Prediction of normal tissue response and individualization of doses in radiotherapy

In this work we estimate the therapeutic gain that could be obtained using a radiotherapy programme in which doses were based on a radiosensitivity test that was able to predict the final response of normal tissues to radiation for each particular patient. To date, no good radiosensitivity assay has been demonstrated and by way of example we use an assay based on initial DNA damage. The individualized programme we propose is based on an increase in the dose delivered to patients showing a resistant behaviour to radiation and on the adoption of alternative programmes or a careful monitoring of those patients in whom an excessive reaction is expected. To quantify the results produced by the individualization programme, both analytical and Monte Carlo simulation methods are used. The increase in tumour control probability obtained by means of this individualization strongly depends on the dose-response curve for the particular tumour. In certain cases, this enhancement can be marked, and 40% of the patients considered in this work could attain more than 10% increase in tumour control probability. The quantitative estimations in this study indicate the need to seek a predictive assay of radiosensitivity, for both normal and tumour tissue response, in order to develop individualized treatment protocols.