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. 2021 Jun 12;6(5):100739.
doi: 10.1016/j.adro.2021.100739. eCollection 2021 Sep-Oct.

Analysis of Hepatocellular Carcinoma Stereotactic Body Radiation Therapy Dose Prescription Method Using Uncomplicated Tumor Control Probability Model

Michael L M Cheung  1   2 , Monica W K Kan  1   2 , Vanessa T Y Yeung  1   2 , Darren M C Poon  2 , Michael K M Kam  2 , Louis K Y Lee  2 , Anthony T C Chan  1   2
Affiliations

Analysis of Hepatocellular Carcinoma Stereotactic Body Radiation Therapy Dose Prescription Method Using Uncomplicated Tumor Control Probability Model

Michael L M Cheung et al. Adv Radiat Oncol. .

Abstract

Purpose: This work was to establish an uncomplicated tumor control probability (UTCP) model using hepatocellular carcinoma (HCC) stereotactic body radiation therapy (SBRT) clinical data in our institution. The model was then used to analyze the current dose prescription method and to seek the opportunity for improvement.

Methods and materials: A tumor control probability (TCP) model was generated based on local clinical data using the maximum likelihood method. A UTCP model was then formed by combining the established TCP model with the normal tissue complication probability model based on the study by Dawson et al. The authors investigated the dependence of maximum achievable UTCP on planning target volume equivalent uniform dose (EUD) at various ratio between planning target volume EUD and normal liver EUD (T/N EUD ratios). A new term uncomplicated tumor control efficiency (UTCE) was also introduced to analyze the outcome. A UTCE value of 1 implied that the theoretical maximum UTCP for the corresponding T/N EUD ratio was achieved.

Results: The UTCE of the HCC SBRT patients based on the current dose prescription method was found to be 0.93 ± 0.05. It was found that the UTCE could be increased to 0.99 ± 0.03 by using a new dose prescription scheme, for which the UTCP could be maximized while keeping the normal tissue complication probability value smaller than 5%.

Conclusions: The dose prescription method of the current HCC SBRT in our institution was analyzed using a UTCP model established based on local clinical data. It was shown that there could be a potential to increase the prescription dose of HCC SBRT. A new dose prescription scheme was proposed to achieve better UTCP. Additional clinical trials would be required to validate the proposed dose prescription scheme in the future.

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Figures

Fig 1
Fig. 1
Tumor control probability (TCP) model of hepatocellular carcinoma stereotactic body radiation therapy fitted with local clinical data. Abbreviation: EUD = equivalent uniform dose.
Fig 2
Fig. 2
Planning target volume (PTV) equivalent uniform dose (EUD) versus normal liver EUD (T/N EUD) ratio for hepatocellular carcinoma (HCC) stereotactic body radiation therapy (SBRT) local cases. The dotted line indicated the beginning of plateau region where the PTV EUD did not increase anymore with further increase in T/N EUD ratio.
Fig 3
Fig. 3
Uncomplicated tumor control probability (UTCP) versus normal liver equivalent uniform dose (T/N EUD) ratio for hepatocellular carcinoma (HCC) stereotactic body radiation therapy (SBRT) local cases. The dotted line indicated the beginning of plateau region where the UTCP did not increase anymore with further increase in T/N EUD ratio.
Fig 4
Fig. 4
Uncomplicated tumor control probability (UTCP) versus normal liver equivalent uniform dose (T/N EUD) ratio using the new dose prescription scheme based on liver UTCP model compared with the original dose prescription scheme.
Fig 5
Fig 5
Percentage change in planning target volume (PTV) equivalent uniform dose (EUD) and TCP using the new dose prescription scheme based on liver uncomplicated tumor control probability model compared with the old dose prescription scheme following Radiation Therapy Oncology Group 1112.
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