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Kobashi K, Prayongrat A, Kimoto T, Toramatsu C, Dekura Y, Katoh N, Shimizu S, Ito YM, Shirato H. Assessing the uncertainty in a normal tissue complication probability difference (∆NTCP): radiation-induced liver disease (RILD) in liver tumour patients treated with proton vs X-ray therapy. JOURNAL OF RADIATION RESEARCH 2018. [PMID: 29538699 PMCID: PMC5868200 DOI: 10.1093/jrr/rry018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Modern radiotherapy technologies such as proton beam therapy (PBT) permit dose escalation to the tumour and minimize unnecessary doses to normal tissues. To achieve appropriate patient selection for PBT, a normal tissue complication probability (NTCP) model can be applied to estimate the risk of treatment-related toxicity relative to X-ray therapy (XRT). A methodology for estimating the difference in NTCP (∆NTCP), including its uncertainty as a function of dose to normal tissue, is described in this study using the Delta method, a statistical method for evaluating the variance of functions, considering the variance-covariance matrix. We used a virtual individual patient dataset of radiation-induced liver disease (RILD) in liver tumour patients who were treated with XRT as a study model. As an alternative option for individual patient data, dose-bin data, which consists of the number of patients who developed toxicity in each dose level/bin and the total number of patients in that dose level/bin, are useful for multi-institutional data sharing. It provides comparable accuracy with individual patient data when using the Delta method. With reliable NTCP models, the ∆NTCP with uncertainty might potentially guide the use of PBT; however, clinical validation and a cost-effectiveness study are needed to determine the appropriate ∆NTCP threshold.
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Affiliation(s)
- Keiji Kobashi
- Department of Medical Physics, Hokkaido University Hospital, North-15 West-7, Kita-ku, Sapporo, 0608638, Japan
- Corresponding author. Department of Medical Physics, Hokkaido University Hospital, North-15 West-7, Kita-ku, Sapporo, 0608638, Japan. Tel: +81-11-706-5977; Fax: +81-11-706-7876;
| | - Anussara Prayongrat
- Department of Radiation Oncology, Graduate School of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo, 0608638, Japan
| | - Takuya Kimoto
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Chie Toramatsu
- Department of Radiation Oncology, Tokyo Women’s Medical University, 8–1,Kawada-cho,Sinjuku,Tokyo, 1628666, Japan
| | - Yasuhiro Dekura
- Department of Radiation Oncology, Graduate School of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo, 0608638, Japan
| | - Norio Katoh
- Department of Radiation Oncology, Hokkaido University Hospital, North-15 West-7, Kita-ku, Sapporo, 0608638, Japan
| | - Shinichi Shimizu
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo, 0608638, Japan
- Global Station for Quantum Biomedical Science and Engineering, Global Institute for Cooperative Research and Education, Hokkaido University, North-15 West-7, Kita-ku, Sapporo, 0608638, Japan
| | - Yoichi M Ito
- Department of Biostatistics, Faculty of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo, 0608638, Japan
| | - Hiroki Shirato
- Global Station for Quantum Biomedical Science and Engineering, Global Institute for Cooperative Research and Education, Hokkaido University, North-15 West-7, Kita-ku, Sapporo, 0608638, Japan
- Department of Radiation Medicine, Faculty of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo, 0608638, Japan
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Durante M, Paganetti H. Nuclear physics in particle therapy: a review. REPORTS ON PROGRESS IN PHYSICS. PHYSICAL SOCIETY (GREAT BRITAIN) 2016; 79:096702. [PMID: 27540827 DOI: 10.1088/0034-4885/79/9/096702] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Charged particle therapy has been largely driven and influenced by nuclear physics. The increase in energy deposition density along the ion path in the body allows reducing the dose to normal tissues during radiotherapy compared to photons. Clinical results of particle therapy support the physical rationale for this treatment, but the method remains controversial because of the high cost and of the lack of comparative clinical trials proving the benefit compared to x-rays. Research in applied nuclear physics, including nuclear interactions, dosimetry, image guidance, range verification, novel accelerators and beam delivery technologies, can significantly improve the clinical outcome in particle therapy. Measurements of fragmentation cross-sections, including those for the production of positron-emitting fragments, and attenuation curves are needed for tuning Monte Carlo codes, whose use in clinical environments is rapidly increasing thanks to fast calculation methods. Existing cross sections and codes are indeed not very accurate in the energy and target regions of interest for particle therapy. These measurements are especially urgent for new ions to be used in therapy, such as helium. Furthermore, nuclear physics hardware developments are frequently finding applications in ion therapy due to similar requirements concerning sensors and real-time data processing. In this review we will briefly describe the physics bases, and concentrate on the open issues.
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Affiliation(s)
- Marco Durante
- Trento Institute for Fundamental Physics and Applications (TIFPA), National Institute of Nuclear Physics (INFN), University of Trento, Via Sommarive 14, 38123 Povo (TN), Italy. Department of Physics, University Federico II, Naples, Italy
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