Role of Overall Treatment Time When Estimating TCP & NTCP of Head & Neck Radiotherapy Treatment Plans in Altered Fractionation

Document Type : Original Paper

Authors

1 RTRM Department, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005, INDIA

2 BANARAS HINDU UNIVERSITY

3 RTRM Department, Institute of Medical Sciences, BHU, Varanasi-221005

4 Department of Radiotherapy and Radiation Medicine Institute of Medical Sciences Banaras Hindu University VARANASI, Uttar Pradesh, INDIA.

Abstract

Introduction: The present study demonstrated role of overall treatment time when estimating tumor control probability (TCP) and normal tissue complication probability (NTCP) for moderately hypofractionated and accelerated fractionation schedules in head & neck treatment plans. Repopulation effect in the squamous cell carcinoma is an influencing factor that should be considered when evaluating TCP and NTCP in early responding tissue. This effect can be incorporated by the means of overall treatment time in days.
Material and Methods: The proposed study separated in two parts. In the first case, we assumed four moderately hypofractionated schedules for demonstration, including conventional fractionation schedule (CFS) (70Gy/35 #), fractionation schedule 1 (66Gy/30#), fractionation schedule 2 (60Gy/24#) & fractionation schedule 3 (55Gy/20#). Four independent volumetric modulated arc treatment plans were generated at different fractionation schedules for 15 patient’s data set and therefore led to a total of 60 treatment plans. The treatment plan created for CFS is the reference plan for comparison of calculated TCP & NTCP amongst the four plans. The rest three plans for each patient were created simply by changing the dose prescription for FS1, FS2 & FS3, the mean total dose and dose per fraction. In the second scenario, conventional fractionation schedule (66Gy/33# with five fractions per week) compared against accelerated fractionation schedule (66Gy/33# with six fractions per week). The cumulative dose volume histogram for all treatment plans were used for TCP/NTCP estimation by Niemierko EUD, Poisson model and LKB model. The TCP/NTCP calculated in two different way for tumor & oral mucosa of head & neck site. Contrary to the second case, the overall treatment time (OTT) in days not accounted in the first case.
Results: It was statistically significant difference (p<0.05) obtained between calculated TCP/NTCP in both moderately hypofractionated and accelerated fractionation schedules.
Conclusion: There is significant impact of OTT and it should be considered when evaluating TCP/NTCP for early responding tissue.

Keywords

Main Subjects

References

  1. González Ferreira JA, Jaén Olasolo J, Azinovic I, Jeremic B. Effect of radiotherapy delay in overall treatment time on local control and survival in head and neck cancer: Review of the literature. Reports of Practical Oncology and Radiotherapy. 2015;20:328– https://doi.org/10.1016/j.rpor.2015.05.010.
  2. Lacas B, Bourhis J, Overgaard J, Zhang Q, Grégoire V, Nankivell M, et al. Role of radiotherapy fractionation in head and neck cancers (MARCH): an updated meta-analysis. Lancet Oncol 2017;18:1221– https://doi.org/10.1016/S1470-2045(17)30458-8.
  3. Overgaard J, Hansen HS, Specht L, Overgaard M, Grau C, Andersen E, et al. Five compared with six fractions per week of conventional radiotherapy of squamous-cell carcinoma of head and neck: DAHANCA 6&7 randomised controlled trial. Lancet 2003;362:933– https://doi.org/10.1016/S0140-6736(03)14361-9.
  4. Fowler JF. 21 Years of biologically effective dose. The British journal of radiology. 2010;83:554– https://doi.org/10.1259/bjr/31372149.
  5. Martin S, Prise KM, Hill MA. Pushing the frontiers of radiobiology: A special feature in memory of sir oliver scott and Professor Jack fowler. The British journal of radiology. 2019;92:1– https://doi.org/10.1259/bjr.20189005.
  6. Fowler JF. Is There an Optimum Overall Time for Head and Neck Radiotherapy? A Review, with New Modelling. Clinical Oncology. 2007 Feb 1;19(1):8-22. https://doi.org/10.1016/j.clon.2006.09.008.
  7. Williams J. Basic clinical radiobiology. Int J Radiat Biol 2019;95:797–https://doi.org/10.1080/09553002.2019.156978.
  8. Ermiş E, Teo M, Dyker KE, Fosker C, Sen M, Prestwich RJD. Definitive hypofractionated radiotherapy for early glottic carcinoma: Experience of 55Gy in 20 fractions. Radiation Oncology. 2015 Dec;10(1):1-9. https://doi.org/10.1186/s13014-015-0505-6.
  9. Sharma N, Spartacus RK, Bhatnagar AR, Rastogi K, Panday RK, Dana R, et al. “ Hypofractionated Acc elerated Radiotherapy Compared with Conventional Radiotherapy of Squamous Cell Carcinoma of Head and Neck with Concurrent Cisplatin ” 2017;16:80– https://doi.org/10.9790/0853-1606048083.
  10. The Royal College of Radiologists. Radiotherapy dose fractionation, third edition. Clin Oncol 2019:17.
  11. Gay HA, Niemierko A. A free program for calculating EUD-based NTCP and TCP in external beam radiotherapy. Physica Medica. 2007 Dec 1;23(3-4):115-25. https://doi.org/10.1016/j.ejmp.2007.07.001.
  12. Warkentin B, Stavrev P, Stavreva N, Field C, Fallone BG. A TCP-NTCP estimation module using DVHs and known radiobiological models and parameter sets. Journal of Applied Clinical Medical Physics. 2004 Dec;5(1):50-63. https://doi.org/10.1120/jacmp.v5i1.1970.
  13. Kukołowicz P. Clinical aspects of normal tissue complication probability. Reports of Practical Oncology & Radiotherapy. 2004 Jan 1;9(6):261-7. https://doi.org/10.1016/S1507-1367(04)71038-X.
  14. Russo G, Haddad R, Posner M, Machtay M. Radiation Treatment Breaks and Ulcerative Mucositis in Head and Neck Cancer. The Oncologist. 2008 Aug;13(8):886-98.https://doi.org/10.1634/theoncologist.2008-0024.
  15. Trott KR, Kummermehr J. The time factor and repopulation in tumors and normal tissues. InSeminars in Radiation Oncology 1993 Apr 1 (Vol. 3, No. 2, pp. 115-125). WB Saunders https://doi.org/10.1016/S1053-4296(05)80087-6.
  16. Dörr W. Modulation of repopulation processes in oral mucosa: Experimental results. Int J International journal of radiation biology. 2003 Jul 1;79(7):531-7. https://doi.org/10.1080/09553002310001600925.
  17. Bentzen SM, Saunders MI, Dische S. Repair halftimes estimated from observations of treatment-related morbidity after CHART or conventional radiotherapy in head and neck cancer. Radiotherapy and Oncology. 1999 Dec 1;53(3):219-26. https://doi.org/10.1016/S0167-8140(99)00151-6.
  18. Trott KR, Kummermehr J. Rapid repopulation in radiotherapy: a debate on mechanism. Accelerated repopulation in tumours and normal tissues. Radiotherapy and Oncology. 1991 Nov 1;22(3):159-60
  19. Allen Li X, Alber M, Deasy JO, Jackson A, Ken Jee KW, Marks LB, et al. The use and QA of biologically related models for treatment planning: Short report of the TG-166 of the therapy physics committee of the AAPM. Medical physics. 2012 Mar;39(3):1386-409. https://doi.org/10.1118/1.3685447.
  20. Van den Bosch L, Schuit E, van der Laan HP, Reitsma JB, Moons KGM, Steenbakkers RJHM, et al. Key challenges in normal tissue complication probability model development and validation: towards a comprehensive strategy. Radiotherapy and Oncology. 2020 Jul 1;148:151-6. https://doi.org/10.1016/j.radonc.2020.04.012.

 

 

 

 

Iranian Journal of Medical Physics
Volume 20, Issue 2
March and April 2023
Pages 106-113

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History

  • Receive Date: 26 September 2021
  • Revise Date: 28 January 2022
  • Accept Date: 31 January 2022

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