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@ARTICLE{Gabry:131578,
      author       = {H. S. Gabryś$^*$ and F. Buettner and F. Sterzing$^*$ and
                      H. Hauswald$^*$ and M. Bangert$^*$},
      title        = {{P}arotid gland mean dose as a xerostomia predictor in
                      low-dose domains.},
      journal      = {Acta oncologica},
      volume       = {56},
      number       = {9},
      issn         = {0284-186X},
      address      = {Abingdon},
      publisher    = {Taylor $\&$ Francis Group},
      reportid     = {DKFZ-2017-06210},
      pages        = {1197 - 1203},
      year         = {2017},
      abstract     = {Xerostomia is a common side effect of radiotherapy
                      resulting from excessive irradiation of salivary glands.
                      Typically, xerostomia is modeled by the mean dose-response
                      characteristic of parotid glands and prevented by mean dose
                      constraints to either contralateral or both parotid glands.
                      The aim of this study was to investigate whether normal
                      tissue complication probability (NTCP) models based on the
                      mean radiation dose to parotid glands are suitable for the
                      prediction of xerostomia in a highly conformal low-dose
                      regime of modern intensity-modulated radiotherapy (IMRT)
                      techniques.We present a retrospective analysis of 153 head
                      and neck cancer patients treated with radiotherapy. The
                      Lyman Kutcher Burman (LKB) model was used to evaluate
                      predictive power of the parotid gland mean dose with respect
                      to xerostomia at 6 and 12 months after the treatment. The
                      predictive performance of the model was evaluated by
                      receiver operating characteristic (ROC) curves and
                      precision-recall (PR) curves.Average mean doses to
                      ipsilateral and contralateral parotid glands were 25.4 Gy
                      and 18.7 Gy, respectively. QUANTEC constraints were met in
                      $74\%$ of patients. Mild to severe (G1+) xerostomia
                      prevalence at both 6 and 12 months was $67\%.$ Moderate to
                      severe (G2+) xerostomia prevalence at 6 and 12 months was
                      $20\%$ and $15\%,$ respectively. G1 + xerostomia was
                      predicted reasonably well with area under the ROC curve
                      ranging from 0.69 to 0.76. The LKB model failed to provide
                      reliable G2 + xerostomia predictions at both time
                      points.Reduction of the mean dose to parotid glands below
                      QUANTEC guidelines resulted in low G2 + xerostomia
                      rates. In this dose domain, the mean dose models predicted
                      G1 + xerostomia fairly well, however, failed to
                      recognize patients at risk of G2 + xerostomia. There is
                      a need for the development of more flexible models able to
                      capture complexity of dose response in this dose regime.},
      cin          = {E040 / E050},
      ddc          = {610},
      cid          = {I:(DE-He78)E040-20160331 / I:(DE-He78)E050-20160331},
      pnm          = {315 - Imaging and radiooncology (POF3-315)},
      pid          = {G:(DE-HGF)POF3-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:28502238},
      doi          = {10.1080/0284186X.2017.1324209},
      url          = {https://inrepo02.dkfz.de/record/131578},
}