{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T15:08:07Z","timestamp":1776352087844,"version":"3.51.2"},"reference-count":51,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,2,22]],"date-time":"2022-02-22T00:00:00Z","timestamp":1645488000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>(1) Background: we proposed an integrated strategy to support clinical allocation of nasopharyngeal patients between proton and photon radiotherapy. (2) Methods: intensity-modulated proton therapy (IMPT) plans were optimized for 50 consecutive nasopharyngeal carcinoma (NPC) patients treated with volumetric modulated arc therapy (VMAT), and differences in dose and normal tissue complication probability (\u0394NTCPx-p) for 16 models were calculated. Patient eligibility for IMPT was assessed using a model-based selection (MBS) strategy following the results for 7\/16 models describing the most clinically relevant endpoints, applying a model-specific \u0394NTCPx-p threshold (15% to 5% depending on the severity of the complication) and a composite threshold (35%). In addition, a comprehensive toxicity score (CTS) was defined as the weighted sum of all 16 \u0394NTCPx-p, where weights follow a clinical rationale. (3) Results: Dose deviations were in favor of IMPT (\u0394Dmean \u2265 14% for cord, esophagus, brainstem, and glottic larynx). The risk of toxicity significantly decreased for xerostomia (\u221212.5%), brain necrosis (\u22122.3%), mucositis (\u22123.2%), tinnitus (\u22128.6%), hypothyroidism (\u22129.3%), and trismus (\u22125.4%). There were 40% of the patients that resulted as eligible for IMPT, with a greater advantage for T3\u2013T4 staging. Significantly different CTS were observed in patients qualifying for IMPT. (4) Conclusions: The MBS strategy successfully drives the clinical identification of NPC patients, who are most likely to benefit from IMPT. CTS summarizes well the expected global gain.<\/jats:p>","DOI":"10.3390\/cancers14051109","type":"journal-article","created":{"date-parts":[[2022,2,22]],"date-time":"2022-02-22T22:35:09Z","timestamp":1645569309000},"page":"1109","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Proton Radiation Therapy for Nasopharyngeal Cancer Patients: Dosimetric and NTCP Evaluation Supporting Clinical Decision"],"prefix":"10.3390","volume":"14","author":[{"given":"Alessandro","family":"Vai","sequence":"first","affiliation":[{"name":"Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Molinelli","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8305-7659","authenticated-orcid":false,"given":"Eleonora","family":"Rossi","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2556-9079","authenticated-orcid":false,"given":"Nicola Alessandro","family":"Iacovelli","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT), 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7140-8642","authenticated-orcid":false,"given":"Giuseppe","family":"Magro","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8780-0734","authenticated-orcid":false,"given":"Anna","family":"Cavallo","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT), 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuele","family":"Pignoli","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT), 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7849-603X","authenticated-orcid":false,"given":"Tiziana","family":"Rancati","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT), 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfredo","family":"Mirandola","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT), 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefania","family":"Russo","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rossana","family":"Ingargiola","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4920-2239","authenticated-orcid":false,"given":"Barbara","family":"Vischioni","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Bonora","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5518-4121","authenticated-orcid":false,"given":"Sara","family":"Ronchi","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Ciocca","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ester","family":"Orlandi","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.canlet.2016.01.040","article-title":"Global Trends in Incidence and Mortality of Nasopharyngeal Carcinoma","volume":"374","author":"Tang","year":"2016","journal-title":"Cancer Lett."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.ejca.2021.09.005","article-title":"Nasopharyngeal Cancer in Non-Endemic Areas: Impact of Treatment Intensity within a Large Retrospective Multicenter Cohort","volume":"159","author":"Bossi","year":"2021","journal-title":"Eur. 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