title: Survival and tumour control probability in tumours with heterogeneous oxygenation: a comparison between the linear-quadratic and the universal survival curve models for high doses.
abstract: BACKGROUND
  The validity of the linear-quadratic (LQ) model at high doses has been questioned due to a decreasing agreement between predicted survival and experimental cell survival data. A frequently proposed alternative is the universal survival curve (USC) model, thought to provide a better fit in the high-dose region. The comparison between the predictions of the models has mostly been performed for uniform populations of cells with respect to sensitivity to radiation. This study aimed to compare the two models in terms of cell survival and tumour control probability (TCP) for cell populations with mixed sensitivities related to their oxygenation.
  
  
  METHODS
  The study was performed in two parts. For the first part, cell survival curves were calculated with both models assuming various homogeneous populations of cells irradiated with uniform doses. For the second part, a realistic three-dimensional (3D) model of complex tumour oxygenation was used to study the impact of the differences in cell survival on the modelled TCP. Cellular response was assessed with the LQ and USC models at voxel level and a Poisson TCP model at tumour level.
  
  
  RESULTS
  For hypoxic tumours, the disputed continuous bend of the LQ survival curve was counteracted by the increased radioresistance of the hypoxic cells and the survival curves started to diverge only at much higher doses than for oxic tumours. This was also reflected by the TCP curves for hypoxic tumours for which the difference in D50 values for the LQ and USC models was reduced from 5.4 to 0.2 Gy for 1 and 3 fractions, respectively, in a tumour with only 1.1% hypoxia and from 9.5 to 0.4 Gy in a tumour with 11.1% hypoxia.
  
  
  CONCLUSIONS
  For a large range of fractional doses including hypofractionated schemes, the difference in predicted survival and TCP between the LQ and USC models for tumours with heterogeneous oxygenation was found to be negligible.
authors: Medical Radiation Physics, Department of Physics, Stockholm University , Stockholm , Sweden.
authors: Emely
authors: E
authors: Lindblom
authors: Alexandru
authors: A
authors: Dasu
authors: Ingmar
authors: I
authors: Lax
authors: Iuliana
authors: I
authors: Toma-Dasu
mesh_terms: D000465:Algorithms; D015687:Cell Hypoxia / Q000502:physiology / Q000528:radiation effects*; D002470:Cell Survival / Q000502:physiology / Q000528:radiation effects*; D019583:Dose Fractionation, Radiation; D016014:Linear Models; D008954:Models, Biological; D009369:Neoplasms / Q000503:physiopathology / Q000532:radiotherapy* / Q000601:surgery; D010101:Oxygen Consumption / Q000502:physiology*; D016012:Poisson Distribution; D011336:Probability; D011836:Radiation Tolerance / Q000502:physiology*; D016634:Radiosurgery