Radiobiological Aspects in Determination of Residual Normal Tissue Tolerance Doses for Various Re-irradiation Scenarios

Pavol Matula; Jan Koncik; Martin Jasencak

doi:doi:10.11648/j.crj.20210904.14

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Radiobiological Aspects in Determination of Residual Normal Tissue Tolerance Doses for Various Re-irradiation Scenarios

Pavol Matula, Jan Koncik, Martin Jasencak

Published in Cancer Research Journal (Volume 9, Issue 4)

Received: 31 October 2021 Accepted: 19 November 2021 Published: 29 December 2021

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Abstract

Introduction. The current state of re-irradiation in radiation oncology is characterized by the high heterogeneity of re-irradiation practices between institutions. The implementation of imaging methods and new irradiation techniques has created scope for the development and application of more accurate re-irradiation procedures associated with the use of radiobiological modelling, that are allowing often the replacement of palliative intent by radical. Therefore, the preparation of a planning protocol for re-irradiation is a significantly more complex process than for primary treatment planning. It requires quantified dose-volume records from primary and second series, radiobiological knowledge of the regeneration capacity of organs at risk (OaR) and using an appropriate SW-tool for modelling tumour control probability (TCP) versus normal tissue complication probability (NTCP) from individual DVH and pause between series taking into account significant differences in OaR regeneration capacity. Significant restoration takes place within 3-6 months e.g. in the skin, spinal, cord, brain, brain stem and lungs. Other tissues, e.g. kidneys, heart, bladder, have only a small regenerative capacity. This knowledge should be included in the process of preparing a re-irradiation protocol for an individual patient. Purpose: In this contribution we present - an overview of residual tolerance doses for selected OaR in the measure% EQD2_cum (biologically equivalent dose of 2 Gy in percents) for 15 - the most critical OaR extirped from retrospective studies (e.g.%EQD2_cumfor brain stem, spin cord and bladder are 170%, 140%, 125%, respectively). Material and methods: A description of simultaneous determination of residual doses in re-irradiation with an original OaR regeneration model (REG_pause) by the authors of paper included into the calculation of the normal tissue complication probability (NTCP) for individual irradiation scenarios of re-irradiation using the “BioGray” program developed in the workplace of authors. Results: A demonstration of the benefits of the tumour control probability (TCP) versus NTCP prediction depending on the location and volume of the clinical tumour volume (CTV) in the primary and second series. Conclusion: The use of the methodology of radiobiological modelling brings a shift from paradigm of verbalism and estimations in the management of re-irradiation to quantitative evaluation of these processes and utilization of translation research knowledge linked to the current technological possibilities of application IMRT, VMAT, SRS/SBRT and proton therapy.

Published in	Cancer Research Journal (Volume 9, Issue 4)
DOI	10.11648/j.crj.20210904.14
Page(s)	202-208
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Re-irradiation, Cumulative EQD2, REG_pause, NTCP, SW BioGray

References

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[2]	Crevoisier R. D. et al.: Full dose reirradiation combined with chemotherapy after salvage surgery in head and neck carcinoma Cancer 2001 Jun 1; 91 (11): 2071-6.
[3]	Dale R. G., Jones B.: Radiobiological modelling in Radiation Oncology, BIR 2007.
[4]	Das S. et al.: Recovery and Tolerance of the Organs at Risk during Rerradiation J. Curr. Oncol. 2018, Vol.1,1, pp. 23-28.
[5]	Embring A. et al.: Overlapping volumes in re-irradiation for head and neck cancer – an important factor for patient selection Radiation Oncology, vol. 15. Nr 147, 2020.
[6]	Embring A. et al.: Re-Irradiation for Head and Neck Cancer: Cumulative Dose to Organs at Risk and Late Side Effects, Cancers cancers 2021 Jun 25; 13 (13): 3173.
[7]	Krause A. et al.: Recommendation of experts Radiation Oncology 2017, 12, 194.
[8]	Matula P.: Contribution of Simultaneous Modelling Radiobiological Effects in Radiation Oncology, Habilitation work Universitis Trnaviensis, 2009.
[9]	Matula P., Koncik J.: Key to Radiobiological Modelling Effects in radiation Oncology, Lambert Academic Publishing, 2018, ISBN 978-613-7-34224-4.
[10]	Matula P., Koncik J., Jasenčak M., Dubinsky P.: Radiobiological aspects of re-irradiation and their modelling in the determination of the tolerance dose in organs at risk; Klin Onkol 2020; 33 (Suppl 1): 1– 7.
[11]	Mayer R., Sminia P.: Reirradiation tolerance of the human brain. Int J. Radiat Oncol Biol Phys 2008; 70: 1350 60.
[12]	McDonald Mark W. et al.: ACR Appropriateness Criteria® Retreatment of Recurrent Head and Neck Cancer After Prior Definitive Radiation: Expert Panel on Radiation Oncology–Head and Neck Cancer, IJROBP Vol. 80, Issue 5, 2011, pages 1292-1298.
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[15]	Nieder G.: Second re-irradiation- review: A delicate balance between safety and efficacy, Medica Physica 58 (2019), 155-158.
[16]	Oinam SA et al.: DVH analysis and comparison of different radiobiological models using in-house developed software. J. Med. Phys 36 (4), 2011, pp 220-229.
[17]	Sminia P. et al.: Re-irradiaton of human spinal cord. Strahlenther. Onkol. 2002, 178 (8).
[18]	Stewart F. A.: Retreatment tolerance of normal tissues, chapter 21 in the book: Steel G.: Basic Clinical Radiobiology 3rd Edition, ARNOLD Publishers, London, 2006.
[19]	Schroder C. et al.: Re-irradiation in the thorax – An analysis of efficacy and safety based on accumulated EQD2 doses, Radiotherapy and Oncology, Volume 152, P 56-62, November 01, 2020.

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APA Style

Pavol Matula, Jan Koncik, Martin Jasencak. (2021). Radiobiological Aspects in Determination of Residual Normal Tissue Tolerance Doses for Various Re-irradiation Scenarios. Cancer Research Journal, 9(4), 202-208. https://doi.org/10.11648/j.crj.20210904.14

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ACS Style

Pavol Matula; Jan Koncik; Martin Jasencak. Radiobiological Aspects in Determination of Residual Normal Tissue Tolerance Doses for Various Re-irradiation Scenarios. Cancer Res. J. 2021, 9(4), 202-208. doi: 10.11648/j.crj.20210904.14

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AMA Style

Pavol Matula, Jan Koncik, Martin Jasencak. Radiobiological Aspects in Determination of Residual Normal Tissue Tolerance Doses for Various Re-irradiation Scenarios. Cancer Res J. 2021;9(4):202-208. doi: 10.11648/j.crj.20210904.14

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@article{10.11648/j.crj.20210904.14,
  author = {Pavol Matula and Jan Koncik and Martin Jasencak},
  title = {Radiobiological Aspects in Determination of Residual Normal Tissue Tolerance Doses for Various Re-irradiation Scenarios},
  journal = {Cancer Research Journal},
  volume = {9},
  number = {4},
  pages = {202-208},
  doi = {10.11648/j.crj.20210904.14},
  url = {https://doi.org/10.11648/j.crj.20210904.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.crj.20210904.14},
  abstract = {Introduction. The current state of re-irradiation in radiation oncology is characterized by the high heterogeneity of re-irradiation practices between institutions. The implementation of imaging methods and new irradiation techniques has created scope for the development and application of more accurate re-irradiation procedures associated with the use of radiobiological modelling, that are allowing often the replacement of palliative intent by radical. Therefore, the preparation of a planning protocol for re-irradiation is a significantly more complex process than for primary treatment planning. It requires quantified dose-volume records from primary and second series, radiobiological knowledge of the regeneration capacity of organs at risk (OaR) and using an appropriate SW-tool for modelling tumour control probability (TCP) versus normal tissue complication probability (NTCP) from individual DVH and pause between series taking into account significant differences in OaR regeneration capacity. Significant restoration takes place within 3-6 months e.g. in the skin, spinal, cord, brain, brain stem and lungs. Other tissues, e.g. kidneys, heart, bladder, have only a small regenerative capacity. This knowledge should be included in the process of preparing a re-irradiation protocol for an individual patient. Purpose: In this contribution we present - an overview of residual tolerance doses for selected OaR in the measure% EQD2cum (biologically equivalent dose of 2 Gy in percents) for 15 - the most critical OaR extirped from retrospective studies (e.g.%EQD2cum for brain stem, spin cord and bladder are 170%, 140%, 125%, respectively). Material and methods: A description of simultaneous determination of residual doses in re-irradiation with an original OaR regeneration model (REGpause) by the authors of paper included into the calculation of the normal tissue complication probability (NTCP) for individual irradiation scenarios of re-irradiation using the “BioGray” program developed in the workplace of authors. Results: A demonstration of the benefits of the tumour control probability (TCP) versus NTCP prediction depending on the location and volume of the clinical tumour volume (CTV) in the primary and second series. Conclusion: The use of the methodology of radiobiological modelling brings a shift from paradigm of verbalism and estimations in the management of re-irradiation to quantitative evaluation of these processes and utilization of translation research knowledge linked to the current technological possibilities of application IMRT, VMAT, SRS/SBRT and proton therapy.},
 year = {2021}
}

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TY  - JOUR
T1  - Radiobiological Aspects in Determination of Residual Normal Tissue Tolerance Doses for Various Re-irradiation Scenarios
AU  - Pavol Matula
AU  - Jan Koncik
AU  - Martin Jasencak
Y1  - 2021/12/29
PY  - 2021
N1  - https://doi.org/10.11648/j.crj.20210904.14
DO  - 10.11648/j.crj.20210904.14
T2  - Cancer Research Journal
JF  - Cancer Research Journal
JO  - Cancer Research Journal
SP  - 202
EP  - 208
PB  - Science Publishing Group
SN  - 2330-8214
UR  - https://doi.org/10.11648/j.crj.20210904.14
AB  - Introduction. The current state of re-irradiation in radiation oncology is characterized by the high heterogeneity of re-irradiation practices between institutions. The implementation of imaging methods and new irradiation techniques has created scope for the development and application of more accurate re-irradiation procedures associated with the use of radiobiological modelling, that are allowing often the replacement of palliative intent by radical. Therefore, the preparation of a planning protocol for re-irradiation is a significantly more complex process than for primary treatment planning. It requires quantified dose-volume records from primary and second series, radiobiological knowledge of the regeneration capacity of organs at risk (OaR) and using an appropriate SW-tool for modelling tumour control probability (TCP) versus normal tissue complication probability (NTCP) from individual DVH and pause between series taking into account significant differences in OaR regeneration capacity. Significant restoration takes place within 3-6 months e.g. in the skin, spinal, cord, brain, brain stem and lungs. Other tissues, e.g. kidneys, heart, bladder, have only a small regenerative capacity. This knowledge should be included in the process of preparing a re-irradiation protocol for an individual patient. Purpose: In this contribution we present - an overview of residual tolerance doses for selected OaR in the measure% EQD2cum (biologically equivalent dose of 2 Gy in percents) for 15 - the most critical OaR extirped from retrospective studies (e.g.%EQD2cum for brain stem, spin cord and bladder are 170%, 140%, 125%, respectively). Material and methods: A description of simultaneous determination of residual doses in re-irradiation with an original OaR regeneration model (REGpause) by the authors of paper included into the calculation of the normal tissue complication probability (NTCP) for individual irradiation scenarios of re-irradiation using the “BioGray” program developed in the workplace of authors. Results: A demonstration of the benefits of the tumour control probability (TCP) versus NTCP prediction depending on the location and volume of the clinical tumour volume (CTV) in the primary and second series. Conclusion: The use of the methodology of radiobiological modelling brings a shift from paradigm of verbalism and estimations in the management of re-irradiation to quantitative evaluation of these processes and utilization of translation research knowledge linked to the current technological possibilities of application IMRT, VMAT, SRS/SBRT and proton therapy.
VL  - 9
IS  - 4
ER  -

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Author Information

Pavol Matula

East Slovak Institute of Oncology, Kosice, Slovakia
Jan Koncik

East Slovak Institute of Oncology, Kosice, Slovakia
Martin Jasencak

East Slovak Institute of Oncology, Kosice, Slovakia

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Plain Text BibTeX RIS

APA Style

Pavol Matula, Jan Koncik, Martin Jasencak. (2021). Radiobiological Aspects in Determination of Residual Normal Tissue Tolerance Doses for Various Re-irradiation Scenarios. Cancer Research Journal, 9(4), 202-208. https://doi.org/10.11648/j.crj.20210904.14

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ACS Style

Pavol Matula; Jan Koncik; Martin Jasencak. Radiobiological Aspects in Determination of Residual Normal Tissue Tolerance Doses for Various Re-irradiation Scenarios. Cancer Res. J. 2021, 9(4), 202-208. doi: 10.11648/j.crj.20210904.14

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AMA Style

Pavol Matula, Jan Koncik, Martin Jasencak. Radiobiological Aspects in Determination of Residual Normal Tissue Tolerance Doses for Various Re-irradiation Scenarios. Cancer Res J. 2021;9(4):202-208. doi: 10.11648/j.crj.20210904.14

Copy | Download

@article{10.11648/j.crj.20210904.14,
  author = {Pavol Matula and Jan Koncik and Martin Jasencak},
  title = {Radiobiological Aspects in Determination of Residual Normal Tissue Tolerance Doses for Various Re-irradiation Scenarios},
  journal = {Cancer Research Journal},
  volume = {9},
  number = {4},
  pages = {202-208},
  doi = {10.11648/j.crj.20210904.14},
  url = {https://doi.org/10.11648/j.crj.20210904.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.crj.20210904.14},
  abstract = {Introduction. The current state of re-irradiation in radiation oncology is characterized by the high heterogeneity of re-irradiation practices between institutions. The implementation of imaging methods and new irradiation techniques has created scope for the development and application of more accurate re-irradiation procedures associated with the use of radiobiological modelling, that are allowing often the replacement of palliative intent by radical. Therefore, the preparation of a planning protocol for re-irradiation is a significantly more complex process than for primary treatment planning. It requires quantified dose-volume records from primary and second series, radiobiological knowledge of the regeneration capacity of organs at risk (OaR) and using an appropriate SW-tool for modelling tumour control probability (TCP) versus normal tissue complication probability (NTCP) from individual DVH and pause between series taking into account significant differences in OaR regeneration capacity. Significant restoration takes place within 3-6 months e.g. in the skin, spinal, cord, brain, brain stem and lungs. Other tissues, e.g. kidneys, heart, bladder, have only a small regenerative capacity. This knowledge should be included in the process of preparing a re-irradiation protocol for an individual patient. Purpose: In this contribution we present - an overview of residual tolerance doses for selected OaR in the measure% EQD2cum (biologically equivalent dose of 2 Gy in percents) for 15 - the most critical OaR extirped from retrospective studies (e.g.%EQD2cum for brain stem, spin cord and bladder are 170%, 140%, 125%, respectively). Material and methods: A description of simultaneous determination of residual doses in re-irradiation with an original OaR regeneration model (REGpause) by the authors of paper included into the calculation of the normal tissue complication probability (NTCP) for individual irradiation scenarios of re-irradiation using the “BioGray” program developed in the workplace of authors. Results: A demonstration of the benefits of the tumour control probability (TCP) versus NTCP prediction depending on the location and volume of the clinical tumour volume (CTV) in the primary and second series. Conclusion: The use of the methodology of radiobiological modelling brings a shift from paradigm of verbalism and estimations in the management of re-irradiation to quantitative evaluation of these processes and utilization of translation research knowledge linked to the current technological possibilities of application IMRT, VMAT, SRS/SBRT and proton therapy.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Radiobiological Aspects in Determination of Residual Normal Tissue Tolerance Doses for Various Re-irradiation Scenarios
AU  - Pavol Matula
AU  - Jan Koncik
AU  - Martin Jasencak
Y1  - 2021/12/29
PY  - 2021
N1  - https://doi.org/10.11648/j.crj.20210904.14
DO  - 10.11648/j.crj.20210904.14
T2  - Cancer Research Journal
JF  - Cancer Research Journal
JO  - Cancer Research Journal
SP  - 202
EP  - 208
PB  - Science Publishing Group
SN  - 2330-8214
UR  - https://doi.org/10.11648/j.crj.20210904.14
AB  - Introduction. The current state of re-irradiation in radiation oncology is characterized by the high heterogeneity of re-irradiation practices between institutions. The implementation of imaging methods and new irradiation techniques has created scope for the development and application of more accurate re-irradiation procedures associated with the use of radiobiological modelling, that are allowing often the replacement of palliative intent by radical. Therefore, the preparation of a planning protocol for re-irradiation is a significantly more complex process than for primary treatment planning. It requires quantified dose-volume records from primary and second series, radiobiological knowledge of the regeneration capacity of organs at risk (OaR) and using an appropriate SW-tool for modelling tumour control probability (TCP) versus normal tissue complication probability (NTCP) from individual DVH and pause between series taking into account significant differences in OaR regeneration capacity. Significant restoration takes place within 3-6 months e.g. in the skin, spinal, cord, brain, brain stem and lungs. Other tissues, e.g. kidneys, heart, bladder, have only a small regenerative capacity. This knowledge should be included in the process of preparing a re-irradiation protocol for an individual patient. Purpose: In this contribution we present - an overview of residual tolerance doses for selected OaR in the measure% EQD2cum (biologically equivalent dose of 2 Gy in percents) for 15 - the most critical OaR extirped from retrospective studies (e.g.%EQD2cum for brain stem, spin cord and bladder are 170%, 140%, 125%, respectively). Material and methods: A description of simultaneous determination of residual doses in re-irradiation with an original OaR regeneration model (REGpause) by the authors of paper included into the calculation of the normal tissue complication probability (NTCP) for individual irradiation scenarios of re-irradiation using the “BioGray” program developed in the workplace of authors. Results: A demonstration of the benefits of the tumour control probability (TCP) versus NTCP prediction depending on the location and volume of the clinical tumour volume (CTV) in the primary and second series. Conclusion: The use of the methodology of radiobiological modelling brings a shift from paradigm of verbalism and estimations in the management of re-irradiation to quantitative evaluation of these processes and utilization of translation research knowledge linked to the current technological possibilities of application IMRT, VMAT, SRS/SBRT and proton therapy.
VL  - 9
IS  - 4
ER  -

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