National Protocol for Model-Based Selection for Proton Therapy in Head and Neck Cancer

Abstract

In the Netherlands, the model-based approach is used to identify patients with head and neck cancer who may benefit most from proton therapy in terms of prevention of late radiation-induced side effects in comparison with photon therapy. To this purpose, a National Indication Protocol Proton therapy for Head and Neck Cancer patients (NIPP-HNC) was developed, which has been approved by the health care authorities. When patients qualify according to the guidelines of the NIPP-HNC, proton therapy is fully reimbursed. This article describes the procedures that were followed to develop this NIPP-HNC and provides all necessary information to introduce model-based selection for patients with head and neck cancer into routine clinical practice.

Keywords: head and neck cancer; model-based selection; national indication protocol; proton therapy; radiation-induced side effects.

Figure.

Flowchart for selecting patients for a plan comparison and PT, respectively. For each toxicity endpoint, the maximum ΔNTCP (ΔNTCP_max) has to be calculated first by the following equation: ΔNTCP_max = [NTCP − PHOTONS] − [NTCP_min − PROTONS], in which, NTCP_min − PROTONS is the NTCP value, assuming that with protons, the dose to all DVH parameters in the model can be reduced to zero. Abbreviations: DVH, dose-volume histogram; NTCP, Normal Tissue Complication Probability; PT, proton therapy.