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. 2017 Apr 27;7:83. doi: 10.3389/fonc.2017.00083

Table 3.

Suggested treatment adaptations based on TCP and NTCP.

Cancer type Suggested treatment adaptations
High NTCP High NTCP Low NTCP Low NTCP
Low TCP High TCP Low TCP High TCP
Breast
  • Consider the risk of recurrence first

  • If possible, discussion of a mastectomy ± reconstructive surgery without adjuvant RT

  • Consider no adjuvant RT if elderly

  • Limit large RT fields (consider partial breast RT or IORT)

  • Increase treatment fields (IMC, axilla)

  • Consider hypofractionation

  • Consider no adjuvant RT or IORT if elderly

  • Consider hypofractionation and accelerated RT ± partial breast RT or IORT

Prostate
  • Discuss possibility of surgery

  • RT with rectal spacer

  • RT with transponders

  • Discuss indication of pelvic RT

  • Discuss interest of proton therapy

  • Active surveillance

  • Focal therapy

  • Brachytherapy

  • RT with rectal spacer

  • RT with transponders with reduced margins

  • Dose escalation (boost brachytherapy if indicated)

  • Pelvic RT if indicated

  • Active surveillance

  • Hypofractionation

  • SBRT

Lung
  • Surgery if possible

  • Discuss hyperfractionation if large volumes

  • Surgery

  • Very limited SBRT in case of non-operable lesions

  • Dose escalation

  • Increase nodal volume (ENI) if indicated

  • SBRT

Rectum Esophagus
  • Consider the risk of recurrence first

  • Reduce the volume of fields if possible discuss interest of proton therapy

  • Involved field RT

  • Discuss the need of RT

  • Dose escalation if boost indicated

  • Involved field RT

  • Contact therapy

Head and neck
  • Consider the risk of recurrence first

  • Reduce the volume of fields if possible discuss interest of proton therapy

  • Involved field RT

  • Dose escalation

  • Discuss the use of radiosensitizers (e.g., nimorazole)

  • Involved field RT

  • Hypofractionation

Gynecological tumors
  • Consider the risk of recurrence first

  • Reduce the volume of fields if possible discuss interest of proton therapy

  • Involved field RT

  • No adjuvant RT in adjuvant setting

  • Dose escalation

  • Involved field RT

  • Hypofractionation

CNS
  • Consider the risk of recurrence first

  • Proton therapy is mandatory

  • Involved field RT

  • No adjuvant RT

  • Dose escalation

  • Involved field RT

  • Hypofractionation

  • SBRT

TCP, tumor control probability; NTCP, normal tissue complication probability; IORT, intraoperative radiotherapy; RT, radiotherapy; IMC, internal mammary chain; SBRT, stereotactic body radiation therapy; ENI, elective nodal irradiation; CNS, central nervous system.