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The dose no longer plays a paramount role in radiotherapy (oncology), but time apparently does
, 2
Affiliations- Div. Research Programmes, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
- Radiotherapy and Chemotherapy Clinic I, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
open access
Abstract
Overall 80 clinical data sets (head and neck, breast, lung and prostate) have been selected from the literature (about 10,000 patients) to analyze and compare the importance of the total dose (D) vs. overall therapy time (OTT). There was no correlation between local tumor control (LTC) and dose used as a single parameter. On the contrary, for tumors (larynx and cervix cancer) treated with a constant TCD50 ± 5%, any extension of the ORT resulted in a significant decrease of the LTC by about 1.5–2% per each one day extension of the ORT. Dose intensity (DI) expressed by the number of gray per unit of time (day) strongly correlated with the LTC, which significantly increases when the DI becomes larger than 7 Gy/day. The results lead to a final conclusion that suggests inverse order of the planned treatment parameters, i.e. TIME plays the primary role in treatment and the DOSE (and its fractionation) is a consequence of the primary choice.
Abstract
Overall 80 clinical data sets (head and neck, breast, lung and prostate) have been selected from the literature (about 10,000 patients) to analyze and compare the importance of the total dose (D) vs. overall therapy time (OTT). There was no correlation between local tumor control (LTC) and dose used as a single parameter. On the contrary, for tumors (larynx and cervix cancer) treated with a constant TCD50 ± 5%, any extension of the ORT resulted in a significant decrease of the LTC by about 1.5–2% per each one day extension of the ORT. Dose intensity (DI) expressed by the number of gray per unit of time (day) strongly correlated with the LTC, which significantly increases when the DI becomes larger than 7 Gy/day. The results lead to a final conclusion that suggests inverse order of the planned treatment parameters, i.e. TIME plays the primary role in treatment and the DOSE (and its fractionation) is a consequence of the primary choice.
Keywords
total dose; overall therapy time; dose intensity
About this articleTitle
The dose no longer plays a paramount role in radiotherapy (oncology), but time apparently does
Journal
Nowotwory. Journal of Oncology
Issue
Article type
Review paper
Pages
80-85
Published online
2022-02-11
Page views
4729
Article views/downloads
459
DOI
Bibliographic record
Nowotwory. Journal of Oncology 2022;72(2):80-85.
Keywords
total dose
overall therapy time
dose intensity
Authors
Bogusław Maciejewski
Krzysztof Składowski
References (26)- Withers HR, Taylor JM, Maciejewski B. The hazard of accelerated tumor clonogen repopulation during radiotherapy. Acta Oncol. 1988; 27(2): 131–146.
- Dragun AE. Altered fractionation schedules. In: Perez and Brady Principles and Practice of radiation oncology 7th ed. Wolters Kluwer, Philadelphia 2018: 308–328.
- Bourhis J, Audry H, Overgaard J, et al. Meta-analysis of conventional versus altered fractionated radiotherapy in head and neck squamous cell carcinoma (HNSCC): Final analysis. International Journal of Radiation Oncology*Biology*Physics. 2004; 60(1): S190–S191.
- Maciejewski B, Preuss-Bayer G, Trott KR. The influence of the number of fractions and of overall treatment time on local control and late complication rate in squamous cell carcinoma of the larynx. Int J Radiat Oncol Biol Phys. 1983; 9(3): 321–328.
- Elicin O, Brolese EK, Bojaxhiu B, et al. The prognostic impact of daytime and seasonality of radiotherapy on head and neck cancer. Radiother Oncol. 2021; 158: 293–299.
- Pignon JP, le Maître A, Maillard E, et al. MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol. 2009; 92(1): 4–14.
- Rodin D, Strauss JB, R Bellon J. "Standard" Fractionation for Breast Cancer is No Longer Standard. Int J Radiat Oncol Biol Phys. 2021; 110(4): 925–927.
- de Paula U, D'Angelillo RM, Andrulli AD, et al. Long-Term Outcomes of Once-Daily Accelerated Partial-Breast Irradiation With Tomotherapy: Results of a Phase 2 Trial. Int J Radiat Oncol Biol Phys. 2021; 109(3): 678–687.
- Mutter RW, Hepel JT. Accelerated Partial Breast Radiation: Information on Dose, Volume, Fractionation, and Efficacy from Randomized Trials. Int J Radiat Oncol Biol Phys. 2020; 108(5): 1123–1128.
- Goyal S, Buchholz T, Haffty BG. Breast cancer. Early stage. In: Haffty BG. ed. Perez and Brady, Principless and Practice of radiation oncology. Wolters Kluwer, Philadelphia 2018: 1269–1378.
- Ratosa I, Chirilă ME, Steinacher M, et al. Hypofractionated radiation therapy for breast cancer: Preferences amongst radiation oncologists in Europe - Results from an international survey. Radiother Oncol. 2021; 155: 17–26.
- Offersen BV, Alsner J, Nielsen HM, et al. Danish Breast Cancer Group Radiation Therapy Committee. Hypofractionated Versus Standard Fractionated Radiotherapy in Patients With Early Breast Cancer or Ductal Carcinoma In Situ in a Randomized Phase III Trial: The DBCG HYPO Trial. J Clin Oncol. 2020; 38(31): 3615–3625.
- Murray Brunt A, Haviland JS, Wheatley DA, et al. FAST-Forward Trial Management Group. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet. 2020; 395(10237): 1613–1626.
- Wang SL, Fang H, Hu C, et al. Hypofractionated Versus Conventional Fractionated Radiotherapy After Breast-Conserving Surgery in the Modern Treatment Era: A Multicenter, Randomized Controlled Trial From China. J Clin Oncol. 2020; 38(31): 3604–3614.
- Bentzen SM, Agrawal RK, Aird EGA, et al. START Trialists' Group, START Trialists' Group. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet. 2008; 371(9618): 1098–1107.
- Francis DM, Brower JV. Post-Mastectomy Radiation After Immediate Reconstruction for Multifocal Early-Stage Breast Cancer; to Irradiate or Not? Int J Radiat Oncol Biol Phys. 2020; 108(5): 1129–1130.
- Celejewska A, Maciejewski B, Wydmański J, et al. The efficacy of IORT (intraoperative radiotherapy) for early advanced breast cancer depending on the time delay of external beam irradiation (EXRT) post conservative breast surgery (CBS). Nowotwory. Journal of Oncology. 2021; 71(3): 133–138.
- Finazzi T, Haasbeek CJA, Spoelstra FOB, et al. Clinical Outcomes of Stereotactic MR-Guided Adaptive Radiation Therapy for High-Risk Lung Tumors. Int J Radiat Oncol Biol Phys. 2020; 107(2): 270–278.
- Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials. PORT Meta-analysis Trialists Group. Lancet. 1998; 352(9124): 257–263.
- Timmerman R, Paulus R, Galvin J, et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA. 2010; 303(11): 1070–1076.
- Tateishi Y, Takeda A, Horita N, et al. Stereotactic Body Radiation Therapy With a High Maximum Dose Improves Local Control, Cancer-Specific Death, and Overall Survival in Peripheral Early-Stage Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys. 2021; 111(1): 143–151.
- Nagar H, Spratt DE. Prostate SBRT Dose Escalation (9 Gy × 5, 13.3 Gy × 3, 24 Gy × 1): Are We Making Progress? Int J Radiat Oncol Biol Phys. 2021; 111(1): 110–112.
- Folkert MR, Zelefsky MJ, Hannan R, et al. A Multi-Institutional Phase 2 Trial of High-Dose SAbR for Prostate Cancer Using Rectal Spacer. Int J Radiat Oncol Biol Phys. 2021; 111(1): 101–109.
- Fletcher GH, Fletcher GH. Clinical dose-response curves of human malignant epithelial tumours. Br J Radiol. 1973; 46(541): 1–12.
- Fyles A, Keane T, Barton M, et al. The effect of treatment duration in the local control of cervix cancer. Radiother Oncol. 1992; 25(4): 273–279.
- De Salles AAF, Gorgulho AA, Agazaryan N. Shaped beam radiosurgery. State of the art. Springer-Verlag, Berlin 2011: 1–305.