Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): an introduction to the scientific issues.

Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): an introduction to the scientific issues.
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DOI:
10.1016/j.ijrobp.2009.09.040
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发表时间:
2010-03-01
影响因子:
7
通讯作者:
Yorke, Ellen D.
Yorke, Ellen D.
中科院分区:
医学1区
文献类型:
--
作者:
Bentzen, Soren M.;Constine, Louis S.;Deasy, Joseph O.;Eisbruch, Avi;Jackson, Andrew;Marks, Lawrence B.;Ten Haken, Randall K.;Yorke, Ellen D.

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回顾了1991年Emami论文发表以来,剂量/体积/结果(或正常组织并发症概率,NTCP)模型的进展。随着对大量患者样本进行三维剂量测定的研究越来越多,已经取得了一些进展。然而,NTCP模型并不理想。副作用的分级、适当统计方法的选择、内部和外部模型有效性的检验、预测能力和统计不确定性的量化等问题,都限制了许多已发表文献的有用性。综合(荟萃分析)来自多个研究的数据往往是不可能的,因为次优的初级分析,不充分的报告和变化的模型和预测分析。目前知识库的临床局限性包括需要更多关于患者相关辅助因素影响的数据,剂量分布与细胞毒性或分子靶向药物之间的相互作用,以及剂量分数和总体治疗时间对非均匀剂量分布的影响。提出了今后5 ~ 10年的研究重点。
Advances in dose/volume/outcome (or normal tissue complication probability, NTCP) modeling since the seminal Emami paper from 1991 are reviewed. There has been some progress with an increasing number of studies on large patient samples with three-dimensional dosimetry. Nevertheless, NTCP models are not ideal. Issues related to the grading of side effects, selection of appropriate statistical methods, testing of internal and external model validity, and quantification of predictive power and statistical uncertainty, all limit the usefulness of much of the published literature. Synthesis (meta-analysis) of data from multiple studies is often impossible due to sub-optimal primary analysis, insufficient reporting and variations in the models and predictors analyzed. Clinical limitations to the current knowledge-base includes the need for more data on the effect of patient-related co-factors, interactions between dose-distribution and cytotoxic or molecular targeted agents, and the effect of dose fractions and overall treatment time in relation to non-uniform dose distributions. Research priorities for the next 5 to 10 years are proposed.
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