Vol 70, No 4 (2020)
Research paper (original)
Published online: 2020-07-27

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Overall and GTV subvolumes tumour control probability (TCP) for head and neck cancer treated by 3D-IMRT with inhomogeneous dose distribution

Leszek Hawrylewicz1, Bogusław Maciejewski2, Klaus Rudiger Trott3, Andrzej Tukiendorf4, Leszek Miszczyk2, Magdalena Markowska5
Nowotwory. Journal of Oncology 2020;70(4):127-134.


Introduction.  In this study, an original model has been developed to estimate the real TCP that is a product of the TCPs calculated for GTV subvolumes of head and neck cancer based on 3D-IMRT dose planning.

Material and methods.  Retrospective pilot group consist of 16 cases of oropharyngeal cancer in stage T1–2N0 previously treated with 3D-IMRT with at least 3-year follow-up. The total dose (TD) was 60–70 Gy in 2.0 Gy fractions delivered over 42–49 days. Within GTV two subvolumes were marked out: SVA with the planned 100% TD, and underdosed (90–95%) SVB. The TCP for both was calculated using the original formula developed by Withers and Maciejewski.

Results.  During 3-year follow-up, 8 local recurrences (LR) occurred. In about 70% of SVB “dose cold spots” encompassed more than 50% GTV volume. This resulted in the TCPSVB decrease to 60%. Thus, the real overall TCP was much lower than a priori predicted, and in these cases local recurrences occurred.

Discussion.Both cold spot SVB volumes and their dose deficit strongly correlated with a high risk of LR.

Conclusions.In conclusion the magnitude of dose deficit and the size of cold subvolume within GTV have an indepen­dent negative impact on real TCP and demand dose re-planning.

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  1. Kummermehr J, Trott KR. Tumour stem cells. Stem Cells. 1997: 363–399.
  2. Suit HD, Shalek RJ, Wette R. Radiation Response of C3H Mouse Mammary Carcinoma Evaluated in Terms of Cellular Radiation Sensitivity. In: Cellular Radiation Biology. Williams and Wilkins , Baltimore 1965.
  3. Guttenberger R, Kummermehr J, Wang J et al. 38 Ann Meeting Radiat Res Soc, abst. Cn-5 New Orleans, 1990.
  4. Maciejewski BA, Skates S, Zajusz A, et al. Importance of tumor size and repopulation for radiocurability of skin cancer. Neoplasma. 1993; 40(1): 51–54.
  5. Dubben HH, Thames HD, Beck-Bornholdt HP. Tumor volume: a basic and specific response predictor in radiotherapy. Radiother Oncol. 1998; 47(2): 167–174.
  6. Magee BJ, Logue JP, Swindell R, et al. Tumour size as a prognostic factor in carcinoma of the cervix: assessment by transrectal ultrasound. Br J Radiol. 1991; 64(765): 812–815.
  7. Tome WA, Fowler JF. Selective boosting of Tumour subvolumes. Int J Radiat Oncol Biol Phys. 2000; 47: 1137–1143.
  8. Tomé WA, Fowler JF. On cold spots in tumor subvolumes. Med Phys. 2002; 29(7): 1590–1598.
  9. Perez C, Brady L. Principles and Practice of Radiation Oncology. Pediatr Hematol Oncol. 1999; 21(6): 560.
  10. Withers HR. Biological aspects of conformal therapy. Acta Oncol. 2000; 39(5): 569–577.
  11. Johnson C, Thames H, Huang D, et al. The tumor voluem and clonogen number relationship: Tumor control predictions based upon tumor volume estimates derived from computed tomography. Int J Radiat Oncol Biol Phys . 1995; 33(2): 281–287.
  12. Deasy J. Tumour control probability model for non-uniform dose distributions. In: Paliwal B, Fowler JF, Hubert D, Mehta MP. ed. Volume and Kinetics in Tumour Control and Normal Tissue Complications. The Fifth Madison International Conference on Time, Dose and Fractionation. AIP, New York 1997: 65–85.
  13. Knöös T, Kristensen I, Nilsson P. Volumetric and dosimetric evaluation of radiation treatment plans: radiation conformity index. Int J Radiat Oncol Biol Phys. 1998; 42(5): 1169–1176.
  14. Mayo CS, Ding L, Addesa A, et al. Initial experience with volumetric IMRT (RapidArc) for intracranial stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 2010; 78(5): 1457–1466.
  15. Guerrero Urbano MT, Clark CH, Kong C, et al. Target volume definition for head and neck intensity modulated radiotherapy: pre-clinical evaluation of PARSPORT trial guidelines. Clin Oncol (R Coll Radiol). 2007; 19(8): 604–613.
  16. Bentzen SM. Quantitative clinical radiobiology. Acta Oncol. 1993; 32(3): 259–275.
  17. Yaes RJ. Tumor heterogeneity, tumor size, and radioresistance. Int J Radiat Oncol Biol Phys. 1989; 17(5): 993–1005.
  18. Harel D, Mills SD, Kwakkenbos L, et al. SPIN Investigators, members of the ISUP Renal Tumor Panel. Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull. 1968; 70(4): 213–220.
  19. Goitein M, Niemierko A. Intensity modulated therapy and inhomogeneous dose to the tumor: A note of caution. Int J Radiat Oncol Biol Phys. 1996; 36(2): 519–522.
  20. Muralikrishnan B, Raja J. Least-squares best fit line and plane. In: Muralikrishnan B, Raja J. ed. Computational Surface and Roundness Metrology. Springer Verlag London Ltd, London 2009: 121–130.
  21. Hartigan JA, Wong MA. Algorithm AS 136: A K-Means Clustering Algorithm. Applied Statistics. 1979; 28(1): 100.
  22. Brenner DJ. Dose, volume, and tumor-control predictions in radiotherapy. Int J Radiat Oncol Biol Phys. 1993; 26(1): 171–179.

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