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What is QUANTEC?

Scientific project to establish radiation dosetolerance for several organs

ctober !""#$ Wisconsin$ first QUANTEC

%eeting$ participants

Scope' organ site(specific overvie)s of*+antitative dose(vol+%e relationships

,es+lts of this project p+blished as a s+pple%entin ,ed -o+rnal

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Anal./ing ,T(related to0icit.

Cancer s+rvival has tripled in the last " .ears 2ate treat%ent se*+ale beco%es %ore i%portant NTC3 %odeling st+dies

Scoring to0icit. CTCAE( %+ltiple s.%pto%es and signs into a single grade (loss of specificit. in to0icit. specific st+dies

S 4A 5s+bjective$objective %anage%ent $anal.tic6 scale (co%ponents of to0icit. are 7ept separate

Unifor%$ co%prehensive reporting of side effects

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8ro% E%a%i to NTC3

E%a%i et al( concept of 19 $ !9 $ )hole organe0pos+re and ,T tolerance 2.%an %odel( +nifor%l. irradiated organ vol+%es :+tcher et al; red+ction algorith%(non+nifor%

dose distrib+tion into partial vol+%e

The co%bination of these t)o' Lyman-Kutcher-Burman model the %ost

)idel. +sed NTC3(%odel Allo)s representation of vario+s dose(vol+%e

dependencies

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2i%itation of (based approach

(based anal.ses ass+%e organ f+nction is+nifor% This in not true!

! e0a%ples fro% ani%al e0periences1; l+ng base ,T %ore pne+%onitis than ape0 ,T!; @erosto%ia %ore prono+nced if e0cretor. d+cts

receive %ore ,T

eside NTC3 %odels$ clinical data are ver.i%portant to esti%ate ,T to0icit.;

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Str+ct+re of QUANTEC p+blication

introd+ctor. papers1B organ specific papers& vision papers

Each organ specific paper has 1" sections' Clinical significance$

endpoints$challenge defining vol+%es$revie) of dose(vol+%e data$

factors affecting the ris7$NTC3 %odel$ special sit+ation

reco%%endation$f+t+re st+dies$ to0icit. scoring

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1. Clinical significance ,T to l+ngs in the treat%ent of (l+ng cancer$ ,T(3ne+%onitis ris7 &(&"

(%ediastinal t+$ ,3 ris7 &(1"(breast cc$ ,3 ris7 1(&

2. Endpoints definition of ,T ind+ced l+ng inj+r.

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3. efinition of lung olume

Single paired organ total l+ng tiss+e

4ost st+dies( l+ng defined )hile free breathing

2+ng edge var. )ith CT )indo)9level

E0cl+de DT= or 3T= fro% the l+ng vol+%e

4odification of l+ng vol+%e d+e to t+; shrin7age d+ring ,T

E0act l+ng vol+%e al%ost i%possible to define

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". #e ie$ of ose-%olume ata(%ore than #" p+blished articles st+died(the %ost +sed NTC3 %odels 2.%an(:+tcher( +r%an %odel )ith para%eters' position$ steepness$

vol+%e 42< %odel( si%ple and efficient

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&. 'actors affecting ris( of #)

No association' DT= lateralit.$ co%orbidit.$$ gender

Association' age$ s+rger.$ s%o7ing stat+s$ che%otherap.5doceta0el$ ge%citabine6

*. +athematic, iologic models

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. /pecial situations

Whole l+ng ,T 5T F$ palliative he%ibod.$ p+l% %ets6igher ris7 in %esothelio%a patients

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0. #ecommended ose,%olume limits

Acceptable ris7 level varies )ith clinical scenarioFtHs pr+dent to li%it

%2 3 -3& $ith con entional fr4+L 2 -23 5y

ris7 of ,3 I!"Central air)a.s IG" D.

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6. 'uture to7icity studies Endpoint interaction

F%pact of clinical factors rgan interaction ,adiation response %odifiers io%ar7ers

1 . To7icity scoring

+se 2ENT(S 4A(t.pe scoring separate s.%pto%s$ f+nction$ radiographic endpoints

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