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.

Proton Therapy for Squamous Cell Carcinoma of the Head and Neck: Early Clinical Experience and Current Challenges

“…The model-based approach represents a more individualized approach to select patients for PT. This approach was accepted as the uniform, national selection strategy in the Netherlands, and is based on the principle that the risk of radiation-induced side effects can be reliably predicted by multivariable normal tissue complication probability (NTCP) models, describing the relationship between dose-volume parameters and the risk on a certain AE of a particular grade [ 67 ]. Patients qualify for PT if the difference in dose (Δdose) based on the photon vs. PT plan comparison translates into a clinically significant ΔNTCP.…”

Evaluation of robustly optimised intensity modulated proton therapy for nasopharyngeal carcinoma

“…They were immobilised using a 5-point thermoplastic mask and underwent a planning CT (pCT) scan using iterative metal artefact reduction techniques. The patients went through a model-based selection procedure and qualified for proton therapy based on a significant reduction in normal tissue complication probability (NTCP) compared to the VMAT plan, as outlined by the National Indication Protocols for PT (NIPP) in the Netherlands [26][27][28][29].…”

It is beneficial to invest resources to implement proton intracranial SRS

“…Standardization and accessibility to intracranial SRS are critical, but they should apply to both photon and proton in terms of planning, treatment delivery, and patient selection. We are glad to see the tremendous progress and a broader adoption across the European countries utilizing the Dutch Model for proton patient selection 45 . A similar approach can be applied to intracranial SRS to optimize the health‐care resource for patients in the United States.…”