[Assessment of radiotherapy plans: dose-volume histograms, integral effects and tumor control]

Suitable criteria are necessary for judgement and for comparison of treatment plans. These criteria must take into account radiobiological effects, i.e. tumor control and treatment complications. Quantitative evaluation of dose volume histograms gives helpful criteria for radiation treatment planning and for the choice between different treatment plans. For normal tissue and organs at risk it is shown, how to assign integral dose effect to inhomogeneous dose distribution. The evaluation algorithm is based on the assumption of a power law for volume dependence of dose effect. The algorithm is discussed for arbitrary form of dose effect function. Explicit evaluation is given in terms of the linear quadratic model. Hot spots influence integral dose effect much stronger than low dose level irradiation. For judgement of treatment plans, the significance of mean organ dose is only poor. Higher moments of dose distribution are more suitable. An effective tumor control probability is derived for judgement of tumor dose distribution. It is shown that tumor control is determined by mean dose and dose inhomogeneity in tumor volume. Control probability falls with increasing dose inhomogeneity in tumor region-in first order approximation characterized by variance of dose distribution. Using a clinical example, the evaluation rules for normal and tumor tissue are demonstrated. Two different treatment techniques are analyzed and discussed. Only numerical evaluation of dose volume histograms for lung region shows the better technique.