Details

Autor(en) / Beteiligte

• He, Yong-Qiao
• Wang, Tong-Min
• Yang, Da-Wei
• Xue, Wen-Qiong
• Deng, Chang-Mi
• Li, Dan-Hua
• Zhang, Wen-Li
• Liao, Ying
• Xiao, Ruo-Wen
• Luo, Lu-Ting
• Diao, Hua
• Tong, Xia-Ting
• Wu, Yan-Xia
• Chen, Xue-Yin
• Zhang, Jiang-Bo
• Zhou, Ting
• Li, Xi-Zhao
• Zhang, Pei-Fen
• Zheng, Xiao-Hui
• Zhang, Shao-Dan
• Hu, Ye-Zhu
• Zhou, Guan-Qun
• Ma, Jun
• Sun, Ying
• Jia, Wei-Hua

Titel

A comprehensive predictive model for radiation-induced brain injury in risk stratification and personalized radiotherapy of nasopharyngeal carcinoma

Ist Teil von

• Radiotherapy and oncology, 2024-01, Vol.190, p.109974, Article 109974

Ort / Verlag

Ireland: Elsevier B.V

Erscheinungsjahr

2024

Quelle

MEDLINE

Beschreibungen/Notizen

• •The polygenic risk score (PRS) based on 38 SNPs exhibited the most robust association with the risk of radiation-induced brain injury (RBI).•Significant interactions were detected between genetic and clinical variables associated with the risk of RBI.•The PRS has the potential to serve as a valuable tool for informing personalized radiotherapy decisions for individuals.•The addition of PRS to the clinical model resulted in a statistically significant improvement in the predictive accuracy of the combined model. Radiation-induced brain injury (RBI) is a severe radiotoxicity for nasopharyngeal carcinoma (NPC) patients, greatly affecting their long-term life quality and survival. We aim to establish a comprehensive predictive model including clinical factors and newly developed genetic variants to improve the precision of RBI risk stratification. By performing a large registry-based retrospective study with magnetic resonance imaging follow-up on RBI development, we conducted a genome-wide association study and developed a polygenic risk score (PRS) for RBI in 1189 NPC patients who underwent intensity-modulated radiotherapy. We proposed a tolerance dose scheme for temporal lobe radiation based on the risk predicted by PRS. Additionally, we established a nomogram by combining PRS and clinical factors for RBI risk prediction. The 38-SNP PRS could effectively identify high-risk individuals of RBI (P = 1.42 × 10−34). Based on genetic risk calculation, the recommended tolerance doses of temporal lobes should be 57.6 Gy for individuals in the top 10 % PRS subgroup and 68.1 Gy for individuals in the bottom 50 % PRS. Notably, individuals with high genetic risk (PRS > P50) and receiving high radiation dose in the temporal lobes (D0.5CC > 65 Gy) had an approximate 50-fold risk over individuals with low PRS and receiving low radiation dose (HR = 50.09, 95 %CI = 24.27–103.35), showing an additive joint effect (Pinteraction < 0.001). By combining PRS with clinical factors including age, tumor stage, and radiation dose of temporal lobes, the predictive accuracy was significantly improved with C-index increased from 0.78 to 0.85 (P = 1.63 × 10−2). The PRS, together with clinical factors, could improve RBI risk stratification and implies personalized radiotherapy.