For cervical carcinoma cases, this study aimed to evaluate the quality of intensity-modulated radiation therapy (IMRT) plans optimized by biological constraints. Furthermore, a new integrated strategy in biological planning module was proposed and verified.
Twenty patients of advanced stage cervical carcinoma were enrolled in this study. For each patient, dose volume optimization (DVO), biological model optimization (BMO) and integrated strategy optimization (ISO) plans were created using same treatment parameters. Different biological models were also used for organ at risk (OAR) in BMO plans, which include the LKB and Poisson models. Next, BMO plans were compared with their corresponding DVO plans, in order to evaluate BMO plan quality. ISO plans were also compared with DVO and BMO plans, in order to verify the performance of the integrated strategy.
BMO plans produced slightly inhomogeneity and less coverage of planning target volume (PTV) (V95=96.79, HI = 0.10: p < 0.01). However, the tumor control probability (TCP) value, both from DVO and BMO plans, were comparable. For the OARs, BMO plans produced lower normal tissue complication probability (NTCP) of rectum (NTCP = 0.11) and bladder (NTCP = 0.14) than in the corresponding DVO plans (NTCP = 0.19 and 0.18 for rectum and bladder; p < 0.01 for rectum and p = 0.03 for bladder). V95, D98, CI and HI values that were produced by ISO plans (V95 = 98.31, D98 = 54.18Gy, CI = 0.76, HI = 0.09) were greatly better than BMO plans (V95 = 96.79, D98 = 53.42Gy, CI = 0.71, HI = 0.10) with significant differences. Furthermore, ISO plans produced lower NTCP values of rectum (NTCP = 0.14) and bladder (NTCP = 0.16) than DVO plans (NTCP = 0.19 and 0.18 for rectum and bladder, respectively) with significant differences.
BMO plans produced lower NTCP values of OARs compared to DVO plans for cervical carcinoma cases, and resulted in slightly less target coverage and homogeneity. The integrated strategy, proposed in this study, could improve the coverage, conformity and homogeneity of PTV greater than the BMO plans, as well as reduce the NTCP values of OARs greater than the DVO plans.
Li X, Alber M, Deasy JO, 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. Med Phys. 2012;39:1386–409. CrossRef
Lee TF, Fang FM. Quantitative analysis of normal tissue effects in the clinic (QUANTEC) guideline validation using quality of life questionnaire datasets for parotid gland constraints to avoid causing xerostomia during head-and-neck radiotherapy. Radiat Oncol. 2013;106:352–8. CrossRef
Kierkels RG, Korevaar EW, Steenbakkers RJ, et al. Direct use of multivariable normal tissue complication probability models in treatment plan optimisation for individualised head and neck cancer radiotherapy produces clinically acceptable treatment plans. Radiat Oncol. 2014;112:430–6. CrossRef
Troeller A, Yan D, Marina O, et al. Comparison and limitations of DVH-based NTCP models derived from 3D-CRT and IMRT data for prediction of gastrointestinal toxicities in prostate cancer patients by using propensity score matched pair analysis. Int J Radiat Oncol Biol Phys. 2015;91:435–43. CrossRefPubMed
Kan MWK, Leung LHT, Yu PKN. The use of biologically related model (Eclipse) for the intensity-modulated radiation therapy planning of nasopharyngeal carcinomas. PLoS One. 2014;9:11.
Sievinen J, Ulmer W, Kaissl W. AAA photon dose calculation model in Eclipse. Palo Alto: Varian Medical Systems; 2005. p. 1–18 [RAD #7170B].
Zhu J, Zhang ZC, Li BS, et al. Analysis of acute radiation-induced esophagitis in non-small-cell lung cancer patients using the Lyman NTCP model. Radiat Oncol. 2010;97:449–54. CrossRef
Rancati T, Fiorino C, Gagliardi G, et al. Fitting late rectal bleeding data using different NTCP models: results from an Italian multi-centric study (AIROPROS0101). Radiat Oncol. 2004;73(1):21–32. CrossRef
Dale E, Hellebust TP, Skjønsberg A, Høgberg T, Olsen DR. Modeling normal tissue complication probability from repetitive computed tomography scans during fractionated high-dose-rate brachytherapy and external beam radiotherapy of the uterine cervix. Int J Radiat Oncol Biol Phys. 2000;47(4):963–71. CrossRefPubMed
van’t Riet A, Mak AC, Moerland MA, et al. A conformation number to quantify the degree of conformality in brachytherapy and external beam irradiation: application to the prostate. Int J Radiat Oncol Biol Phys. 1997;37:731–6. CrossRef
- An integrated strategy of biological and physical constraints in biological optimization for cervical carcinoma
- BioMed Central
Neu im Fachgebiet Onkologie
Mail Icon II