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Linear quadratic and tumour control probability modelling in external beam radiotherapy

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Abstract

The standard linear-quadratic (LQ) survival model for external beam radiotherapy is reviewed with particular emphasis on studying how different schedules of radiation treatment planning may be affected by different tumour repopulation kinetics. The LQ model is further examined in the context of tumour control probability (TCP) models. The application of the Zaider and Minerbo non-Poissonian TCP model incorporating the effect of cellular repopulation is reviewed. In particular the recent development of a cell cycle model within the original Zaider and Minerbo TCP formalism is highlighted. Application of this TCP cell-cycle model in clinical treatment plans is explored and analysed.

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References

  1. Antipas VP, Stamatakos GS, Uzunoglu NK, Dionysiou DD and Dale RG (2004). A spatio-temporal simulation model of the response of solid tumours to radiotherapy in vivo: parametric validation concerning oxygen enhancement ratio and cell cycle. Phys Med Biol49:1485–1504

    Google Scholar 

  2. Armpilia CI, Dale RG and Jones B (2004). Determination of the optimum dose per fraction in fractionated radiotherapy when there is delayed onset of tumour repopulation during treatment. Br J Radio 77: 765–767

    Google Scholar 

  3. Barendsen GW (1982). Dose fractionation, dose rate and iso-effect relationships for normal tissue responses. Int J Radiat Oncol Bio Phys 8: 1981–1997

    Google Scholar 

  4. Bedford JS and N.Cornforth M (1987). Relationship between recovery from sublethal x-ray damage and the rejoining of chromosome breaks in normal human fibroblasts. Radiat Res 111: 406–423

    Google Scholar 

  5. Bentzen SM, Saunders MI and Dische S (1999). Repair halftimes estimated from observations of treatment-related morbidity after chart or conventional radiotherapy in head and neck cancer. Radiother Oncol 53: 219–226

    Google Scholar 

  6. Brahme A (1984). Dosimetric precision requirements in radiation therapy. Acta Radiol Oncol 23: 379–391

    Google Scholar 

  7. Brenner D, Hltaky LR, Hahnfeldt PJ, Huang Y and Sachs RK (1998). The linear quadratic and most other common radiobiogical models. Radiat Res 150: 83–88

    Google Scholar 

  8. Brenner DJ and Hall EJ (1999). Fractionation and protraction for radiotherapy of prostate carcinoma. Int J Radiat Oncol Biol Phys 43: 1095–1101

    Google Scholar 

  9. Brenner DJ, Hlatky LR, Hahnfeldt PJ, Hall EJ and Sachs RK (1995). A convenient extension of the linear-quadratic model to include redistribution and reoxygenation. Int J Radiat Oncol Biol Phys 32: 379–390

    Google Scholar 

  10. Brenner JD (1993). Dose, volume and tumour control predictions in radiotherapy. Int J Radiat Oncol Biol Phys 26: 171–179

    Google Scholar 

  11. Buffa FM, West C, Byrne K, Moore JV and Nahum AE (2001). Radiation response and cure rate of human colon adenocarcinoma spheroids of different size: the significance of hypoxia on tumour control modelling. Int J Radiat Oncol Biol Phys 49: 1109–1118

    Google Scholar 

  12. Butler EB, Teh BS, Grant WH, Uhl BM, Kuppersmith RB, Chiu JK, Donovan DT and Woo SY (1999). Smart (simultaneous modulated accelerated radiation therapy) boost: a new accelerated fractionation schedule for the treatment of head and neck cancer with intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 45: 21–32

    Google Scholar 

  13. Carlson DJ, Stewart RD, Li XA, Jennings K, Wang JZ and Guerro M (2004). Comparison of in vitro and in vivo α/β ratios for prostate cancer. Phys Med Biol 49: 4477–4491

    Google Scholar 

  14. Chadwick KH and Leenhouts HP (1973). A molecular theory of cell survival. Phys Med Biol 18: 78–87

    Google Scholar 

  15. Chadwick KH and Leenhouts HP (1981). The molecualr theory of radiation biology. Springer, Berlin

    Google Scholar 

  16. Chen PL, Brenner DJ and Sachs RK (1995). Ionizing radiation damage to cells: effects of cell cycle resdistribution. Math Biosci 126: 147–170

    MATH  Google Scholar 

  17. Curtis SB (1986). Lethal and potentially lethal lesions induced by radiation—a unified repair model. Radiat Res 106: 252–270

    Google Scholar 

  18. Dale RG (1985). The application of the linear-quadratic dose-effect equation to fractionated and protracted radiotherapy. Br J Rad 58: 515–528

    Google Scholar 

  19. Dale RG (1989). Time-dependent tumour repopulation factors in linear quadratic equations—implications for treatment strategies. Radiother Oncol 15: 371–382

    Google Scholar 

  20. Dale RG (1996). Dose-rate effects in targeted radiotherapy. Phys Med Biol 41: 1871–1884

    Google Scholar 

  21. Dawson A and Hillen T (2006). Derivation of the tumour control probability (tcp) from a cell cycle model. Comput Math Meth Med 7: 121–142

    MATH  MathSciNet  Google Scholar 

  22. Dillehay LE (1990). A model of cell killing by low-dose radiation including repair of sub-lethal damage, g 2 block and cell division. Radiat Res 124: 201–07

    Google Scholar 

  23. Dionysiou DD and Stamatakos GS (2006). Applying a 4d multiscale in vivo tumor growth model to the exploration of radiotherapy scheduling: The effects of weekend treatment gaps and p53 gene status on the response of fast growing solid tumours. Cancer Inform 2: 113–121

    Google Scholar 

  24. Dionysiou DD, Stamatakos GS, Uzunoglu NK, Nikita KS and Marioli A (2004). A four-dimensional simulation model of tumour response to radiotherapy in vivo: parametric validation considering radiosensitivity, genetic profile and fractionation. J Theor Biol 230: 1–20

    Google Scholar 

  25. Duchesne GM and Peters LJ (1999). What is the α/β ratio for prostate cancer? rationale for hypofractionated high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys 44: 747–748

    Google Scholar 

  26. Fenwick JD (1998). Predicting the radiation control probability of heterogeneous tumour ensembles: data analysis and parameter estimation using a closed form expression. Phys Med Biol 43: 2159–2178

    Google Scholar 

  27. Fowler JF (1989). The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol 62: 679–694

    Google Scholar 

  28. Fowler JF (1991). The phantom of tumor treatment—continually rapid proliferation unmasked. Radiother Oncol 22: 156–158

    Google Scholar 

  29. Fowler JF (2001). Biological factors influencing optimum fractionation in radiotherapy. Acta Oncol 40: 712–717

    Google Scholar 

  30. Fowler JF (2003). What hypofractionated protocols should be tested for prostate cancer?. Int J Radiat Oncol Biol Phys 56: 1093–1104

    Google Scholar 

  31. Fowler JF (2006). Development of radiobiology for oncology—a personal view. Phys Med Biol 51: R263–R286

    MathSciNet  Google Scholar 

  32. Fowler JF and Chappell R (2000). Non-small cell lung tumours repopulate rapidly during radiation therapy. Int J Radiat Oncol Biol Phys 46: 516–517

    Google Scholar 

  33. Fowler JF and Stern BE (1960). Dose-rate effects: some theoretical and practical considerations. Br J Radiol 33: 389–395

    Google Scholar 

  34. Gray LH, Conger AD, Ebert M, Hornsey S and Scott OC (1953). The concentration of oxygen dissolved in tissues at the time of irradiation as a factor in radiotherapy. Br J Radiol 26: 638–648

    Google Scholar 

  35. Guerrero M, Stewart RD, Wang J and Li XA (2002). Equivalence of the linear-quadratic and two-lesion kinetic models. Phys Med Biol 47: 3197–3209

    Google Scholar 

  36. Hahnfeldt P and Hlatky L (1996). Resensitization due to redistribution of cells in the phases of the cell cycle during arbitrary radiation protocols. Radiat Res 145: 134–143

    Google Scholar 

  37. Hall EJ and Giaccia AJ (2006). Radiobiology for the radiologist, 6th edn. JB Lippincott, Philadelphia

    Google Scholar 

  38. Harder D (1988). The pairwise lesion interaction model. In: Kiefer, J (eds) Quantitative mathematical models in radiative biology, pp 159–170. Springer, Berlin

    Google Scholar 

  39. Hlatky LR, Hahnfeldt P and Sachs RK (1994). Influence of time dependent stochastic heterogeneity on the radiation response of a cell population. Math Biosci 122: 201–220

    MATH  Google Scholar 

  40. Horas JA, Olguin OR and Rizzotto MG (2005). On the surviving fraction in irradiated multicellular tumour spheroids: calculation of overall radiosensitivity parameters, influence of hypoxia and volume effects. Phys Med Biol 50: 1689–1701

    Google Scholar 

  41. Horiot J, Fur RL, N’Guyen T, Chenal C, Schraub S, Alfonsi S, Gardani G, Bogaert WVD, Danczak S and Bolla M (1992). Hyperfractionation versus conventional fractionation in oropharyngeal carcinoma: Final analysis of a randomized trial of the eortc cooperative group of radiotherapy. Radiother Oncol 25: 231–241

    Google Scholar 

  42. Jones B and Dale RG (1995). Cell loss factors and the linear-quadratic model. Radiother Oncol 37: 136–139

    Google Scholar 

  43. Jones B and Dale RG (1999). Mathematical models of tumour and normal tissue response. Acta Oncol 38: 883–893

    Google Scholar 

  44. Kellerer AM and Rossi HH (1972). The theory of dual radiation action. Curr Top Radiat Res Q 8: 85–158

    Google Scholar 

  45. Kendal WS (1998). A closed form description of tumour control with fractionated radiotherapy and repopulation. Radiat Biol 73: 207–210

    Google Scholar 

  46. Kim JJ and Tannock IF (2005). Repopulation of cancer cells during therapy: an important cause of treatment failure. Nat Rev: Cancer 5: 516–525

    Google Scholar 

  47. King CR, DiPetrillo TA and Wazer DE (2000). Optimal radiotherapy for prostate cancer: predictions for conventional external beam, imrt, and brachytherapy from radiobiologic models. Int J Radiat Oncol Biol Phys 46: 165–172

    Google Scholar 

  48. Kirk J, Gray WM and Watson ER (1971). Cumulative radiation effect. part 1: Fractionated treatment regimes. Clin Radiol 22: 145–155

    Google Scholar 

  49. Kirkpatrick JP and Marks LB (2004). Modelling killing and repopulation kinetics of subclinical cancer: direct calculations from clinical data. Int J Radiat Oncol Biol Phys 58: 641–654

    Google Scholar 

  50. Kutcher GJ, Burman C, Brewster L, Goitein M and Mohan R (1991). Histogram reduction method for calculating complication probabilities for three dimensional treatment planning evaluations. Int J Radiat Oncol Biol Phys 21: 137–146

    Google Scholar 

  51. Lea DE (1946). Actions of radiations on living cells. Cambridge University Press, London

    Google Scholar 

  52. Lindsay KA, Wheldon EG, Deehan C and Wheldon TE (2001). Radiation carcinogenesis modelling for risk of treatment-related second tumours following radiotherapy. Br J Radiol 74: 529–536

    Google Scholar 

  53. Maciejewski B and Majewski S (1991). Dose fractionation and tumour repopulation in radiotherapy for bladder cancer. Radiother Oncol 21: 163–170

    Google Scholar 

  54. Maciejewski B, Skladowskia K, Pileckia B, Taylor JMG, Withersd RH, Miszczyka L, Zajusza A and Suwinskia R (1996). Randomized clinical trial on accelerated 7 days per week fractionation in radiotherapy for head and neck cancer. preliminary report on acute toxicity. Radiother Oncol 40: 137–145

    Google Scholar 

  55. Mao JH, Lindsay KA, Mairs RJ and Wheldon TE (2001). The effect of tissue-specific growth patterns of target stem cells on the spectrum of tumours resulting from multistage tumorigenesis. J Theor Biol 210: 93–100

    Google Scholar 

  56. McAneney H and O’Rourke SFC (2007). Investigation of various growth mechanisms of solid tumour growth within the linear quadratic model for radiotherapy. Phys Med Biol 52: 1039–1054

    Google Scholar 

  57. Mohan R, Mageras GS, Baldwin B, Brewster LJ and Kutcher GJ (1992). Clinically relevant optimisation of 3d conformal treatments. Med Phys 19: 933–944

    Google Scholar 

  58. Munro TR and Gilbert CW (1961). The relation between tumor lethal doses and the radiosensitivity of tumor cells. Br J Radiol 34: 246–251

    Google Scholar 

  59. Nahum AE and Tait DM (1992). Maximising control by customized dose prescription for pelvic tumours. In: Breit, A (eds) Advanced radiation therapy: tumour response monitoring and treatment planning, pp 425–431. Springer, Heidelberg

    Google Scholar 

  60. Niemierko A and Goitein M (1991). Calculation of normal tissue complication probability and dose-volume histogram reduction schemes for tissues with a critical element architecture. Radiother Oncol 20: 166–176

    Google Scholar 

  61. Niemierko A and Goitein M (1993). Implementation of a model for estimating tumour control probability for an inhomogeneously irradiated tumor. Radiother Oncol 29: 140–147

    Google Scholar 

  62. O’Donoghue JA (1997). The response of tumours with gompertzian growth characteristics to fractionated radiotherapy. Int J Radiat Biol 72: 325–339

    Google Scholar 

  63. O’Sullivan JM, Hollywood DP, Cody N, Dillon J, Buckney S, Moriarty MJ and Armstrong JG (2002). Accelerated radiation therapy, seven fractions per week, for advanced head and neck cancer–a feasibility study. Clin Oncol (R Coll Radiol) 14: 236–240

    Google Scholar 

  64. Overaaard J, Hansen HS, Sapru W, Overgaard M, Grau C, Jorgensen K, Bastholt L, Hansen O, Specht L, Berthelsen A and Pedersen M (1996). Conventional radiotherapy as the primary treatment of squamous cell carcinoma of the head and neck. a randomized multicentre study of 5 versus 6 fractions per week-preliminary report from the dahanca 6 and 7 trial. Radiother Oncol 40: S31

    Google Scholar 

  65. Peters L, Ang KK and Thames HD (1988). Accelerated fractionation in the radiation treatment of head and neck cancer: a critical comparison of different strategies. Acta Oncol 27: 185–194

    Google Scholar 

  66. Porter EH (1980) The statistics of dose–cure relationships for irradiated tumors. Part I and II. Br J Radiol 53:210–27, 336–45

    Google Scholar 

  67. Ribba B, Cloin T and Schnell S (2006). A multiscale model of cancer, and its use in analyzing irradiation therapies. Theor Biol Med Mod 3: 1–19

    Google Scholar 

  68. Sachs RK and Brenner DJ (1998). The mechanistic basis of the linear-quadratic model. Med Phys 25: 2071–2073

    Google Scholar 

  69. Sachs RK, Hahnfeld P and Brenner DJ (1997). The link between low-let dose–response relations and the underlying kinetics of damage production/repair/misrepair. Int J Radiat Biol 72: 351–374

    Google Scholar 

  70. Sachs RK, Hlatky LR and Hahnfeldt P (2001). Simple ode models of tumour growth and anti-angiogenic or radiation treatment. Mathl Comput Model 33: 1297–1305

    MATH  MathSciNet  Google Scholar 

  71. Saunders MI and Barrett AD (1997). Continuous hyperfractionated accelerated radiotherapy (chart) versus conventional radiotherapy in non-small cell lung cancer: a randomized multicenter trial. Lancet 350: 161–165

    Google Scholar 

  72. Saunders MI, Barrett AD, Pamar MK, Harvey A and Gibson A (1996). Randomized multicentre trials of chart v conventional radiotherapy in head and neck and non-small cell lung cancer. Br J Cancer 73: 1455–1462

    Google Scholar 

  73. Sham E and Durand RE (1998). Cell kinetics and repopulation during multifraction irradiation of spheriods. Radiother Oncol 46: 201–207

    Google Scholar 

  74. Sinclair WK (1966). The shape of radiation survival curves of mammalain cells cultured in vitro. Biophys Asp Radiat Qual Int At Energy Agency Tech Rep Ser 58: 21–43

    Google Scholar 

  75. Spratt JA, Fournier Dvon , Spratt JS, Weber EE (1993) Decelerating growth and human breast cancer. Cancer 71: 2013–2019

    Google Scholar 

  76. Stavrev P, Warkentin MWB, Stavreva N and Fallone BG (2003). Radiation damage, repopulation and cell recovery analysis of in vitro tumour cell megacolony culture data using a non-poissonian cell repopulation tcp model. Phys Med Biol 50: 3053–3061

    Google Scholar 

  77. Steel GG (1977). Growth kinetics of tumours. Clarendon Press, Oxford

    Google Scholar 

  78. Steel GG (ed) (2002). Basic Clinical Radiobiology, 3rd edn. Arnold, London

    Google Scholar 

  79. Steel GG, McMillan TJ and Peacock JH (1989). The 5rs of radiobiology. Int J Radiat Biol 56: 1045–1048

    Google Scholar 

  80. Swierniak A, Polanski A and Kimmel M (1996). Optimal control problems arising in cell-cycle-specific cancer chemotherapy. Cell Prolif 29: 117–139

    Google Scholar 

  81. Thames HD, Bentzen SM, Turesson I, Overgaard M and den Bogaert WV (1990). Time-dose factors in radiotherapy: a review of the human data. Radiother Oncol 19: 219–235

    Google Scholar 

  82. Thames HD and Hendry JH (1987). Fractionation in radiotherapy. Taylor and Francis, London, 279

    Google Scholar 

  83. Tobias CA (1985). The repair-misrepair model in radiobiology, comparison to other models. Radiat Res 8: S77–S95

    Google Scholar 

  84. Tomé WA and Fowler J (2003). On the inclusion of proliferation in tumour control probability calculations for inhomogeneously irradiated tumours. Phys Med Biol 48: N261–N268

    Google Scholar 

  85. Travis EL and Tucker SL (1987). Isoeffect models and fractionated radiation therapy. Int J Radiat Biol 13: 283–287

    Google Scholar 

  86. Tucker SL and Taylor JMG (1996). Improved models of tumor cure. Int J Radiol Biol 70: 539–553

    Google Scholar 

  87. Tucker SL, Thames HD and Taylor JMG (1990). How well is the probability of tumor cure after fractionated irradiation described by poisson statistics?. Radiat Res 124: 273–282

    Google Scholar 

  88. Usher JR (1980). Mathematical derivation of optimal uniform treatment schedule for the fractionated irradiation of human tumours. Math Biosc 49: 157–184

    MATH  MathSciNet  Google Scholar 

  89. Wang CC (1988). Local control of oropharyngeal carcinoma after two accelerated hyperfractionated radiation therapy schemes. Int J Radiat Oncol Biol Phys 14: 1143–1146

    Google Scholar 

  90. Webb S (1994). Optimum parameters in a model for tumour control probability including interpatient heterogeneity. Phys Med Biol 39: 1895–1914

    Google Scholar 

  91. Webb S and Nahum AE (1993). A model for calculating tumour control probability in radiotherapy including the effects of inhomogeneous distributions of dose and clonogenic cell density. Phys Med Biol 38: 653–666

    Google Scholar 

  92. Wein LM, Cohen JE and Wu JT (2000). Dynamic optimization of a linear-quadratic model with incomplete repair and volume-dependent sensitivity and repopulation. Int J Radiat Biol Phys 47: 1073–1083

    Google Scholar 

  93. Wheldon EG, Lindsay KA and Wheldon TE (2000). The dose–response relationship for cancer incidence in a two-stage radiation carcinogenesis model incorporating cellular repopulation. Int J Radiat Biol 76: 699–710

    Google Scholar 

  94. Wheldon TE and Amin AE (1988). The linear-quadratic model. Br J Radiol 61: 700–702

    Google Scholar 

  95. Wheldon TE, Deehan C, Wheldon EG and Barrett A (1998). The linear quadratic transformation of dose-volume histograms in fractionated radiotherapy. Radiother Oncol 46: 285–295

    Google Scholar 

  96. Wheldon TE, Kirk J and Orr JS (1977). Optimal radiotherapy of tumour cells following exponential-quadratic survival curves and exponential repopulation kinetics. Br J Radiol 50: 681–682

    Google Scholar 

  97. Withers HR (1975). The four r’s of radiotherapy. Adv Radiat Biol 5: 241–247

    Google Scholar 

  98. Withers HR (1988). Some changes in concepts of dose fractionation over 20 years. In: Vaeth, JM and Meyer, J (eds) Time, dose and Fractionation in the Radiation Therapy of Cancer Frontiers of Radiation Therapy and Oncology, vol. 22, pp 1–13. Karger, Basel

    Google Scholar 

  99. Withers HR, Thames HD and Peters LJ (1983). A new isoeffect curve for change in dose per fraction. Radiother Oncol 1: 187–191

    Google Scholar 

  100. Woulters BG and Brown JM (1997). Cells at intermediate oxygen levels can be more important than the hypoxic fraction in determining tumour response to fractionated radiotherapy. Radiat Res 147: 541–550

    Google Scholar 

  101. Wratten CR, Poulsen MG, Williamson S, Tripcony , Keller J and Dickie G (2002). Effect of surgery on normal tissue toxicity in patients treated with accelerated radiotherapy. Acta Oncol 41: 56–62

    Google Scholar 

  102. Yakovlev AY (1993). Comments on the distribution of clonogens in irradiated tumors. Radiat Res 134: 117–120

    Google Scholar 

  103. Zaider M and Minerbo GN (2000). Tumour control probability: a formulation applicable to any temporal protocol of dose delivery. Phys Med Biol 45: 279–293

    Google Scholar 

  104. Zaider M, Wuu CS and Minerbo GN (1996). The combined effects of sublethal damage repair, cellular repopulation and redistribution in the mitotic cycle. i survival probabilities after exposure to radiation. Radiat Res 145: 457–466

    Google Scholar 

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O’Rourke, S.F.C., McAneney, H. & Hillen, T. Linear quadratic and tumour control probability modelling in external beam radiotherapy. J. Math. Biol. 58, 799–817 (2009). https://doi.org/10.1007/s00285-008-0222-y

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