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S.C. Radioterapia
Laboratorio di Fisica Medica e Sistemi Esperti
I.F.O. Istituto Regina Elena, Roma
3D-CRT:
TCP/NTCP Model
1.0
0.8
0.6
0.4
0.2
3D-IMRT
Prescribed Dose
Prescribed Dose
6
Hypothetical Model
Study design
IMRT
C.T. scans taken also at the middle and at the end of RT course
Contours re-outlined
DVH evaluation
Patients selection:
12 patients at intermediate risk prostate cancer,
without clinical evidence of lymph node and distant
metastases entered our study
C.T. scans were acquired with a spiral C.T. and the slides were
reconstructed at 5 mm increments
11
The pubic symphysis and the ischiatic bone on L-L DRR, the ilium
bone, the ileo-pubic branch and the ischio-pubic branch on A-P
DRR were chosen as reference structures
13
CT 1
CT 3
CT 2
15
CT 1
CT 3
CT 2
16
CT 1
CT 3
CT 2
17
LATERAL
ANTERIOR-POSTERIOR
CRANIO-CAUDAL
*J.C. Stroom et al.: Geometrical uncertainties, radiotherapy planning margins, and ICRU-62 report; Radiotherapy and Oncology 64 (2002) 75-83.
18
Volumes (cm3) of rectal wall, CTV and PTV to rectal wall intersection
calculated from baseline, intermediate and final CT scan
Volumes (cm3)
rectal wall
CTV
patient
initial
intermediate
final
initial
intermediate
final
initial
intermediate
final
32,56
27,37
32,08
82,54
63,67
61,00
9,29
3,93
2,71
38,89
37,27
39,51
56,98
58,59
57,58
5,39
5,55
4,81
30,21
29,66
31,03
52,64
53,28
51,97
3,25
3,64
2,55
31,72
24,98
32,92
61,23
43,81
52,11
8,14
5,08
6,68
53,79
56,28
69,58
63,09
70,05
71,44
6,03
5,85
4,03
34,69
32,81
42,53
59,98
62,49
69,24
2,97
2,78
3,20
42,59
49,40
49,64
93,39
82,22
93,16
6,44
5,46
6,27
39,06
52,61
55,68
74,95
76,79
58,93
5,69
2,26
5,88
29,95
47,68
50,00
87,96
72,42
71,65
3,81
8,82
5,84
10
43,18
44,88
49,17
43,11
34,08
42,23
3,22
2,22
3,23
11
29,42
43,18
45,43
95,11
102,8
97,84
4,82
5,42
4,03
12
33,58
37,85
40,12
99,92
108,5
96,84
2,97
3,25
3,3
median value
34,14
40,52
43,98
69,02
66,86
65,12
5,11
4,51
4,03
std deviation
7,23
10,27
11,08
18,87
21,81
18,56
2,08
1,89
1,47
20
Gr 1
Gr 2
Gr 3
Rectal
4 (33%)
3 (25%)
Vesical
5 (42%)
3 (25%)
1 (8%)
20-30%
40-50%
60-70%
80-90%
90-100%
100-105%
23
25
V%
1.8 MM IN ANTERIOR
DIRECTION
100
90
80
3.4 MM IN CRANIAL
DIRECTION
70
60
50
recalculat ed CTV
40
30
recalculat ed rect al
wall
init ial CTV
20
10
0
10
20
30
40
50
60
70
80 Gy 90
26
27
V%
Planning DVHs
dose to the 50% of CTV: from 76.8 to 81.2 Gy
dose to the whole CTV: from 75.6 to 84.8 Gy
Treatment DVHs
dose to the 50% of CTV: from 75.6 to 81.6 Gy
dose to the whole CTV: from 54.4 to 85.6 Gy
70
60
50
40
30
20
10
0
50
55
60
65
70
75
80
85
Gy
90
V%
100
90
80
70
60
50
40
30
20
10
0
0
10
20
30
40
50
60
70
80
28
Gy
90
No time dependance
PERCENTAGE RECTAL
WALL RECEIVING 70 Gy
V70 moves beyond the maximum
initial volume constraint obtained of
35 % in 5 out of 12
PERCENTAGE RECTAL
WALL RECEIVING 40 Gy
RADIOBIOLOGICAL ANALISYS
NORMAL TISSUE COMPLICATION PROBABILITY
NTCP
1
2
exp t
D TD50(v)
m * TD50(v)
V
Vref
/ 2 dt
Vref = whole organ;
v = fraction of volume irradiated with a dose D;
TD50(1) = tolerance dose that gives 50%
probability of damage for whole organ
irradiation;
m = parameter that gives the slope of the doseresponse curve;
n = parameter that gives the dependance of
TD50 on the fraction of volume irradiated;
TDv TD1 v n
[1] Burman C., Kutcher G.J., Emami B., and Gotein M. Fitting of normal tissue tolerance data to an analytic function.
Int. J. Radiation Oncology Biol. Phys. 1991; 21: 123-135.
30
RADIOBIOLOGICAL ANALISYS
NORMAL TISSUE COMPLICATION PROBABILITY
31
RADIOBIOLOGICAL ANALISYS
TUMOR CONTROL PROBABILITY
TCP was calculated by using the Poisson model without taking into account tumor
repopulation. Since patients recruited for this study were those classified at the
intermediate risk group (i.e. PSA=10-20 ng/ml, or Gleason 7 ,or stage T2b) we
fitted clinical data for external beam irradiation reported by Fowler et al. [1].
TCP
exp vi exp a b Di /N Di
i
32
RADIOBIOLOGICAL ANALISYS
TUMOR CONTROL PROBABILITY
33
TCP (%)
TCP (%)
TCP (%)
patient
(planning)
(intermediate)
(final)
(planning)
(intermediate)
(final)
86,08
88,03
88,20
11,04
6,49
2,94
87,60
88,27
87,95
8,25
6,92
5,69
87,30
89,51
89,37
5,16
10,02
4,27
87,67
92,49
90,42
11,61
15,01
5,32
85,60
81,18
85,96
4,85
11,60
0,58
87,58
86,99
86,05
4,09
3,25
10,32
76,56
83,42
82,16
5,47
10,68
10,35
78,28
73,45
59,18
9,37
3,76
3,92
83,96
83,63
87,22
7,55
22,14
19,16
10
89,31
93,98
92,44
6,56
4,33
11,52
11
71,27
68,27
70,85
6,62
14,43
6,24
12
80,95
77,81
81,46
3,95
5,95
3,44
mean TCP
mean TCP
mean NTCP
mean NTCP
planning
treatment
planning
treatment
83.515.57
83.627.53
7.042.58
7.864.65
34
PERCENTAGE DEVIATION
FROM INITIAL NTCP
VALUE
Variations in NTCP are mostly limited to
within 10 % of the initial value. In only
one patient the intermediate and final
NTCP showed values of 11.6 % and 14. 6
% higher than the initial one
PERCENTAGE DEVIATION
FROM INITIAL TCP
VALUE
Variations in TCP are mostly
limited to within 5% of the
initial value. In only one patient
final TCP was 19.1 % lower than
initial one
35
37
38