Expansion and clinical validation of Markov model‐based quality‐adjusted life expectancy (QALE) simulations for head‐and‐neck cancer radiotherapy patients
Abstract
Background: Radiotherapy treatment plan comparisons often utilize structure doses, tumor control probabilities (TCPs), and normal tissue complication probabilities (NTCPs), but such metrics do not reflect the duration for which a patient suffers from a developed toxicity. Markov models allowing for the simulation of the patient's entire lifetime post-treatment and the determination of quality-adjusted life expectancy (QALE) have been developed but generally disregard important considerations such as additional treatments received and second primary malignancies (SPMs). Clinical validation also largely remains outstanding. Purpose: This study aims to expand and clinically validate a Markov model focusing on head-and-neck cancer patients. Methods: A Markov model considering tumor control, healthy tissue toxicities, distant metastases, radiation-associated secondary cancer, and death from various causes was expanded to further include additional treatments received, SPMs, and the patient's smoking history. For each of 148 head-and-neck cancer patients, 437,000 simulations of the patient's entire lifetime post-treatment were performed and compared to the patient's clinically-documented outcomes (wherever available). Results: 94.4% of simulations exhibited locoregional control, compared to 89.9% of patients in clinical reality. Simulated death with locoregional failure was 4.9%, compared to 5.4% in real life. Patients developed and died with distant metastases in 8.0% of simulations, while 10.8% of patients developed distant metastases in real life and 5.7% of patients passed away with distant disease. The simulated second primary cancer rate was 13.5%. Patients exhibited at least one healthy tissue toxicity in 43.8% of simulations, and simulated life expectancy and QALE were 76.5 ± 11.6 years and 74.3 ± 11.0 quality-adjusted life years (QALYs), respectively. Conclusions: Agreement between simulation results and available clinicallydocumented outcomes was generally excellent, enabling the evaluation of prospective clinical outcomes and comparisons between different patient populations along with variable treatment combinations.
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BibTeX
@article{tattenberg2026expansion,
title = {{Expansion and clinical validation of Markov model‐based quality‐adjusted life expectancy (QALE) simulations for head‐and‐neck cancer radiotherapy patients}},
author = {Sebastian Tattenberg and Benoit Allignet and Xuanfeng Ding and Cornelia Hoehr and Peter Chen and Olivier Beuf},
journal = {Medical Physics : The international journal of medical physics research and practice},
year = {2026},
month = oct,
doi = {10.1002/mp.70696},
url = {https://hal.science/hal-05787066v1},
note = {CC BY-NC-SA 4.0},
}
RIS
TY - JOUR
TI - Expansion and clinical validation of Markov model‐based quality‐adjusted life expectancy (QALE) simulations for head‐and‐neck cancer radiotherapy patients
AU - Sebastian Tattenberg
AU - Benoit Allignet
AU - Xuanfeng Ding
AU - Cornelia Hoehr
AU - Peter Chen
AU - Olivier Beuf
PY - 2026
DA - 2026/10/15
JO - Medical Physics : The international journal of medical physics research and practice
DO - 10.1002/mp.70696
UR - https://hal.science/hal-05787066v1
AB - Background: Radiotherapy treatment plan comparisons often utilize structure doses, tumor control probabilities (TCPs), and normal tissue complication probabilities (NTCPs), but such metrics do not reflect the duration for which a patient suffers from a developed toxicity. Markov models allowing for the simulation of the patient's entire lifetime post-treatment and the determination of quality-adjusted life expectancy (QALE) have been developed but generally disregard important considerations such as additional treatments received and second primary malignancies (SPMs). Clinical validation also largely remains outstanding. Purpose: This study aims to expand and clinically validate a Markov model focusing on head-and-neck cancer patients. Methods: A Markov model considering tumor control, healthy tissue toxicities, distant metastases, radiation-associated secondary cancer, and death from various causes was expanded to further include additional treatments received, SPMs, and the patient's smoking history. For each of 148 head-and-neck cancer patients, 437,000 simulations of the patient's entire lifetime post-treatment were performed and compared to the patient's clinically-documented outcomes (wherever available). Results: 94.4% of simulations exhibited locoregional control, compared to 89.9% of patients in clinical reality. Simulated death with locoregional failure was 4.9%, compared to 5.4% in real life. Patients developed and died with distant metastases in 8.0% of simulations, while 10.8% of patients developed distant metastases in real life and 5.7% of patients passed away with distant disease. The simulated second primary cancer rate was 13.5%. Patients exhibited at least one healthy tissue toxicity in 43.8% of simulations, and simulated life expectancy and QALE were 76.5 ± 11.6 years and 74.3 ± 11.0 quality-adjusted life years (QALYs), respectively. Conclusions: Agreement between simulation results and available clinicallydocumented outcomes was generally excellent, enabling the evaluation of prospective clinical outcomes and comparisons between different patient populations along with variable treatment combinations.
SN - 0094-2405
SN - 2473-4209
ER -