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Biological Indices for Treatment Planning: A Clinical Perspective

Martel et al.

BIOLOGICAL INDICES IN TREATMENT PLANNING: A CLINICAL PERSPECTIVE Mary K. Martel, Ph.D. Department of Radiation Oncology University of Michigan Medical Center Ann Arbor Michigan

Evaluation of 3D treatment plans is often limited to inspection of dose distributions in 2D, or at most, to analysis of dose-volume histogram (DVH) statistics. In the last several decades, biological models have been developed that use 3D dose-volume information as input. The purpose of the models is to predict the normal tissue complication risk or tumor control probability and, so, can be used to "score" plans based on an index of risk versus cure. The predictive power of the models is assessed through analysis of complication or control data before they can be considered reliable for clinical treatment planning. Consequently, model parameters may need to be adjusted. Aspects of the models may be used in the design of dose escalation trials to gather normal organ tolerance data in a safe and systematic fashion. Biological indices can be used in cost functions in automated optimization planning systems to aid in the determination of the "optimal" treatment plan. This refresher course will attempt to elucidate the: 1) Analysis and correlation of 3D dose distributions with complication or tumor control data; 2) Description and use of biological models to design and evaluate treatment plans; 3) Development of cost or score functions (with biological indices) for treatment plan optimization.

Biological Indices for Treatment Planning: A Clinical Perspective

Martel et al.

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Biological Indices for Treatment Planning: A Clinical Perspective

Martel et al.

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Biological Indices for Treatment Planning: A Clinical Perspective

Martel et al.

escalation. [12 refs] Frontiers of Radiation Therapy & Oncology. 29:57-66, 1996. Lawrence TS. Ten Haken RK. Kessler ML. Robertson JM. Lyman JT. Lavigne ML. Brown MB. DuRoss DJ. Andrews JC. Ensminger WD. et al. The use of 3-D dose volume analysis to predict radiation hepatitis. International Journal of Radiation Oncology, Biology, Physics. 23(4):781-8, 1992. Lee SP. Leu MY. Smathers JB. McBride WH. Parker RG. Withers HR. Biologically effective dose distribution based on the linear quadratic model and its clinical relevance. IJROBP. 33(2):375-89, 1995 Sep 30. Ling CC. Roy J. Sahoo N. Wallner K. Anderson L. Quantifying the effect of dose inhomogeneity in brachytherapy: application to permanent prostatic implant with 125I seeds. IJROBP. 28(4):971-8, 1994 Mar 1. Lyman JT. Wolbarst AB. Optimization of radiation therapy, III: A method of assessing complication probabilities from dose-volume histograms. International Journal of Radiation Oncology, Biology, Physics. 13(1):103-9, 1987 Jan. Marcus RB Jr. Million RR. The incidence of myelitis after irradiation of the cervical spinal cord [see comments]. International Journal of Radiation Oncology, Biology, Physics. 19(1):3-8, 1990 Jul. Marks LB. Munley MT. Bentel GC. Zhou SM. Hollis D. Scarfone C. Sibley GS. Kong FM. Jirtle R. Jaszczak R. Coleman RE. Tapson V. Anscher M. Physical and biological predictors of changes in whole-lung function following thoracic irradiation [see comments]. International Journal of Radiation Oncology, Biology, Physics. 39(3):563-70, 1997 Oct 1. Martel MK. Sahijdak WM. Ten Haken RK. Kessler ML. Turrisi AT. Fraction size and dose parameters related to the incidence of pericardial effusions. International Journal of Radiation Oncology, Biology, Physics. 40(1):155-61, 1998 Jan 1. Martel MK. Strawderman M. Hazuka MB. Turrisi AT. Fraass BA. Lichter AS. Volume and dose parameters for survival of non-small cell lung cancer patients. Radiotherapy & Oncology. 44(1):23-9, 1997 Jul.

Biological Indices for Treatment Planning: A Clinical Perspective

Martel et al.

Martel MK. Sandler HM. Cornblath WT. Marsh LH. Hazuka MB. Roa WH. Fraass BA. Lichter AS. Dose-volume complication analysis for visual pathway structures of patients with advanced paranasal sinus tumors. International Journal of Radiation Oncology, Biology, Physics. 38(2):27384, 1997 May 1 Martel MK. Ten Haken RK. Hazuka MB. Turrisi AT. Fraass BA. Lichter AS. Dose-volume histogram and 3-D treatment planning evaluation of patients with pneumonitis [see comments]. International Journal of Radiation Oncology, Biology, Physics. 28(3):575-81, 1994 Feb 1. Mohan R. Wang X. Jackson A. Bortfeld T. Boyer AL. Kutcher GJ. Leibel SA. Fuks Z. Ling CC. The potential and limitations of the inverse radiotherapy technique. Radiotherapy & Oncology. 32(3):232-48, 1994 Sep. Niemierko A. Reporting and analyzing dose distributions: a concept of equivalent uniform dose [see comments]. Medical Physics. 24(1):103-10, 1997 Jan. Niemierko A. Goitein M. Implementation of a model for estimating tumor control probability for an inhomogeneously irradiated tumor. Radiotherapy & Oncology. 29(2):140-7, 1993 Nov Niemierko A. Goitein M. Modeling of normal tissue response to radiation: the critical volume model [see comments]. IJROBP. 25(1):135-45, 1993 Jan. Niemierko A. Urie M. Goitein M. Optimization of 3D radiation therapy with both physical and biological end points and constraints. IJROBP. 23(1):99108, 1992. Niemierko A. Goitein M. Calculation of normal tissue complication probability and dose-volume histogram reduction schemes for tissues with a critical element architecture. Radiotherapy & Oncology. 20(3):166-76, 1991 Mar. Niemierko A. Radiobiological models of tissue response to radiation in treatment planning systems. Tumori. 84(2):140-3, 1998 Mar-Apr

Biological Indices for Treatment Planning: A Clinical Perspective

Martel et al.

Parsons JT. Bova FJ. Fitzgerald CR. Mendenhall WM. Million RR. Radiation optic neuropathy after megavoltage external-beam irradiation: analysis of time-dose factors. International Journal of Radiation Oncology, Biology, Physics. 30(4):755-63, 1994 Nov 15. Parsons JT. Bova FJ. Fitzgerald CR. Mendenhall WM. Million RR. Radiation retinopathy after external-beam irradiation: analysis of time-dose factors. International Journal of Radiation Oncology, Biology, Physics. 30(4):765-73, 1994 Nov 15. Peters LJ. Withers HR. Brown BW. Complicating issues in complication reporting [editorial; comment]. IJROBP. 31(5):1349-51, 1995 Mar 30. Peters LJ. Withers HR. Applying radiobiological principles to combined modality treatment of head and neck cancer--the time factor. IJROBP. 39(4):831-6, 1997 Nov 1. Schultheiss TE. Orton CG. Models in radiotherapy: definition of decision criteria. Medical Physics. 12(2):183-7, 1985 Mar-Apr. Schultheiss TE. Orton CG. Peck RA. Models in radiotherapy: volume effects. Medical Physics. 10(4):410-5, 1983 Jul-Aug. Schultheiss TE. Lee WR. Hunt MA. Hanlon AL. Peter RS. Hanks GE. Late GI and GU complications in the treatment of prostate cancer. International Journal of Radiation Oncology, Biology, Physics. 37(1):3-11, 1997 Jan 1. Stephens LC. Schultheiss TE. Small SM. Ang KK. Peters LJ. Response of parotid gland organ culture to radiation. Radiation Research. 120(1):140-53, 1989 Oct. Stewart JR. Fajardo LF. Gillette SM. Constine LS. Radiation injury to the heart. [Review] [49 refs] International Journal of Radiation Oncology, Biology, Physics. 31(5):1205-11, 1995 Mar 30. Ten Haken RK. Martel MK. Kessler ML. Hazuka MB. Lawrence TS. Robertson JM. Turrisi AT. Lichter AS. Use of Veff and iso-NTCP in the implementation of dose escalation protocols. International Journal of Radiation Oncology, Biology, Physics. 27(3):689-95, 1993 Oct 20

Biological Indices for Treatment Planning: A Clinical Perspective

Martel et al.

Theuws JC. Kwa SL. Wagenaar AC. Boersma LJ. Damen EM. Muller SH. Baas P. Lebesque JV. Dose-effect relations for early local pulmonary injury after irradiation for malignant lymphoma and breast cancer. Radiotherapy & Oncology. 48(1):33-43, 1998 Jul. Withers HR. Taylor JM. Critical volume model [editorial; comment]. IJROBP. 25(1):151-2, 1993 Jan. Withers HR. Biological basis of radiation therapy for cancer. Lancet. 339(8786):156-9, 1992 Jan 18. [19 refs]

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