Conversion and Validation of Rectal Constraints for Prostate Carcinoma Receiving Hypofractionated Carbon-ion Radiotherapy With a Local Effect Model

Abstract Purpose: The study objective was to convert the microdosimetric kinetic model (MKM) rectum constraints for 16-fraction carbon-ion radiotherapy (CIRT) to local effect model (LEM) constraints for 12-fraction, 8-fraction, and 4-fraction CIRT for prostate carcinoma patients (PCAs).Methods: Two strategies were employed. To understand the fractionation effects, MKM linear-quadric (LQ) strategy first converted MKM rectum constraints for 16-fraction CIRT to 12-fraction, 8-fraction, and 4-fraction CIRT. To examine the differences in the biophysical models, MKM constraints were converted to LEM constraints using an RBE-conversion model. The LEM LQ strategy first converted MKM rectum constraints for 16-fraction CIRT to LEM constraints using the RBE-conversion model. Then, the LEM constraints converted the 16-fraction constraints to the rectum constraints for 12-fraction, 8-fraction, and 4-fraction CIRT using the LQ model. The LEM rectum constraints for 16 and 12-fraction CIRTs were compared to the rectum doses and the clinical follow-ups in 40 patients.Results: The 16-fraction NIRS rectum constraint Dmax < 60.8 Gy(RBE) and CNAO rectum constraint D1cc < 66.00 Gy(RBE) were converted by MKM LQ strategy to LEM constraints 58.01 and 55.97 Gy(RBE) (12fx), 45.47 and 43.97 Gy(RBE) (8fx), and 29.64 and 28.67 Gy(RBE) (4fx) and by LEM LQ strategy to 61.73 and 59.69 Gy(RBE) (12fx), 53.03 and 51.33 Gy(RBE) (8fx), and 40.10 and 38.88 Gy(RBE) (4fx). Differences of 36.13% were found. No late rectum complications were reported.Conclusions: The LEM rectum constraints from MKM LQ strategy were more conservative and can be used as the reference constraints for starting the hypofractionated CIRT.