title: An integrated strategy of biological and physical constraints in biological optimization for cervical carcinoma.
abstract: BACKGROUND
  For cervical carcinoma cases, this study aimed to evaluate the quality of intensity-modulated radiation therapy (IMRT) plans optimized by biological constraints. Furthermore, a new integrated strategy in biological planning module was proposed and verified.
  
  
  METHODS
  Twenty patients of advanced stage cervical carcinoma were enrolled in this study. For each patient, dose volume optimization (DVO), biological model optimization (BMO) and integrated strategy optimization (ISO) plans were created using same treatment parameters. Different biological models were also used for organ at risk (OAR) in BMO plans, which include the LKB and Poisson models. Next, BMO plans were compared with their corresponding DVO plans, in order to evaluate BMO plan quality. ISO plans were also compared with DVO and BMO plans, in order to verify the performance of the integrated strategy.
  
  
  RESULTS
  BMO plans produced slightly inhomogeneity and less coverage of planning target volume (PTV) (V95=96.79, HI = 0.10: p < 0.01). However, the tumor control probability (TCP) value, both from DVO and BMO plans, were comparable. For the OARs, BMO plans produced lower normal tissue complication probability (NTCP) of rectum (NTCP = 0.11) and bladder (NTCP = 0.14) than in the corresponding DVO plans (NTCP = 0.19 and 0.18 for rectum and bladder; p < 0.01 for rectum and p = 0.03 for bladder). V95, D98, CI and HI values that were produced by ISO plans (V95 = 98.31, D98 = 54.18Gy, CI = 0.76, HI = 0.09) were greatly better than BMO plans (V95 = 96.79, D98 = 53.42Gy, CI = 0.71, HI = 0.10) with significant differences. Furthermore, ISO plans produced lower NTCP values of rectum (NTCP = 0.14) and bladder (NTCP = 0.16) than DVO plans (NTCP = 0.19 and 0.18 for rectum and bladder, respectively) with significant differences.
  
  
  CONCLUSIONS
  BMO plans produced lower NTCP values of OARs compared to DVO plans for cervical carcinoma cases, and resulted in slightly less target coverage and homogeneity. The integrated strategy, proposed in this study, could improve the coverage, conformity and homogeneity of PTV greater than the BMO plans, as well as reduce the NTCP values of OARs greater than the DVO plans.
authors.affiliation: Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, Institute of Biomedical Sciences, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Lixia District, Jinan, 250014, China.
authors.forename: Ziwei
authors.initials: Z
authors.lastname: Feng
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, No.440, Jiyan Road, Jinan, 250117, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Tao
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, No.440, Jiyan Road, Jinan, 250117, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, No.440, Jiyan Road, Jinan, 250117, China.
authors.forename: Jinhu
authors.initials: J
authors.lastname: Chen
authors.affiliation: Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, Institute of Biomedical Sciences, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Lixia District, Jinan, 250014, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Yu
authors.affiliation: Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, Institute of Biomedical Sciences, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Lixia District, Jinan, 250014, China.
authors.forename: Shaohua
authors.initials: S
authors.lastname: Qin
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, No.440, Jiyan Road, Jinan, 250117, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yin
authors.affiliation: Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, Institute of Biomedical Sciences, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Lixia District, Jinan, 250014, China. lidengwang@sdnu.edu.cn.
authors.forename: Dengwang
authors.initials: D
authors.lastname: Li
mesh_terms: D002277:Carcinoma / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008954:Models, Biological; D008962:Models, Theoretical; D058958:Organs at Risk; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*
keywords: Biology optimization; Cervical carcinoma; Intensity-modulated radiation therapy; Normal tissue complication probability; Physical optimization; Tumor control probability