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BackgroundSquamous cell carcinoma of the head and neck (HNSCC) comprises a variety of malignant tumors. Due to the rarity of each individual malignant entity, knowledge of epidemiological changes and trends over time may be derived from data compiled in regional and national registries. This study analyzed the development in incidence rates and mortality in elderly HNSCC patients in Denmark between 1980 and 2012 with specific attention to compliance to radiotherapy, the main treatment modality of HNSCC in Denmark. Material and methodsHNSCC consisting of more than 25 patients per year over the age of 70 years were analyzed. This included cancer of the oral cavity defined as ICD-codes C00.3-4, C02-04, C05.0, C06; oropharynx as C01, C05.1-9, C09-10; and larynx as C32 recorded in the NORDCAN database. Additional data from the DAHANCA database was added to assess differences in compliance to treatment between younger and older patient groups. ResultsHNSCC was predominant in younger patients. Only 17% were older than 70 years. The median age was 60 years. Generally, incidence rates rose for cancer of the oral cavity and oropharynx between 1980 and 2012 and stabilized for laryngeal cancer. Mortality rates had a shallower increase, especially in younger age groups, which translated into improved age-specific survival rates. Compliance to radiotherapy was high for all age groups. Failure to receive at least 60 Gy during radical radiation treatment was 2.3% despite a significant increase in patients with poor WHO performance status over time. ConclusionHNSCC is a rare disease in patients above 70 years accounting for only 17% of all HNSCC patients. Incidence rates increased over time, but age-specific survival rates improved, especially in younger patients. Failure rates to comply with radiation treatment, however, were low in both young and elderly patients. [ABSTRACT FROM PUBLISHER]

Objective. Deep learning shows promise in autosegmentation of head and neck cancer (HNC) primary tumours (GTV-T) and nodal metastases (GTV-N). However, errors such as including non-tumour regions or missing nodal metastases still occur. Conventional methods often make overconfident predictions, compromising reliability. Incorporating uncertainty estimation, which provides calibrated confidence intervals can address this issue. Our aim was to investigate the efficacy of various uncertainty estimation methods in improving segmentation reliability. We evaluated their confidence levels in voxel predictions and ability to reveal potential segmentation errors. Approach. We retrospectively collected data from 567 HNC patients with diverse cancer sites and multi-modality images (CT, PET, T1-, and T2-weighted MRI) along with their clinical GTV-T/N delineations. Using the nnUNet 3D segmentation pipeline, we compared seven uncertainty estimation methods, evaluating them based on segmentation accuracy (Dice similarity coefficient, DSC), confidence calibration (Expected Calibration Error, ECE), and their ability to reveal segmentation errors (Uncertainty-Error overlap using DSC, UE-DSC). Main results. Evaluated on the hold-out test dataset ( n = 97), the median DSC scores for GTV-T and GTV-N segmentation across all uncertainty estimation methods had a narrow range, from 0.73 to 0.76 and 0.78 to 0.80, respectively. In contrast, the median ECE exhibited a wider range, from 0.30 to 0.12 for GTV-T and 0.25 to 0.09 for GTV-N. Similarly, the median UE-DSC also ranged broadly, from 0.21 to 0.38 for GTV-T and 0.22 to 0.36 for GTV-N. A probabilistic network-PhiSeg method consistently demonstrated the best performance in terms of ECE and UE-DSC. Significance. Our study highlights the importance of uncertainty estimation in enhancing the reliability of deep learning for autosegmentation of HNC GTV. The results show that while segmentation accuracy can be similar across methods, their reliability, measured by calibration error and uncertainty-error overlap, varies significantly. Used with visualisation maps, these methods may effectively pinpoint uncertainties and potential errors at the voxel level., (© 2024 Institute of Physics and Engineering in Medicine.)

Background and Purpose: In planning to meet evidence based needs for radiotherapy, guidelines for the provision of capital and human resources are central if access, quality and safety are not to be compromised. A component of the ESTRO-HERO (Health Economics in Radiation Oncology) project is to document the current availability and content of guidelines for radiotherapy in Europe., Materials and Methods: An 84 part questionnaire was distributed to the European countries through their national scientific and professional radiotherapy societies with 30 items relating to the availability of guidelines for equipment and staffing and selected operational issues. Twenty-nine countries provided full or partial evaluable responses., Results: The availability of guidelines across Europe is far from uniform. The metrics used for capital and human resources are variable. There seem to have been no major changes in the availability or specifics of guidelines over the ten-year period since the QUARTS study with the exception of the recent expansion of RTT staffing models. Where comparison is possible it appears that staffing for radiation oncologists, medical physicists and particularly RTTs tend to exceed guidelines suggesting developments in clinical radiotherapy are moving faster than guideline updating., Conclusion: The efficient provision of safe, high quality radiotherapy services would benefit from the availability of well-structured guidelines for capital and human resources, based on agreed upon metrics, which could be linked to detailed estimates of need., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: Documenting the distribution of radiotherapy departments and the availability of radiotherapy equipment in the European countries is an important part of HERO - the ESTRO Health Economics in Radiation Oncology project. HERO has the overall aim to develop a knowledge base of the provision of radiotherapy in Europe and build a model for health economic evaluation of radiation treatments at the European level. The aim of the current report is to describe the distribution of radiotherapy equipment in European countries., Methods: An 84-item questionnaire was sent out to European countries, principally through their national societies. The current report includes a detailed analysis of radiotherapy departments and equipment (questionnaire items 26-29), analyzed in relation to the annual number of treatment courses and the socio-economic status of the countries. The analysis is based on validated responses from 28 of the 40 European countries defined by the European Cancer Observatory (ECO)., Results: A large variation between countries was found for most parameters studied. There were 2192 linear accelerators, 96 dedicated stereotactic machines, and 77 cobalt machines reported in the 27 countries where this information was available. A total of 12 countries had at least one cobalt machine in use. There was a median of 0.5 simulator per MV unit (range 0.3-1.5) and 1.4 (range 0.4-4.4) simulators per department. Of the 874 simulators, a total of 654 (75%) were capable of 3D imaging (CT-scanner or CBCT-option). The number of MV machines (cobalt, linear accelerators, and dedicated stereotactic machines) per million inhabitants ranged from 1.4 to 9.5 (median 5.3) and the average number of MV machines per department from 0.9 to 8.2 (median 2.6). The average number of treatment courses per year per MV machine varied from 262 to 1061 (median 419). While 69% of MV units were capable of IMRT only 49% were equipped for image guidance (IGRT). There was a clear relation between socio-economic status, as measured by GNI per capita, and availability of radiotherapy equipment in the countries. In many low income countries in Southern and Central-Eastern Europe there was very limited access to radiotherapy and especially to equipment for IMRT or IGRT., Conclusions: The European average number of MV machines per million inhabitants and per department is now better in line with QUARTS recommendations from 2005, but the survey also showed a significant heterogeneity in the access to modern radiotherapy equipment in Europe. High income countries especially in Northern-Western Europe are well-served with radiotherapy resources, other countries are facing important shortages of both equipment in general and especially machines capable of delivering high precision conformal treatments (IMRT, IGRT)., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)