Abstract
The main aim of radiotherapy is to deliver a dose of radiation that is high enough to destroy the tumour cells while at the same time minimising the damage to normal healthy tissues. Clinically, this has been achieved by assigning a prescription dose to the tumour volume and a set of dose constraints on critical structures. Once an optimal treatment plan has been achieved the dosimetry is assessed using the physical parameters of dose and volume. There has been an interest in using radiobiological parameters to evaluate and predict the outcome of a treatment plan in terms of both a tumour control probability (TCP) and a normal tissue complication probability (NTCP). In this study, simple radiobiological models that are available in a commercial treatment planning system were used to compare three dimensional conformal radiotherapy treatments (3D-CRT) and intensity modulated radiotherapy (IMRT) treatments of the prostate. Initially both 3D-CRT and IMRT were planned for 2 Gy/fraction to a total dose of 60 Gy to the prostate. The sensitivity of the TCP and the NTCP to both conventional dose escalation and hypo-fractionation was investigated. The biological responses were calculated using the Källman S-model. The complication free tumour control probability (P+) is generated from the combined NTCP and TCP response values. It has been suggested that the α/β ratio for prostate carcinoma cells may be lower than for most other tumour cell types. The effect of this on the modelled biological response for the different fractionation schedules was also investigated.
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Pavone-Macaluso, M.,Patient selection criteria for surgery, inRadiotherapy of prostate cancer, Greco, C. and Zelefsky, M.J., Editors. Harwood Academic Publishers: Amsterdam, The Netherlands. p. 69–74, 2000.
Small, W., Jr. and Woloschak, G.,Introduction, inRadiation Toxicity A Practical Guide, Small, W., Jr. and Woloschak, G., Editors. Springer: Chicago, IL, USA, 2006.
Schlegel, W.,New technologies in conformal radiation therapy inThree-Dimensional Radiation Treatment technological innovations and clinical results, Feldmann, H.J., Kneschaurek, P., and Molls, M., Editors. Karger: Basel, Switzerland. p. 26–39, 2000.
Al-Mamgani, A., et al.,Update of Dutch Multicenter Dose-Escalation Trial of Radiotherapy for Localized Prostate Cancer, International Journal of Radiation Oncology Biology Physics, 72(4): p. 980–988, 2008.
Pollack, A., Zagars, G.K., and Starkschall, G.,Prostate cancer radiation dose response: results of the MD Anderson phase III randomized trial, International Journal of Radiation Oncology Biology Physics, 53(5): p. 1097–1105, 2002.
Prado, K.L., Starkschall, G., and Mohan, R.,Threedimensional conformal radiation therapy, inTreatment Planning in Radiation Oncology, Khan, F.M., Editor. Lippincott Williams & Wilkins: Philadelphia, PA, USA. p. 116–141, 2007.
Kutcher, G.J.,Quantitative plan evaluation: TCP/NTCP models, in3-D Conformal Radiotherapy A New Era in the Irradiation of Cancer, Meyer, J.L. and Purdy, J.A., Editors. Karger: Basel, Switzerland. p. 67–80, 1996.
Webb, S.,The Physics of Conformal Radiotherapy, Institute of Physics Publishing., Bristol, UK., 1997.
Kutcher, G.J.,Quantitative plan evaluation, in Advances in Radiation Oncology Physics Dosimetry, Treatment Planning, and Brachytherapy, Purdy, J.A., Editor. American Association of Physicists in Medicine: Kansas, USA, p. 998–1021, 1990.
Haken, R.K.T. and Kessler, M.L.,Quantitaitve tools for plan evaluation, inGeneral Practice of Radiation Oncology Physics in the 21st Century, Shiu, A.S. and Mellenberg, D.E., Editors. Medical Physics Publishing: Illinois, USA, p. 16–36 2000.
11.Niemierko, A.,Current status of TCP and NTCP calculations, in3-D Conformal and Intensity Modulated Radiation Therapy: Physics & Clinical Applications, Purdy, J.A., et al., Editors. Advanced Medical Publishing: Madison, WI, USA, p. 95–111, 2001.
Brahme, A.,Optimized radiation therapy based on radiobiological objectives, Seminars in Radiation Oncology, 9(1): p. 35–47, 1999.
McAneney, H. and O’Rourke, S.F.C.,Investigation of various growth mechanisms of solid tumour growth within the linearquadratic model for radiotherapy, Phys. Med. Biol., 52: p. 1039–1054, 2007.
Fowler, J., Chappell, R., and Ritter, M.,Is α/β for prostate tumors really low? International Journal of Radiation Oncology Biology Physics, 50(4): p. 1021–1031, 2001.
Fowler, J.F.,Development of radiobiology for oncology-a personal view, Physics in Medicine and Biology, 51: p. R263-R286, 2006.
Garcia, L.M., Wilkins, D.E., and Raaphorst, G.P.,α/β ratio: a dose range dependence study, International Journal of Radiation Oncology Biology Physics, 67(2): p. 587–593, 2007.
Kal, H.B. and M. P. van Gellekom,How low is the alpha/beta ratio for prostate cancer? International Journal of Radiation Oncology Biology Physics, 57: p. 1116–1121, 2003.
King, C.R. and Fowler, J.F.,A simple analytic derivation suggests that prostate cancer alpha/beta ratio is low, International Journal of Radiation Oncology Biology Physics, 51(1): p. 213–214, 2001.
Wang, J.Z., Guerrero, M., and Li, X.A.,How low is the α/β ratio for prostate cancer? International Journal of Radiation Oncology Biology Physics, 55: p. 194–203, 2005.
Williams, S.G., et al.,Use of individual fraction size data from 3756 patients to directly determine the α/β ratio of prostate cancer, International Journal of Radiation Oncology Biology Physics, 68(1): p. 24–33, 2007.
Muriel, V.P.,Hypofractionation in radiotherapy, Clinical and Translational Oncology, 9(1): p. 21–27, 2007.
Nahum, A.E., et al.,Incorporating clinical measurements of hypoxia into tumor local control modelling of prostate cancer: Implications for the alpha/beta ratio, Int. J. Radiat. Oncol. Biol. Phys., 57: p. 391–401, 2003.
Brahme, A., Nilsson, J., and Belkic, D.,Biologically optimized radiation therapy, Acta Oncologica, 40(6): p. 725–734, 2001.
Haworth, A., et al.,Prostate implant evaluation using tumour control probability-the effect of input parameters, Physics in Medicine and Biology, 49: p. 3649–3664, 2004.
Ebert, M.,Ranking radiotherapy treatment plans: physical or biological objectives? Radiology Oncology, 35(3): p. 215–24, 2004.
Zaider, M. and Minerbo, G.N.,Tumour control probability: a formulation applicable to any temporal protocol of dose delivery, Physics in Medicine and Biology, 45: p. 279–293, 2000.
Stavrev, P., et al.,An objective function for TCP/NTCP curve fitting, Medical Physics, 34(6): p.2417, 2007.
Kallman, P., Agren, A., and Brahme, A.,Tumour and normal tissue responses to fractionated non uniform dose delivery, Int. J. Radiat. Biol., 62(2): p. 249–262, 1992.
Lof, J.,Development of a general framework for optimization of radiation therapy, 2000, Stockholm University: Stockholm.
Agren, A. K., Brahme, A. and Turesson, I.,Optimization of uncomplicated control for head and neck tumours, International Journal of Radiation Oncology Biology Physics, 19(4): p. 1077–85, 1990.
International Commission on Radiation Units and Measurements (ICRU) Report 50,Prescribing, Recording, and Reporting Photon Beam Therapy, 1993: Bethesda, MD, USA.
International Commission on Radiation Units and Measurements (ICRU) Report 62,Prescribing, Recording, and Reporting Photon Beam Therapy (Supplement to ICRU Report 50), 1999: Bethesda, MD, USA.
Fowler, J.F.,The radiobiology of prostate cancer including new aspects of fractionated radiotherapy, Acta Oncologica, 44: p. 265–276, 2005.
Moiseenko, V., Duzenli, C., and Durand, R.E.,In vitro study of cell survival following dynamic MLC intensity-modulated radiation therapy dose delivery, Medical Physics, 34(4): p. 1514, 2007.
Suchowerska, N., et al.,In vitro response of tumour cells to non-uniform irradiation, Physics in Medicine and Biology, 50: p. 3041–3051, 2005.
Khoo, V. S. and Dearnaley, D. P.,Question of Dose, Fractionation and Technique: Ingredients for Testing Hypofractionation in Prostate Cancer-the CHHiP Trial, Clinical Oncology, 20: p. 12–14, 2008.
Martin, J.M., et al.,Phase II trial of hypofractionated imageguided intensity modulated radiotherapy for localized prostate adenocarcinoma, International Journal of Radiation Oncology Biology Physics, 69(4): p. 1084–1089, 2007.
Kupelian, P.A., et al.,Hypofractionated intensity-modulated radiotherapy (70 Gy at 2.5 Gy per fraction) for localized prostate cancer: Cleveland clinic experience, International Journal of Radiation Oncology Biology Physics, 68(5): p. 1424–1430, 2007.
Livsey, J.E., et al.,Hypofractionated conformal radiotherapy in carcinoma of the prostate: five-year outcome analysis, International Journal of Radiation Oncology Biology Physics, 57(5): p. 1254–1259, 2003.
Yeoh, E.E., et al.,Hypofractionated versus conventionally fractionated radiation therapy for prostate carcinoma: updated results of a phase III randomized trial, International Journal of Radiation Oncology Biology Physics, 66(4): p. 1072–1083, 2006.
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Deb, P., Fielding, A. Radiobiological model comparison of 3D conformal radiotherapy and IMRT plans for the treatment of prostate cancer. Australas. Phys. Eng. Sci. Med. 32, 51–61 (2009). https://doi.org/10.1007/BF03178629
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DOI: https://doi.org/10.1007/BF03178629