Voxel-based analysis unveils regional dose differences associated with radiation-induced morbidity in head and neck cancer patients

• Published in: Scientific reports Vol. 7; no. 1; pp. 7220 - 8
• Main Authors: Monti, Serena, Palma, Giuseppe, D’Avino, Vittoria, Gerardi, Marianna, Marvaso, Giulia, Ciardo, Delia, Pacelli, Roberto, Jereczek-Fossa, Barbara A., Alterio, Daniela, Cella, Laura
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 03-08-2017; Nature Publishing Group; Nature Portfolio
• Subjects: 639/705/531; 692/4028/67/1536; Cancer; Dysphagia; Esophagus; Head & neck cancer; Humanities and Social Sciences; Localization; Morbidity; multidisciplinary; Philosophy; Radiation therapy; Science; Science (multidisciplinary); Statistical analysis; Toxicity
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-017-07586-x

The risk of radiation-induced toxicity in patients treated for head and neck (HN) cancer with radiation therapy (RT) is traditionally estimated by condensing the 3D dose distribution into a monodimensional cumulative dose-volume histogram which disregards information on dose localization. We hypothesized that a voxel-based approach would identify correlations between radiation-induced morbidity and local dose release, thus providing a new insight into spatial signature of radiation sensitivity in composite regions like the HN district. This methodology was applied to a cohort of HN cancer patients treated with RT at risk of radiation-induced acute dysphagia (RIAD). We implemented an inter-patient elastic image registration framework that proved robust enough to match even the most elusive HN structures and to provide accurate dose warping. A voxel-based statistical analysis was then performed to test regional dosimetric differences between patients with and without RIAD. We identified a significantly higher dose delivered to RIAD patients in two voxel clusters in correspondence of the cricopharyngeus muscle and cervical esophagus. Our study goes beyond the well-established organ-based philosophy exploring the relationship between radiation-induced morbidity and local dose differences in the HN region. This approach is generally applicable to different HN toxicity endpoints and is not specific to RIAD.