Journal
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
Volume 76, Issue 3, Pages S3-S9Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.ijrobp.2009.09.040
Keywords
QUANTEC; Normal tissue complications; Overview; Modeling
Funding
- NATIONAL CANCER INSTITUTE [P30CA014520, R01CA129182, R29CA069579, R29CA085181, R01CA085181, R01CA069579] Funding Source: NIH RePORTER
- NCI NIH HHS [R01 CA129182-01A2, R01 CA129182, R01 CA069579, CA69579, P30 CA014520, CA85181, R29 CA085181, CA014520, R29 CA069579, R01 CA085181] Funding Source: Medline
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Advances in dose-volume/outcome (or normal tissue complication probability, NTCP) modeling since the seminal Emami paper from 1991 are reviewed. There has been some progress with an increasing number of studies on large patient samples with three-dimensional dosimetry. Nevertheless, NTCP models are not ideal. Issues related to the grading of side effects, selection of appropriate statistical methods, testing of internal and external model validity, and quantification of predictive power and statistical uncertainty, all limit the usefulness of much of the published literature. Synthesis (meta-analysis) of data from multiple studies is often impossible because of suboptimal primary analysis, insufficient reporting and variations in the models and predictors analyzed. Clinical limitations to the current knowledge base include the need for more data on the effect of patient-related cofactors, interactions between dose distribution and cytotoxic or molecular targeted agents, and the effect of dose fractions and overall treatment time in relation to nonuniform dose distributions. Research priorities for the next 5-10 years are proposed. (C) 2010 Elsevier Inc.
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