Robustness of tumor control (TCP) and normal tissue complication probabilities (NTCP) for intensity modulated particle radiotherapy in locally advanced lung cancer: a scenario-based uncertainty analysis compared to photon radiotherapy (IMRT).

Xue Ming, Yinxiangzi Sheng, Jian Chen, Kailiang Wu, Xufei Wang, Jingfang Mao, Ningyi Ma

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Article in Journal of thoracic disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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7 authors.

Xue MingDepartment of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology, Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.

Yinxiangzi ShengDepartment of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology, Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.

Jian ChenDepartment of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology, Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.

Kailiang WuDepartment of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology, Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.

Xufei WangInstitute of Modern Physics, Key Laboratory of Nuclear Physics and Ion-beam Application (MOE), Fudan University, Shanghai, China.

Jingfang MaoDepartment of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology, Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.

Ningyi MaDepartment of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology, Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.

Funding

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6 · The paper itself

Abstract

Background: Particle radiotherapy offers significant dose sparing but is more susceptible to dose perturbations caused by physical uncertainties. This study aimed to assess the impact of dosimetric uncertainties on tumor control probability (TCP) and normal tissue complication probability (NTCP) for locally advanced lung cancer (LA-LC) among intensity-modulated proton radiotherapy (IMPT), intensity-modulated carbon-ion radiotherapy (IMCT), and intensity-modulated photon radiotherapy (IMRT). Methods: Ten LA-LC patients were enrolled in this retrospective study with three radiation modalities of IMPT, IMCT and IMRT for treatment planning. The nominal IMPT/IMCT plans were recalculated according to the four major uncertainty factors respectively, including the type of calculation engine, range uncertainty, setup uncertainty and intra-fractional respiratory movement uncertainty. TCP values were assessed by the model for curative intent. Radiation-induced esophageal injury (RIEI) and radiation-induced lung injury (RILI) were studied as the NTCP endpoints. NTCP and the difference of NTCP between the particle radiotherapy (PT) and IMRT (∆NTCP) values were evaluated through the 6 Lyman-Kutcher-Burman models (4 models for RIEI and 2 for RILI). Results: Under the same prescription doses and similar dose distribution to the targets, deviations of the mean TCP values were less than 0.7% in IMPT, IMCT and IMRT plans under all the uncertainty scenarios. The deviations of the mean values of the ∆NTCP evaluation were -3.3-2.9% for the four models for RIEI and -0.8-1.9% for the two models for RILI under different uncertainty scenarios. The mean values of ∆NTCP Conclusions: For non-robustly optimized IMPT and IMCT plans, the stability of TCP and reduction of NTCP of RILI, especially for larger tumor volumes, maintained in IMPT and IMCT after considering the calculation engine, range uncertainty, setup uncertainty and intra-fractional respiratory motions respectively with the application of several planning strategies. Proper TCP, NTCP and ∆NTCP evaluation may support the individual model-based selection for PT to maximize the clinical benefit for LA-LC.

Indexed as

carbon-ion radiotherapyNormal tissue complication probability (NTCP)proton radiotherapyrobustness evaluationtumor control probability (TCP)

Identifiers

PMID42306662

DOI10.21037/jtd-2026-1-0266

PMCPMC13266662

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