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- W2017492073 abstract "This editorial uses insights gained from mucosal tolerance studies in head and neck radiotherapy, together with standard Linear Quadratic radiotherapy modeling, to predict whether some hypofractionated prostate schedules could cause acute rectal mucosal reactions by using too short schedules. With conventional radiotherapy, including hypofractionation, we restrict total dose to a late normal tissue complications dose limit, depending on the tissue and volume irradiated, of 50 to 70–80 Gy equivalent total dose in 2-Gy fractions (EQD2). These late-effect dose–volume constraints are well reported in many publications. Some stereotactic body radiotherapy schedules give high doses and biologically effective doses (BED), and new information is still being obtained that might change accepted doses. But there is also the question of acute reactions; they are the main factor determining whether any fractionation schedule can be accepted as tolerable. Until recently acute reactions were checked for ‘‘tolerability’’ by irradiating the first few patients in any new schedule and observing their acute reactions to ensure healing within a reasonable time. We suggest that radiobiologic modeling (1) can now be used to predict whether proposed fractionation schemes are in danger of causing acute mucosal reactions in the treatment of prostate cancer. An additional potential hazard is the phenomenon of consequential late damage induced by very high acute reactions. This has been identified in animal experiments (2), although it has skeptics in clinical circles. The important difference between acute and late reactions is the time factor. Acute reactions are very sensitive to overall time, unlike late reactions. It means that if acute reactions are too severe, then a week added to the overall time can avoid some Grade 3 acute reactions, as shown below. It was not until 2003 that modeling was proposed to help predict whether any schedule might cause intolerable acute complications (1). This was based on the well-known linearquadratic formula used for predicting log cell kill in tumors," @default.
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- W2017492073 date "2009-10-01" @default.
- W2017492073 modified "2023-09-24" @default.
- W2017492073 title "Don't Squeeze Hypofractionated Schedules into Too-Short Overall Times" @default.
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- W2017492073 doi "https://doi.org/10.1016/j.ijrobp.2009.06.022" @default.
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