Use of Normal Tissue Complication Probability Models in the Clinic

Abstract

The QUANTEC (quantitative analysis of normal tissue effects in the clinic) review summarizes the currently-available three dimensional dose/volume/outcome data to update and refine the normal tissue dose/volume tolerance guidelines provided by the classic “Emami” paper (IJROBP 21:109, 1991). A “clinician’s view” on using the QUANTEC information in a responsible manner is presented along with a description of the most commonly-used normal tissue complication probability (NTCP) models. A summary of organ-specific dose/volume/outcome data, based on the QUANTEC reviews, is included.

Volumetric‐modulated arc therapy and intensity‐modulated radiation therapy treatment planning for prostate cancer with flattened beam and flattening filter free linear accelerators

“…Therefore, they were not further regarded according to Kjaer‐Kristoffersen et al 39. The volume data evaluated according the QUANTEC review33 show as a general result that in no single plan the given maximum percentage volume values were reached which means V 70 Gy R  < 20%, V 60 Gy R  < 35%, V 50 Gy R  < 50%, V 70 Gy UB  < 35%, and V 65 Gy UB  < 35%. The average values stay far below as can be seen from Table 2.…”

“…Additional parameters were taken from the QUANTEC review summary:33 The percentage of volume receiving less than a specified dose value, taking 70 Gy, 60 Gy, and 50 Gy for the rectum (V 70 Gy R , V 60 Gy R , V 50 Gy R ) and 70 Gy and 65 Gy for the urinary bladder (V 70 Gy UB , V 65 Gy UB ). Furthermore, the total number of MU was recorded.…”

Dosimetric validation and clinical implementation of two 3D dose verification systems for quality assurance in volumetric‐modulated arc therapy techniques

“…Maximum and mean doses were obtained for ORs. In addition, classical (42) and recently reviewed dose constraints (QUANTEC) (43) were reported for normal tissue. Comparisons with TPS by means of global gamma passing rates for all structures were reported with two criteria ($2\%/2\hspace{0.17em}\text{mm}$ and $3\%/3\hspace{0.17em}\text{mm}$, global normalization to maximum, with a low‐dose threshold at 10% of global maximum).…”

Normal tissue complication probability (NTCP) parameters for breast fibrosis: Pooled results from two randomised trials

“…Results: 26.8% patients in the Cambridge trial (5 years) and 20.7% patients in the EORTC trial (10 years) developed moderate-severe breast fibrosis. The best fit NTCP parameters were BEUD 3 (50) = 136.4 Gy, c50 = 0.9 and n = 0.011 for the Niemierko model and BEUD 3 (50) = 132 Gy, m = 0.35 and n = 0.012 for the Lyman Kutcher Burman model. The observed rates of fibrosis in the START-pilot trial agreed well with the predicted rates.…”