Cited by 1,826Advanced Radiotherapy TechniquesRadiation Therapy and DosimetryEffects of Radiation Exposure

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Use of Normal Tissue Complication Probability Models in the Clinic

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Marks, Lawrence B., Yorke, Ellen D., Jackson, Andrew, Ten Haken, Randall K., Constine, Louis S., Eisbruch, Avraham, Bentzen, Søren M., Nam, Jiho, Deasy, Joseph O.·2010·International Journal of Radiation Oncology*Biology*Physics

DOI 10.1016/j.ijrobp.2009.07.1754PMC PMC4041542

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Abstract

The Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) review summarizes the currently available three-dimensional dose/volume/outcome data to update and refine the normal tissue dose/volume tolerance guidelines provided by the classic Emami et al. paper published in 1991. A "clinician's view" on using the QUANTEC information in a responsible manner is presented along with a description of the most commonly used normal tissue complication probability (NTCP) models. A summary of organ-specific dose/volume/outcome data, based on the QUANTEC reviews, is included.

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Radiobiological modeling of acute esophagitis after radiation therapy of head, neck, and thorax tumors
Alizade‐Harakiyan, M., Jangjoo, A. G., Jafari‐Koshki, T., Fatemi, A. B., & Mesbahi, A. (2021) · Journal of Cancer Research and Therapeutics · doi:10.4103/jcrt.jcrt_271_20 · Cited by 5
The Efficacy of Radiotherapy without Surgery for External Auditory Canal Squamous Cell Carcinoma
Osu, N., Musha, A., Yumisaki, H., Okada, K., Kubo, N., Okano, N., Takayasu, Y., Shino, M., Nikkuni, O., Ida, S., et al. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11195905 · Cited by 5
Non-small Cell Lung Cancer (NSCLC) and Small Cell Lung Cancer (SCLC)
Gomez, D. R., & Liao, Z. X. (2012) · Springer eBooks · doi:10.1007/978-3-642-28860-9_12 · Cited by 5
Radiation dose to the left anterior descending coronary artery during interstitial pulsed-dose-rate brachytherapy used as a boost in breast cancer patients undergoing organ-sparing treatment
Sinacki, M., Serkies, K., Dziadziuszko, R., Narkowicz, M., Kaminska, J., & Lipniewicz, J. (2017) · Journal of Contemporary Brachytherapy · doi:10.5114/jcb.2017.66043 · Cited by 5
Radiation Therapy with a Simultaneous Integrated Boost
Katsochi, D. M. (2017) · InTech eBooks · doi:10.5772/67326 · Cited by 5
Radiation Therapy in Acoustic Neuroma
Krengli, M., Zanoletti, E., & Deantonio, L. (2017) · Springer eBooks · doi:10.1007/978-3-319-52619-5_11-1 · Cited by 5
“Boari et al. reported a local control of 97.1% with a tumor volume downsizing of 82.7% at 6.5 years follow-up in 523 patients treated with Gamma Knife SRS to a median margin dose of 13 Gy.”
BackgroundInfluential
Adrenal Oligometastases Secondary to Non-small Cell Lung Cancer—What is the Optimal Treatment Approach?
Thomsen, B., & Fairchild, A. M. (2017) · touchREVIEWS in Oncology & Haematology · doi:10.17925/ohr.2017.13.02.117 · Cited by 4
Rapid recovery of vision following early intervention with fractionated stereotactic radiotherapy for optic nerve sheath meningioma
Inoue, T., Okuno, Y., NISHIGUCHI, I., Ikenaga, K., & Mimura, O. (2018) · International Medical Case Reports Journal · doi:10.2147/imcrj.s149592 · Cited by 5
Influence of inhomogeneous radiosensitivity distributions and intrafractional organ movement on the tumour control probability of focused IMRT in prostate cancer
Thomann, B., Sachpazidis, I., Koubar, K., Zamboglou, C., Mavroidis, P., Wiehle, R., Grosu, A., & Baltas, D. (2018) · Radiotherapy and Oncology · doi:10.1016/j.radonc.2018.02.006 · Cited by 5
Simulation study of dosimetric effect in proton beam therapy using concomitant boost technique for unresectable pancreatic cancers
Fukumitsu, N., Okumura, T., Hiroshima, Y., Ishida, T., Numajiri, H., Murofushi, K. N., Ohnishi, K., Aihara, T., Ishikawa, H., Tsuboi, K., et al. (2018) · Japanese Journal of Radiology · doi:10.1007/s11604-018-0743-2 · Cited by 5
An overview on personalisation of radiotherapy prescriptions in locally advanced non-small cell lung cancer: Are we there yet?
Barrett, S., Hanna, G. G., & Marignol, L. H. (2018) · Radiotherapy and Oncology · doi:10.1016/j.radonc.2018.05.029 · Cited by 5
Planned Gamma Knife Boost After Chemoradiotherapy for Selected Sinonasal and Nasopharyngeal Cancers
Díaz-Martínez, J. A., Esquenazi, Y., Martir, M., Citardi, M. J., Karni, R. J., & Blanco, A. I. (2018) · World Neurosurgery · doi:10.1016/j.wneu.2018.07.183 · Cited by 5
Is SBRT Boost Feasible for PET Positive Lymph Nodes for Cervical Cancer? Evaluation using Tumor Control Probability and QUANTEC Criteria
Snyder, J. E., Willett, A. B., Sun, W., & Kim, Y. (2018) · Practical Radiation Oncology · doi:10.1016/j.prro.2018.10.012 · Cited by 5
Craniospinal Irradiation in Medulloblastoma using High Energy Medical Linear Accelerator: an Innovative Approach to Planning Technique
Gurjar, O. P., Arya, R. S., Goyal, H., Handa, P., Bagdare, P., Khan, A., Paliwal, R. K., & Mishra, S. (2018) · Journal of Biomedical Physics and Engineering · doi:10.31661/jbpe.v0i0.767 · Cited by 5
“In case of the children, the single posterior beam is passing through the part of heart, although the doses in both kinds of the plans are very less as compared to the dose constraints for heart (mean dose < 26 Gy and V25 < 10%) [21].”
BackgroundMethodInfluential
Practices, knowledge and inter‐professional relationships between speech pathologists and radiation therapists managing patients with head and neck cancer
Hutchison, A. R., Cartmill, B., Wishart, L. R., Ward, E. C., Hargrave, C., & Brown, E. (2019) · Journal of Medical Radiation Sciences · doi:10.1002/jmrs.332 · Cited by 5
Future options: the potential role of proton irradiation
Maduro, J. H. (2019) · The Breast · doi:10.1016/s0960-9776(19)31129-4 · Cited by 5
“Changing the dose to the OAR’s can result in a higher or lower NTCP value in this way the treatment plan can be optimized tomake the chance of toxicityas low as possible.”
BackgroundInfluential
Definitive Radiation Treatment Patterns and Outcomes for Low and Intermediate Risk Prostate Cancer Patients
Asamoah, F. A., Yarney, J., Awasthi, S., Vanderpuye, V. D. N. K., Dadzie, M. A., Fink, A., Naghavi, A. O., Abrahams, A. O. D., Mensah, J. E., Sasu, E., et al. (2019) · American Journal of Clinical Oncology · doi:10.1097/coc.0000000000000589 · Cited by 5
Dosimetric Impact of the Positional Imaging Frequency for Hypofractionated Prostate Radiotherapy – A Voxel-by-Voxel Analysis
Splinter, M., Sachpazidis, I., Bostel, T., Fechter, T., Zamboglou, C., Thieke, C., Jäkel, O., Huber, P., Debus, J., Baltas, D., et al. (2020) · Frontiers in Oncology · doi:10.3389/fonc.2020.564068 · Cited by 5
Impact of Active Breathing Control-Deep Inspiration Breath Hold (ABC-DIBH) on the dose to surrounding normal structures in tangential field left breast radiotherapy
Kuo, C.-C., Chang, C.-C., Cheng, H.-W., & Tsai, J. (2020) · Therapeutic Radiology and Oncology · doi:10.21037/tro-20-49 · Cited by 5
“The dose constraints for OARs used in optimization were based on the Quantitative Analyses of Normal Tissue Effects in the Clinic Summary (QUANTEC) guidelines (18).”
Method
Mixed modality treatment planning of accelerated partial breast irradiation: to improve complex dosimetry cases
Nemr, M. E., Heymann, S., Verstraet, R., Biron, B., Azoury, F., Marsiglia, H. R., & Bourgier, C. (2011) · Radiation Oncology · doi:10.1186/1748-717x-6-154 · Cited by 5
Overlap‐guided fixed‐patient support positioning optimization for cranial SRT
MacDonald, R. L., Robar, J. L., & Thomas, C. G. (2017) · Medical Physics · doi:10.1002/mp.12008 · Cited by 5
Using biologically based objectives to optimize boost intensity‐modulated radiation therapy planning for brainstem tumors in dogs
Meier, V., Besserer, J., & Bley, C. R. (2019) · Veterinary Radiology & Ultrasound · doi:10.1111/vru.12815 · Cited by 5
Optimization Problems in Radiation Therapy Treatment Planning.
Long, T. (2015) · Deep Blue (University of Michigan) · Cited by 5
Evaluation of the geometric and dosimetric accuracies of deformable image registration of targets and critical organs in prostate CBCT‐guided adaptive radiotherapy
Jassim, H. H., Nedaie, H. A., Banaee, N., Geraily, G., Kazemian, A., & Makrani, D. S. (2024) · Journal of Applied Clinical Medical Physics · doi:10.1002/acm2.14490 · Cited by 4
“36 The planning characteristics of the dCT C -based plan were compared with those of DVHs computed using rCT plan data.”
Method
Clinical outcomes following stereotactic radiosurgery for brain metastases from sarcoma primaries: An international multicenter analysis
Singh, R. B., Roubil, J. G., Bowden, G. N., Mathieu, D., Carrier, L., Shepard, M. J., Kite, T. S., Wegner, R. E., Picozzi, P., Franzini, A., et al. (2025) · Cancer · doi:10.1002/cncr.35931 · Cited by 4
Dosimetric evaluation of field width variation in helical Tomotherapy for sinonasal tumours: Implications for organ-at-risk sparing, treatment efficiency, and setup error sensitivity
Sen, S., Singh, S., Singh, A. K., Dipesh, Bhushan, M., Mahipal, Tandon, S., & Gairola, M. (2025) · Radiation Physics and Chemistry · doi:10.1016/j.radphyschem.2025.113338 · Cited by 4
The Role of Radiotherapy for Meningeal Melanocytomas – A 20 Year Update
Rades, D., Zemskova, O. V., Gliemroth, J., & YU, N. Y. (2024) · In Vivo · doi:10.21873/invivo.13558 · Cited by 4
Critical review of patient outcome study in head and neck cancer radiotherapy
Chen, J., Yang, Y., Liu, C., Feng, H., Holmes, J., Zhang, L., Frank, S. J., Simone, C. B., Ma, D. J., Patel, S. H., et al. (2025) · Meta-Radiology · doi:10.1016/j.metrad.2025.100151 · Cited by 6
Proton beam therapy for mediastinal Hodgkin lymphoma: A prospective study of clinical efficacy and safety
Dědečková, K., Andrlík, M., Móciková, H., Kaliská, L., Zapletalová, S., Kubeš, J., Al-Hamami, S. F. A., Cutter, D. J., Ntentas, G., Vondráček, V., et al. (2025) · Radiotherapy and Oncology · doi:10.1016/j.radonc.2025.110931 · Cited by 4
Comprehensive analysis of the role of deep inspiration breath‐hold in right‐sided breast cancer radiotherapy: A focus on cardiac substructures and right coronary artery
Semiz, V., AYDIN, B., Gulsan, D., Atac, E., Duymaz, E. Ö., Kınay, Ş., Akçay, D., Kandemir, R., Can, M., & Görken, İ. B. (2025) · Journal of Applied Clinical Medical Physics · doi:10.1002/acm2.70216 · Cited by 4
Bilateral diffuse grade 5 radiation pneumonitis after intensity modulated radiation therapy for localized lung cancer
Osborn, V. W., Leaf, A. N., Lee, A., Garay, E., Safdieh, J. J., Schwartz, D. A., & Schreiber, D. P. (2017) · World Journal of Clinical Oncology · doi:10.5306/wjco.v8.i3.285 · Cited by 4
Is a reduction of radiation dose feasible in patients affected by glioblastoma undergoing radio-chemotherapy according to MGMT promoter methylation status without jeopardizing survival?
Tini, P., Nardone, V., Pastina, P., Marampon, F., Sebaste, L., Cerase, A., Tombolini, V., Pirtoli, L., & Mazzei, M. A. (2019) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2019.105445 · Cited by 4
Difference in VMAT dose distribution for prostate cancer with/without rectal gas removal and/or adaptive replanning
Wada, Y., Monzen, H., Otsuka, M., Doi, H., Nakamatsu, K., & Nishimura, Y. (2021) · Medical dosimetry · doi:10.1016/j.meddos.2021.09.002 · Cited by 4
BRIDGE −1 TRIAL: BReak Interval Delayed surgery for Gastrointestinal Extraperitoneal rectal cancer, a multicentric phase III randomized trial
Chiloiro, G., Meldolesi, E., Corvari, B., Romano, A., Barbaro, B., Coco, C., Crucitti, A., Genovesi, D., Lupattelli, M., Mantello, G., et al. (2022) · Clinical and Translational Radiation Oncology · doi:10.1016/j.ctro.2022.03.002 · Cited by 4
“The dose to OARs will be assessed according to the dose constraints reported in the QUANTEC report [37].”
Method
Comparison of 3DCRT and IMRT out-of-field doses in pediatric patients using Monte Carlo simulations with treatment planning system calculations and measurements
Sá, A. C., Barateiro, A. P., Bednarz, B. P., Almeida, P. M. D., Vaz, P., & Madaleno, T. (2022) · Frontiers in Oncology · doi:10.3389/fonc.2022.879167 · Cited by 4
Comparison of Dose Statistics of Intensity-Modulated Radiation Therapy Plan from Varian Eclipse Treatment Planning System with Novel Python-Based Indigenously Developed Software
Dashnamoorthy, S., Rajamanickam, K., Jeyasingh, E., Pandey, V. P., Nachimuthu, K., Ahmed, I., & Venkatraman, P. (2022) · Progress in Medical Physics · doi:10.14316/pmp.2022.33.3.25 · Cited by 4
Impact of Adapted Radiotherapy Schedules on Bowel Sparing in Node-Positive Cervical Cancer
Garrett, M. D., Li, F., Lemus, O. D., Lavrova, E., Savacool, M. K., Price, M. J., Kachnic, L. A., Horowitz, D. P., & Chin, C. (2022) · Practical Radiation Oncology · doi:10.1016/j.prro.2022.11.012 · Cited by 4
Pathophysiology of Radiation Fibrosis Syndrome
Kline‐Quiroz, C. M., Byrd, H., Dovgan, J., & Lockney, N. A. (2023) · Current Physical Medicine and Rehabilitation Reports · doi:10.1007/s40141-023-00403-9 · Cited by 4
“Tissues and organs have varying degrees of tolerance to RT, and radiation oncologists utilize establish parameters to guide treatment dosing [40].”
Background
Development and Validation of Single-Optimization Knowledge-Based Volumetric Modulated Arc Therapy Model Plan in Nasopharyngeal Carcinomas
Sinha, S., Kumar, A., Maheshwari, G., Mohanty, S., Joshi, K., Shinde, P., Gupta, D., Kale, S. N., Phurailatpam, R. D., Swain, M., et al. (2023) · Advances in Radiation Oncology · doi:10.1016/j.adro.2023.101311 · Cited by 4
Evaluation of variables predicting PFT changes for lung cancer patients treated on a prospective 4DCT-ventilation functional avoidance clinical trial
Ghassemi, N., Castillo, R., Castillo, E. M., Jones, B. L., Miften, M. M., Kavanagh, B. D., Werner‐Wasik, M., Miller, C. R., Barta, J. A., Grills, I. S., et al. (2023) · Radiotherapy and Oncology · doi:10.1016/j.radonc.2023.109821 · Cited by 4
Comparative Evaluation of Proton Therapy and Volumetric Modulated Arc Therapy for Brachial Plexus Sparing in the Comprehensive Reirradiation of High-Risk Recurrent Breast Cancer
Choi, J. I., McCormick, B. L., Park, P. J., Millar, M., Walker, K. M., Tung, C. C., Huang, S., Florio, P., Chen, C., Lozano, A. J., et al. (2023) · Advances in Radiation Oncology · doi:10.1016/j.adro.2023.101355 · Cited by 4
“24 In an study from investigators at MD Anderson Cancer Center, 90 patients with non-small cell lung cancer (NSCLC) treated with de ﬁ nitive chemoradiation with > 55 Gy delivered to the BP and median BP dose of 70 Gy, 16% developed brachial plexopathy at a median follow-up of 14 months.”
Background

Authors: Marks, L. B., Yorke, E. D., Jackson, A., Ten Haken, R. K., Constine, L. S., Eisbruch, A., Bentzen, S. M., Nam, J., & Deasy, J. O.
Affiliations: University of North Carolina at Chapel Hill (US)
Memorial Sloan Kettering Cancer Center (US)
University of Rochester Medicine (US)
University of Michigan (US)
University of Wisconsin–Madison (US)
Washington University in St. Louis (US)
Corresponding author: Marks, Lawrence B.
ORCID: Marks, Lawrence B.
Yorke, Ellen D.
Jackson, Andrew
Constine, Louis S.
Eisbruch, Avraham
Bentzen, Søren M.
Nam, Jiho
Deasy, Joseph O.
Venue: International Journal of Radiation Oncology*Biology*Physics
Publisher: Elsevier BV
Published: 2010-03
Volume: 76
Issue: 3
Pages: S10-S19
ISSN: 0360-3016 (ISSN-L)
DOI: 10.1016/j.ijrobp.2009.07.1754
PMC: PMC4041542
OpenAlex: W2046701188
Cited by: 1,826
References: 30
Citations by year: 2026: 92 · 2025: 110 · 2024: 125 · 2023: 132 · 2022: 130 · 2021: 160 · 2020: 138 · 2019: 146 · 2018: 164 · 2017: 122 · 2016: 108 · 2015: 102 · 2014: 112 · 2013: 87 · 2012: 55
FWCI: 56.07
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: International Journal of Radiation Oncology*Biology*Physics (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: Lance Armstrong Foundation
Armstrong Foundation
National Institutes of Health
National Cancer Institute (CA69579, R29CA069579, R29CA085181, R01CA069579, R01CA129182, R01CA085181, CA85181)
Topics: Physical Sciences › Physics and Astronomy › Radiation › Advanced Radiotherapy Techniques
Physical Sciences › Physics and Astronomy › Radiation › Radiation Therapy and Dosimetry
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Effects of Radiation Exposure
Keywords: normal tissue complication probability, QUANTEC, normal tissue tolerance, NTCP models
MeSH terms: Adult, Child, Dose-Response Relationship, Radiation, Humans, Models, Biological, Organ Specificity, Radiation Injuries, Radiation Tolerance, Models, Statistical, Practice Guidelines as Topic, Radiation Oncology, Dose Fractionation, Radiation

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Use of Normal Tissue Complication Probability Models in the Clinic

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