ArticleFrontiers in oncology2022
Empirical Relative Biological Effectiveness (RBE) for Mandible Osteoradionecrosis (ORN) in Head and Neck Cancer Patients Treated With Pencil-Beam-Scanning Proton Therapy (PBSPT): A Retrospective, Case-Matched Cohort Study.
Article in Frontiers in oncology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
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24 citing papers in PubMed, 31 citations in OpenAlex.
- Dose-Linear Energy Transfer Interactions Predict Capsular Contracture After Proton Postmastectomy Radiation Therapy.International journal of radiation oncology, biology, physics · 2026Article
- Causal Machine Learning Analysis of Empirical Relative Biological Effectiveness for Mandible Osteoradionecrosis in Head and Neck Cancer Radiation Therapy.International journal of radiation oncology, biology, physics · 2026Article
- Radiation-Induced Fibrosis (RIF) in Head and Neck Squamous Cell Carcinoma (HNSCC): A Review.Cells · 2025Review
- Article
- Osteoradionecrosis as a complication following post-operative intensity-modulated radiation therapy or proton therapy for oral cavity cancer.Oral oncology · 2025Article
- Critical review of patient outcome study in head and neck cancer radiotherapy.Meta-radiology · 2025Article
- Modelling of a double-scattering proton therapy nozzle using the FLUKA Monte Carlo code and analysis of linear energy transfer in patients treated for prostate cancer.Journal of applied clinical medical physics · 2025Article
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- Enabling clinical use of linear energy transfer in proton therapy for head and neck cancer - A review of implications for treatment planning and adverse events study.Visualized cancer medicine · 2025Article
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- Accurate patient alignment without unnecessary imaging using patient-specific 3D CT images synthesized from 2D kV images.Communications medicine · 2024Article
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- Deep learning-based synthetic dose-weighted LET map generation for intensity modulated proton therapy.Physics in medicine and biology · 2024Article
- Synthesizing Efficiency Tools in Radiotherapy to Increase Patient Flow: A Comprehensive Literature Review.Clinical Medicine Insights. Oncology · 2024Review
- Deep-learning based fast and accurate 3D CT deformable image registration in lung cancer.Medical physics · 2023Article
- Artificial general intelligence for radiation oncology.Meta-radiology · 2023Article
- Oral Complications from Oropharyngeal Cancer Therapy.Cancers · 2023Review
- Osteoradionecrosis and Proton Therapy-Reply.JAMA otolaryngology-- head & neck surgery · 2023Article
- Deep-Learning-based Fast and Accurate 3D CT Deformable Image Registration in Lung Cancer.ArXiv · 2023Article
- Rotating Gantries Provide Individualized Beam Arrangements for Charged Particle Therapy.Cancers · 2023Article
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Authors and funding
15 authors at 4 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
Purpose: To retrospectively investigate empirical relative biological effectiveness (RBE) for mandible osteoradionecrosis (ORN) in head and neck (H&N) cancer patients treated with pencil-beam-scanning proton therapy (PBSPT). Methods: We included 1,266 H&N cancer patients, of which, 931 patients were treated with volumetric-modulated arc therapy (VMAT) and 335 were treated with PBSPT. Among them, 26 VMAT and 9 PBSPT patients experienced mandible ORN (ORN group), while all others were included in the control group. To minimize the impact of the possible imbalance in clinical factors between VMAT and PBSPT patients in the dosimetric comparison between these two modalities and the resulting RBE quantification, we formed a 1:1 case-matched patient cohort (335 VMAT patients and 335 PBSPT patients including both the ORN and control groups) using the greedy nearest neighbor matching of propensity scores. Mandible dosimetric metrics were extracted from the case-matched patient cohort and statistically tested to evaluate the association with mandibular ORN to derive dose volume constraints (DVCs) for VMAT and PBSPT, respectively. We sought the equivalent constraint doses for VMAT so that the critical volumes of VMAT were equal to those of PBSPT at different physical doses. Empirical RBEs of PBSPT for ORN were obtained by calculating the ratio between the derived equivalent constraint doses and physical doses of PBSPT. Bootstrapping was further used to get the confidence intervals. Results: Clinical variables of age, gender, tumor stage, prescription dose, chemotherapy, hypertension or diabetes, dental extraction, smoking history, or current smoker were not statistically related to the incidence of ORN in the overall patient cohort. Smoking history was found to be significantly associated with the ORN incidence in PBSPT patients only. V40Gy[RBE], V50Gy[RBE], and V60Gy[RBE] were statistically different ( Conclusions: Our study suggested that RBEs were larger than 1.1 at moderate doses (between 40 and 60 Gy[RBE=1.1]) with high LET for mandible ORN. RBEs are underestimated in current clinical practice in PBSPT. The derived DVCs can be used for PBSPT plan evaluation and optimization to minimize the incidence rate of mandible ORN.
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