Walsh Seán, Roelofs Erik, Kuess Peter, Lambin Philippe, Jones Bleddyn, Georg Dietmar, Verhaegen Frank
Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC+), Maastricht 6229 ET, The Netherlands and Department of Oncology, Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford OX3 7DQ, United Kingdom.
Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC+), Maastricht 6229 ET, The Netherlands.
Med Phys. 2016 Feb;43(2):734-47. doi: 10.1118/1.4939260.
A fully heterogeneous population averaged mechanistic tumor control probability (TCP) model is appropriate for the analysis of external beam radiotherapy (EBRT). This has been accomplished for EBRT photon treatment of intermediate-risk prostate cancer. Extending the TCP model for low and high-risk patients would be beneficial in terms of overall decision making. Furthermore, different radiation treatment modalities such as protons and carbon-ions are becoming increasingly available. Consequently, there is a need for a complete TCP model.
A TCP model was fitted and validated to a primary endpoint of 5-year biological no evidence of disease clinical outcome data obtained from a review of the literature for low, intermediate, and high-risk prostate cancer patients (5218 patients fitted, 1088 patients validated), treated by photons, protons, or carbon-ions. The review followed the preferred reporting item for systematic reviews and meta-analyses statement. Treatment regimens include standard fractionation and hypofractionation treatments. Residual analysis and goodness of fit statistics were applied.
The TCP model achieves a good level of fit overall, linear regression results in a p-value of <0.000 01 with an adjusted-weighted-R(2) value of 0.77 and a weighted root mean squared error (wRMSE) of 1.2%, to the fitted clinical outcome data. Validation of the model utilizing three independent datasets obtained from the literature resulted in an adjusted-weighted-R(2) value of 0.78 and a wRMSE of less than 1.8%, to the validation clinical outcome data. The weighted mean absolute residual across the entire dataset is found to be 5.4%.
This TCP model fitted and validated to clinical outcome data, appears to be an appropriate model for the inclusion of all clinical prostate cancer risk categories, and allows evaluation of current EBRT modalities with regard to tumor control prediction.
一个完全异质性群体平均机械性肿瘤控制概率（TCP）模型适用于外照射放疗（EBRT）分析。这已在中危前列腺癌的EBRT光子治疗中得以实现。就整体决策而言，将TCP模型扩展至低危和高危患者将大有裨益。此外，诸如质子和碳离子等不同的放射治疗方式越来越普及。因此，需要一个完整的TCP模型。
对从文献综述中获取的低危、中危和高危前列腺癌患者（5218例用于模型拟合，1088例用于验证）的5年无疾病生物学证据临床结局数据的主要终点，拟合并验证了一个TCP模型，这些患者接受了光子、质子或碳离子治疗。该综述遵循系统评价和Meta分析的首选报告项目声明。治疗方案包括标准分割和大分割治疗。应用了残差分析和拟合优度统计。
TCP模型总体拟合度良好，线性回归得出的p值<0.000 01，调整加权R²值为0.77，加权均方根误差（wRMSE）为1.2%，与拟合的临床结局数据相符。利用从文献中获得的三个独立数据集对模型进行验证，得出调整加权R²值为0.78，wRMSE小于1.8%，与验证临床结局数据相符。整个数据集的加权平均绝对残差为5.4%。
这个根据临床结局数据拟合并验证的TCP模型，似乎是一个适用于纳入所有临床前列腺癌风险类别的模型，并且能够在肿瘤控制预测方面评估当前的EBRT方式。
