估的个性化放疗质控策略。
摘要：
目的：本研究量化了头颈部（HN）癌症患者在治疗计划制定与治疗计划评估中使用备选危及器官（OAR）勾画时，剂量体积直方图（DVH）与正常组织并发症概率（NTCP）指标的变异情况。我们重点关注每日患者定位/摆位变异（SV）与治疗技术、勾画变异性相关的影响。材料与方法：我们为209名头颈部患者队列生成了双弧VMAT、5野IMRT和9野IMRT治疗计划。这些计划纳入了5组不同的OAR勾画集，包括手动勾画和4种自动算法的勾画。我们在多种模拟的分次治疗患者摆位不确定性下评估每个治疗计划，通过DVH和NTCP指标评估潜在临床影响。结果：研究表明，摆位变异性增加通常会缩小不同备选勾画之间DVH指标的差异。但与之相反，NTCP指标的差异往往随摆位变异性升高而增大。这一模式在不同治疗计划和勾画者组合中均一致观察到，体现了摆位变异（SV）与勾画准确性之间的复杂关联。此外，研究显示治疗计划中对勾画准确性的需求具有病例特异性，且取决于几何变异之外的因素。结论：研究结果凸显了放疗中制定全面质量保证计划的必要性，需同时纳入剂量学影响分析与几何变异评估，以确保最佳勾画质量。本研究强调了放疗治疗规划的复杂动态特性，倡导在临床实践中采用个性化、病例特异性的策略，以在摆位变异（SV）和勾画准确性各异的情况下提升患者护理质量与疗效。
英文摘要：
Purpose: This study quantifies the variation in dose-volume histogram (DVH) and normal tissue complication probability (NTCP) metrics for head-and-neck (HN) cancer patients when alternative organ-at-risk (OAR) delineations are used for treatment planning and for treatment plan evaluation. We particularly focus on the effects of daily patient positioning/setup variations (SV) in relation to treatment technique and delineation variability. Materials and Methods: We generated two-arc VMAT, 5-beam IMRT, and 9-beam IMRT treatment plans for a cohort of 209 HN patients. These plans incorporated five different OAR delineation sets, including manual and four automated algorithms. Each treatment plan was assessed under various simulated per-fraction patient setup uncertainties, evaluating the potential clinical impacts through DVH and NTCP metrics. Results: The study demonstrates that increasing setup variability generally reduces differences in DVH metrics between alternative delineations. However, in contrast, differences in NTCP metrics tend to increase with higher setup variability. This pattern is observed consistently across different treatment plans and delineator combinations, illustrating the intricate relationship between SV and delineation accuracy. Additionally, the need for delineation accuracy in treatment planning is shown to be case-specific and dependent on factors beyond geometric variations. Conclusions: The findings highlight the necessity for comprehensive quality assurance programs in radiotherapy, incorporating both dosimetric impact analysis and geometric variation assessment to ensure optimal delineation quality. The study emphasizes the complex dynamics of treatment planning in radiotherapy, advocating for personalized, case-specific strategies in clinical practice to enhance patient care quality and efficacy in the face of varying SV and delineation accuracies.
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