Complication Probability as Assessed from Dose-Volume Histograms

Optimization of a treatment plan for radiation therapy will produce a plan with the highest probability for tumor control without exceeding an acceptable complication rate. To achieve this goal it is necessary to have a means to estimate probabilities of local control and normal tissue complication. In general, good treatment plans deliver a high uniform dose to the target volume and lower doses to the surrounding normal tissues. The tolerance dose values available for various normal tissues are usually assumed to apply to partial or full volumes of the tissue which have been uniformly irradiated. These values are the best guidelines for estimating complication probabilities in tissues that receive a uniform dose to a fraction of the tissue and no dose to the remainder. Dose-volume histograms are one means of evaluating the uniformity of the irradiation on the tissues. Frequently the normal tissues are not uniformly irradiated as is demonstrated by dose-volume histograms for different treatment plans. A recursive algorithm which uses these tolerance dose data has been written and can be applied to arbitrary dose-volume histograms to estimate the complication probability.