Abstract
Radiation-induced temporal lobe injury (TLI) is one of the most serious late complications after definitive radiotherapy of nasopharyngeal carcinoma patients. We aimed to develop and validate a nomogram for prediction of radiation-induced temporal lobe injury in patients with nasopharyngeal carcinoma. The prediction model was developed in a cohort that consisted of 194 patients with clinicopathologically confirmed nasopharyngeal carcinoma, and data was gathered from January 2007 to December 2009. TLI was diagnosed by follow-up enhanced magnetic resonance imaging. Clinical factors associated with TLI and Dose-volume histograms for 388 evaluable temporal lobes were analyzed. Multivariable logistic regression analysis was used to develop the predicting model. The performance of the nomogram was assessed with respect to its calibration and discrimination. Internal validation was assessed by 1000 bootstrap resamples. Of the 194 patients, 59 patients developed TLI. Predictors contained in the prediction nomogram included Dmax (the maximum point dose) of temporal lobe (p=.000, 1.563 [95%, 1.398-1.747]), D1cc (the maximum dose delivered to a volume of 1 mL) (p=.000, 0.865 [95%, 0.825-0.907]), concurrent chemotherapy (p=.060, 7.671 [95%, 0.918-64.086]), T stage (p=.070, 11.115 [95%, 0.825-79.739]). The nomogram prediction model was developed and Internal validation showed good discrimination and calibration. The ROC curve analysis showed that the C index was 0.8036 [95% CI, 0.7558-0.8515]. This study presents a nomogram that incorporates Dmax, D1cc, T stage, and concurrent chemotherapy, which may be conveniently used to facilitate the individualized prediction of TLI in patients with nasopharyngeal carcinoma.
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