Physician/patient-driven risk assignment in radiation oncology: Reality or fancy?
Physician/patient-driven risk assignment in radiation oncology: Reality or fancy?
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DOI：
10.1016/s0360-3016(97)00093-x
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发表时间：
1997-06-01
影响因子：
7
通讯作者：
Schiff, PB
中科院分区：
文献类型：
--
作者：
Amols, HI;Zaider, M;Schiff, PB
目的：放射肿瘤学中的治疗计划优化需要设计多个 X 射线束以一定剂量照射肿瘤，从而实现局部区域控制，同时最大限度地减少正常组织并发症。对于某些解剖部位，可以估计肿瘤控制概率 (TCP) 和正常组织并发症概率 (NTCP) 作为辐射剂量的函数。因此，治疗计划优化可以基于生物学终点，而不仅仅是剂量计算。给定具有不同 NTCP 和 TCP 的多个计划，必须在最大化 TCP 和维持可接受的 NTCP 之间进行权衡，医生如何做出这些决定？过程可以量化吗？患者应该参与该过程吗？方法和材料：医生和患者被要求对一系列具有不同 TCP 和 NTCP 组合的治疗计划进行排序，响应被参数化为品质因数 (FM) 方程，该方程量化了 TCP 和 NTCP 的偏好。结果：基于医生的 FM 方程是因部位和患者而异的。医生之间存在差异，但治疗计划的选择通常是保守的，符合首要的非诺斯雷格言，从患者反应生成的 FM 方程表明，一些患者可能愿意接受更高的治疗毒性以换取增加的 TCP。结论：术语“优化治疗计划”包含固有的主观标准，反映一个人愿意接受治疗发病率以换取治愈概率，这些标准可能因患者和/或医生而异，可量化的 FM 可能会有所不同。允许设计包含医生和患者意见的定制治疗计划，(C) 1997 Elsevier Science Inc.
Purpose: Treatment plan optimization in radiation oncology entails designing multiple x-ray beams to irradiate a tumor to a dose that will achieve locoregional control while minimizing normal tissue complications, For some anatomical sites, it is possible to estimate tumor control probabilities (TCP) and normal tissue complication probabilities (NTCP) as a function of radiation dose, Thus, treatment plan optimization can be based on biologic end points rather than on dose calculations alone, Given multiple plans with different NTCPs and TCPs, a tradeoff must be made between maximizing TCP and maintaining an acceptable NTCP, How do physicians reach these decisions? Can the process be quantified? Should patients participate in the process?Methods and Materials: Physicians and patients were asked to rank a series of treatment plans having different combinations of TCP and NTCP, Responses were parametrized into a figure of merit (FM) equation which quantifies predilections of TCP and NTCP.Results: Physician-based FM equations are site- and patient-specific. Variations exist among physicians, but treatment plan selection is often conservative in accordance with the primum non nocere dictum, FM equations generated from the responses of patients suggest that some patients may be willing to accept higher treatment toxicity in exchange for increased TCP.Conclusion: The term ''optimized treatment plan'' contains inherently subjective criteria which reflect one's willingness to accept treatment morbidity in exchange for probability of cure, These criteria may differ among patients and/or physicians, A quantifiable FM may permit the design of custom-made treatment plans that include physician and patient input, (C) 1997 Elsevier Science Inc.