Actions for Assignment 2 - Biologic Models for Treatment Planning

Read the short report of the AAPM TG-166 regarding biologically based treatment planning
systems (BBTPS) found HERE . Within the discussion forum, describe the importance of this
report to you as a medical dosimetrist on or before November 8th.
Effective treatment planning and delivery in RT depends on the work of the dosimetrist to
maximize tumor coverage while minimizing normal tissue (NT) dose. Traditional methods of
optimizing plans rely on physical quantities such as dose-volume (DV) constraints for
assessment of biological effects.1 DV based constraints such as QUANTEC rely on the body of
published research to establish a correlation between DV data and biological effects. Although
the use of DV tolerances is useful, it does have its limitations.
Commonly used DV data relies on the use of one or possibly a few points on the DVH curve to
correlate with biological effects.1 In reality, variations in the entire curve can affect the biological
outcome. As well, the relative biological risks associated with different combinations of normal
tissue DV curves is difficult to assess using a simple DV approach. For these reasons among
others, biologically based treatment planning systems (BBTPS) are being introduced for clinical
use.
BBTPS have the advantage of using the DV curve as a function correlating biological outcomes.1
This enables the evaluation of all points on the DV curve instead of a single data point. BBTPS
also have the advantage of being able to optimize multiple functions for multiple critical
structures instead of simply evaluating each NT individually. These advantages herald BPTPS as
the plan optimization modality of the future. However, BPTPS has its limitations in
implementation today.
Stand-alone BBTPS optimization does not currently work well for controlling cold or hot spots
within target volumes.1 As well, BBTPS are in the early stages of clinical use, and do not yet
have a large body of supporting evidence on efficacy of use. As more data is generated over time,
BBTPS can be perfected and implemented with confidence. For the present, however, BBTPS
are used as a supplement to 3D dose evaluation in the implementation of radiation therapy.
1. Li X, Alber M, Deasy J, et al. The use and QA of biologically related models for treatment
planning: short report of the TG-166 of the therapy physics committee of the AAPM. Med Phys:
2012;29(3):1386-1409. http://dx.doi.org/10.1118/1.3685447.