Time-dose response of human tumors and normal tissues during and after fractionated radiation treatment. A new model.

This paper presents the background and some results of initial applications of a new model of time-dose response of tumors as well as fast-renewing normal tissues, to fractionated radiation therapy. Both the linear-quadratic and the single-hit/single-target, single-hit/multi-target model may be used for the single-dose survival of both the viable stem cells and the clonogenic tumor cells. Normal tissue tolerance is expressed as a minimum acceptable level of normal tissue functionality, due to insufficient production of replacement cells, which in turn is caused by radiation-induced depletion of the viable stem cell population. A logistic function describes the homeostatically controlled inter-fraction and post-treatment normal tissue stem cell repopulation. The onset of stem cell repopulation may be delayed, and the doubling rate of clonogenic tumor cells may increase, upon the onset of treatment. Criteria for the selection of acceptable parameter values for normal tissue as well as tumors are described. An interactive Fortran 77 program has been developed to assist in the search for acceptable parameter values, the simulation of the time-dose response of normal tissues and tumors to conventional clinical fractionation schemes and the exploration of alternative schedules, including hyperfractionation. Some provisional results are presented.