Influence of SBRT fractionation on TCP and NTCP estimations for prostate cancer

Abstract

Introduction: Stereotactic body radiation therapy is widely used for the hypofractionated treatment of prostate cancer. The range of total doses used in different clinical trials varies from 33.5 to 50 Gy delivered in 4 or 5 fractions. The choice of an optimal total dose value and fractionation regimen for a particular patient can be carried out using the integral radiobiological criteria, namely tumour control probability (TCP) and normal tissue complication probability (NTCP). In this study, we have investigated the dependence of simulated TCP/NTCP values on total dose in the range of 30-40 Gy delivered in 4 or 5 fractions for patients with low-risk prostate cancer in order to find the optimal total dose value and fractionation regimen.

Methods: The anatomic data (DICOM CT images) of 12 patients with low-risk prostate cancer, who were treated at Tomsk Regional Oncology Centre, were used for the calculation. Dosimetric treatment plans for all patients were simulated using VMAT with 2 arcs in the Monaco treatment planning system v5.10 (Elekta Instrument AB, Stockholm) with a total dose equal to 36.25 Gy. The dosimetric plans were rescaled in the dose range of 30-40 Gy. The TCP and NTCP values were calculated based on differential dose volume histograms using the Niemierko model for both TCP and NTCP, and the Källman-s model for NTCP calculations. The TCP calculation was carried out using the uncertainty of well-known tumour radiobiological parameters values, including α/β value. NTCP was calculated for an anterior rectal wall, which was the most irradiated organ at risk due to its close contact with the planning target volume.

Results: The TCP and NTCP calculations for VMAT of the prostate cancer have shown that the optimal total dose ranges were equal to 32-34 Gy delivered in 4 fractions or 35-38 Gy delivered in 5 fractions. At doses lower than the optimal ones, the TCP values were lower than 95%, while TCP uncertainties were significant (as low as 80%). This fact might bring unexpectedly poor treatment results. At doses higher than optimal ones, the probability of toxicity to the anterior rectal wall became significant.

Conclusion: The optimization of radiation therapy regimen based on TCP/NTCP criteria could help to determine an optimal total dose and a number of fractions for a particular patient depending on patient-specific anatomic features and planned dose distribution.

Keywords: Hypofractionated radiotherapy; Prostate cancer; Radiobiological simulation; Volumetric modulated arc therapy.