Assessing the shift of radiobiological metrics in lung radiotherapy plans using 2D gamma index

The purpose of this work is to investigate the 2D gamma (γ) maps to illustrate the change of radiobiological outcomes for lung radiotherapy plans and evaluate the correlation between tumor control probability (TCP), normal tissue complication probability (NTCP) with γ passing rates (γ-rates).

Nine patients with lung cancer were used. The doses were calculated using Modified Batho method integrated with pencil beam convolution (MB-PBC) and anisotropic analytical algorithm (AAA) using the same beam arrangements and prescription dose. The TCP and NTCP were estimated, respectively, using equivalent uniform dose (EUD) model and Lyman-Kutcher-Burman (LKB) model. The correlation between ΔTCP or ΔNTCP with γ-rates, from 2%/2 and 3%/3 mm, were tested to explore the best correlation predicting the relevant γ criteria using Spearman's rank test (ρ). Wilcoxon paired test was used to calculate P value.

TCP value was significantly lower in the recalculated AAA plans as compared to MB plans. However, AAA predicted more NTCP on lung pneumonitis according to the LKB model and using relevant radiobiological parameters (n, m and TD50) for MB-PBC and AAA, with P=0.03. The data showed a weak correlation between radiobiological metrics with γ-rates or γ-mean, ρ<0.3.

AAA and MB yield different TCP values as well as NTCP for lung pneumonitis based on the LKB model parameters. Therefore, 2D γ-maps, generated with 2%/2 or 3%/3 mm, could illustrate visual information about the radiobiological changes. The information is useful to evaluate the clinical outcome of a radiotherapy treatment and to approve the treatment plan of the patient if the dose constraints are respected. On the other hand, the γ-maps tool can be used as quality assurance (QA) process to check the predicted TCP and NTCP from radiobiological models.