Describing patients' normal tissue reactions: Concerning the possibility of individualising radiotherapy dose prescriptions based on potential predictive assays of normal tissue radiosensitivity†
(For and on behalf of the Steering Committee of the BioMed2 European Union Concerted Action Programme on the Development of Predictive Tests of Normal Tissue Response to Radiation Therapy)
The Steering Committee of the European Union Concerted Action Programme on the Development of Predictive Tests of Normal Tissue Response to Radiation Therapy is as follows: Dr J.H. Peacock (Coordinator), Radiotherapy Research Unit, The Institute of Cancer Research, Sutton, UK; Dr A.C. Begg, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Dr N.G. Burnet, Department of Oncology, Addenbrooke's Hospital, Cambridge, UK; Dr J.B. Court, Cancer Research Laboratories, Velindre Hospital, Cardiff, UK; Dr E. Dikomey, Institute of Biophysics and Radiobiology, University of Hamburg, Hamburg, Germany; Dr M.C. Joiner, Gray Laboratory, Mount Vernon Hospital, Northwood, UK; Dr H.H. Kampinga, Department of Radiobiology, University of Groningen, Groningen, The Netherlands; Dr C. Mothersill, Physics Department, Dublin Institute of Technology, Dublin, Ireland; Dr J. Overgaard, Department of Experimental Clinical Oncology, Danish Cancer Society, Aarhus, Denmark; Dr G.E. Pantelias, Laboratory of Biological Dosimetry and Cancer Cytogenetics, Institute of Nuclear Technology and Radiation Protection, Demokritos, Athens, Greece; Dr H.P. Rodemann, Section of Radiobiology and Molecular Environmental Research, University of Tübingen, Tübingen, Germany; Dr J.M. Ruiz de Almodovar, Department of Radiology, Universidad de Granada, Granada, Spain; Dr D. Scott, Paterson Institute for Cancer Research, Christie Hospital NHS Trust, Manchester, UK; Dr C. Streffer, Institut für Medizinische Strahlenbiologie, Universitäts Klinikum Essen, Essen, Germany; Dr I. Turesson, Department of Oncology, Sahlgren's Hospital, Göteborg, and Department of Oncology, Academic Hospital, Uppsala, Sweden; Dr R. Wurm, Universitäts Klinikum Charité, Klinik für Strahlentherapie, Berlin, Germany.
Abstract
Clinical radiotherapeutic doses are limited by the tolerance of normal tissues. Patients given a standard treatment exhibit a range of normal tissue reactions, and a better understanding of this individual variation might allow for individualisation of radiotherapeutic prescriptions, with consequent improvement in the therapeutic ratio. At present, there is no simple way to describe normal tissue reactions, which hampers communication between clinic and laboratory and between groups from different centres. There is also no method for comparing the severity of reactions in different normal tissues. This arises largely because there is no definition of a “normal” reaction, an “extreme” reaction or the particular term “over-reactor” (OR). This report proposes definitions for these terms, as well as a simple terminology for describing normal tissue reactions in patients having radiotherapy. The “normal” range represents the individual variation in normal tissue reactions amongst large numbers of patients treated in the same way which is within clinically acceptable limits. The term “OR” is applied to an individual whose reaction is more severe than the normal range but also implies that this forced a major change in the radiotherapeutic prescription or that the reactions were very severe or fatal. A “severe OR” would develop serious problems with a typical radical dose, while an “extreme OR” would have such difficulties at a much lower dose. To describe the normal range, a numerical scale is suggested, from 1 to 5, resistant to sensitive. The term “highly radiosensitive” (HR) is suggested for category 5. An “informal” relative scale, as suggested here, is quick and simple. It should allow comparison between different hospitals, compensate for differences in radiotherapeutic dose and technique and allow comparison of reactions between different anatomical sites. It should be adequate for discriminating patients at the extremes of the normal range from those at the centre. It is hoped that the definitions and terminology proposed here will aid communication in the field of predictive testing of normal tissue radiosensitivity. Int. J. Cancer (Pred. Oncol.) 79:606–613, 1998. © 1998 Wiley-Liss, Inc.
