Methods to calculate normal tissue complication and tumour control probabilities for fractionated inhomogeneous dose distribution of intensity-modulated radiation therapy

Abstract

AbstractObjectives: This study is designed to present and evaluate radiobiological-based dose–volume histogram (DVH) reduction schemes to calculate normal tissue complication probability (NTCP) and tumour control probability (TCP) for intensity-modulated radiation therapy (IMRT).Methods: The proposed DVH reduction schemes were derived for 2 Gy per fraction and prescribed dose per fraction for critical organs and tumours, respectively. Sample computed tomography scans were used to generate two IMRT plans to deliver 54 Gy to PTV1 and 24 Gy to PTV2 via sequential IMRT boost (SqIB) and simultaneous integrated IMRT boost (SIB) plans. Differential DVHs were used to calculate effective volumes using published values of related parameters of critical organs and prostate.Results: NTCP values for bladder were almost zero for both IMRT plans. The plots between k and NTCP for rectum and femurs (k = 0.1–1.0) show higher NTCP for SqIB than that for SIB. The TCP decreases with increasing clonogenic cell density and is higher for SIB than that for SqIB for all clonogenic cell densities. The value of α proposed by Brenner and Hall shows very low radio sensitivity of clonogens of the prostate, which gives very low TCP for conventional doses of 70–80 Gy delivered in 7–8 weeks, even for very low clonogenic cell density in the prostate.Conclusion: The presented DVH reduction schemes have radiobiological bearing and therefore seem to be effective in calculating fairly accurate NTCP and TCP.