Biphasic cellular repair and implications for multiple field radiotherapy treatments

Data describing the response of several normal tissues to fractionated irradiation, in terms of a biphasic repair of sub-lethal damage, have now been published. Typical results of such analyses have been taken and applied to a conventional radiotherapy protocol of 60 Gy in 30 daily fractions. The effect of using a four field treatment plan is shown to reduce the biological effect of the radiation schedule by increments dependent upon the time interval between each field in a treatment fraction, with a 10% reduction in the extrapolated dose response (ERD) resulting from a 5 min interfield interval. When applied to tissues having the same repair characteristics as pig skin this reduction in ERD is predicted to result in an approximately 25% reduction in the probability of acute morbidity from a protocol of 60 Gy in 30 fractions. These results imply that the basic LQ model, which is unable to correct for interfield intervals, overestimates the effect on normal tissues of radical clinical protocols, most of which use more than a single field. Increasing the interfield interval could be used to reduce the normal tissue side effects from radical radiotherapy when multiple fields are used.