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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies

Published on: February 6, 2019

Tumor control probability in radiation treatment.

Marco Zaider1, Leonid Hanin

  • 1Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA. zaiderm@mskcc.org

Medical Physics
|April 2, 2011
PubMed
Summary

Current tumor control definitions in radiation therapy are insufficient. A new approach linking treatment outcomes to the number of surviving malignant cells and their post-treatment behavior is needed for improved cancer-free survival.

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Published on: June 7, 2015

Area of Science:

  • Radiation oncology
  • Mathematical oncology
  • Cancer biology

Background:

  • Current radiation therapy practices define tumor control (TC) as the extinction of clonogenic tumor cells post-treatment.
  • This definition is problematic as it's unobservable and often unnecessary for achieving cure (long-term recurrence-free survival).
  • Many cancers are lethal due to metastasis, not primary tumor growth, necessitating a focus on preventing metastatic spread.

Purpose of the Study:

  • To critique the existing definition of tumor control in radiation therapy.
  • To propose a revised framework for defining and achieving tumor control based on the distribution of surviving clonogenic cells (Pm(T)).
  • To advocate for linking Pm(T) to treatment planning and tumor-specific parameters to improve patient outcomes.

Main Methods:

  • Review of existing paradigms in radiation oncology and cancer evolution.
  • Discussion of mathematical modeling of clonogenic cell populations.
  • Exploration of the relationship between cell survival distributions and clinical outcomes like recurrence-free and cancer-specific survival.

Main Results:

  • The current definition of tumor control is an unobservable event and not always required for cure.
  • The distribution of surviving clonogenic cells (Pm(T)) and their post-treatment dynamics are critical for predicting long-term outcomes.
  • Preventing metastatic spread should be a primary objective for cancers that kill via metastasis.

Conclusions:

  • A shift in focus from 'tumor control' to 'cancer-free survival' is necessary.
  • Establishing a link between survival time and Pm(T) is crucial for improving radiation therapy.
  • Integrating Pm(T) with treatment planning and tumor biology parameters will enhance radiation therapy efficacy and patient outcomes.