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Radiation Oncology

, 12:64

First Online: 04 April 2017Received: 05 October 2016Accepted: 22 February 2017DOI: 10.1186-s13014-017-0784-1

Cite this article as: Feng, Z., Tao, C., Zhu, J. et al. Radiat Oncol 2017 12: 64. doi:10.1186-s13014-017-0784-1


BackgroundFor cervical carcinoma cases, this study aimed to evaluate the quality of intensity-modulated radiation therapy IMRT plans optimized by biological constraints. Furthermore, a new integrated strategy in biological planning module was proposed and verified.

MethodsTwenty patients of advanced stage cervical carcinoma were enrolled in this study. For each patient, dose volume optimization DVO, biological model optimization BMO and integrated strategy optimization ISO plans were created using same treatment parameters. Different biological models were also used for organ at risk OAR in BMO plans, which include the LKB and Poisson models. Next, BMO plans were compared with their corresponding DVO plans, in order to evaluate BMO plan quality. ISO plans were also compared with DVO and BMO plans, in order to verify the performance of the integrated strategy.

ResultsBMO plans produced slightly inhomogeneity and less coverage of planning target volume PTV V95=96.79, HI = 0.10: p < 0.01. However, the tumor control probability TCP value, both from DVO and BMO plans, were comparable. For the OARs, BMO plans produced lower normal tissue complication probability NTCP of rectum NTCP = 0.11 and bladder NTCP = 0.14 than in the corresponding DVO plans NTCP = 0.19 and 0.18 for rectum and bladder; p < 0.01 for rectum and p = 0.03 for bladder. V95, D98, CI and HI values that were produced by ISO plans V95 = 98.31, D98 = 54.18Gy, CI = 0.76, HI = 0.09 were greatly better than BMO plans V95 = 96.79, D98 = 53.42Gy, CI = 0.71, HI = 0.10 with significant differences. Furthermore, ISO plans produced lower NTCP values of rectum NTCP = 0.14 and bladder NTCP = 0.16 than DVO plans NTCP = 0.19 and 0.18 for rectum and bladder, respectively with significant differences.

ConclusionsBMO plans produced lower NTCP values of OARs compared to DVO plans for cervical carcinoma cases, and resulted in slightly less target coverage and homogeneity. The integrated strategy, proposed in this study, could improve the coverage, conformity and homogeneity of PTV greater than the BMO plans, as well as reduce the NTCP values of OARs greater than the DVO plans.

KeywordsCervical carcinoma Intensity-modulated radiation therapy Biology optimization Physical optimization Tumor control probability Normal tissue complication probability AbbreviationsAAAAnisotropic analytical algorithm

CTComputed tomography

CTVClinical target volume

gEUDGeneralized equivalent uniform dose

HIHomogeneity index

IMRTIntensity-modulated radiation therapy

NTCPNormal tissue complication probability

OAROrgan at risk

PTVPlanning target volume

TCPTumor control probability

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Autor: Ziwei Feng - Cheng Tao - Jian Zhu - Jinhu Chen - Gang Yu - Shaohua Qin - Yong Yin - Dengwang Li


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