Wael Mekhael

Conformal Terminology
March 2015
TCP (Tumor Control Probability)
In order to cure a tumor, the last surviving clonogen must be killed, and even then it is a
probability function of dose. Calculation of the response probability of tumor control (TCP) is a
function of the likelihood of inactivating all tumor cells in a given tumor following Poisson
statistics.1 If it is assumed that every tumor cell must be killed to control a tumor, TCP is given
by TCP = e-(N. SF)
Where SF is the surviving fraction and N is the total number of cells in the tumor. SF N is then
the average number of viable surviving clonogenic stem cells remaining in a tumor receiving a
certain treatment. If there is an average of 1 cell surviving TCP=37%, TCP is then the probability
of no cells remaining viable under these conditions. TCP is a function of total dose, dose per
fraction and radiosensitivity of the tumor. This model leads to a sigmoid dose response curve for
TCP, relationship between the complexity of a treatment prescription, measured by the number
of prescribed dose levels, and the quality of the plan, represented by the tumor control
probability.2 The TCP can be used to predict the outcome of a given treatment schedule.

Various levels of radiation yield different tumor-control probabilities, depending on the size and
anatomic extent of the lesion. The total number of surviving cells is proportional to the initial
number and biologic characteristics of clonogenic cells and the total cell kill achieved with a
specified dose of radiation. Dose-response relationships for local control of homogeneous tumor
groups have been empirically determined. The higher the doses of radiation delivered, the more
likely is tumor control. The dose of radiation that can be delivered to a tumor is limited by the
probability of serious normal tissue complications. Therefore, the choice of a tumor dose is based
on the relative probability of tumor control and normal tissue complications. The potential
therapeutic gain can be estimated for an average group of patients on the basis of tumor size,
histologic type, and the normal tissues that will be included in the treatment fields.

TCP is the probability that a given dose of radiation will provide tumor control or eradication
considering the specific biological cells of the tumor. The TCP is used in treatment planning as a
tool to differentiate among treatment plans.
Factors affecting shape and slope of TCP curves:

Interaction of radiation in matter, including cells, tissues and organs, is a nonspecific, random
process, with no specificity to tumor cells;
Radiation delivered from the sources outside the body is absorbed by normal tissues in its path to
the tumor, and the damage to the normal cells occurs.
The -values derived from the literature average less than 2%, compared with an expected
average value of at least 5% based on reasonable estimates of tumor cell radiosensitivity
This reflects the enormous heterogeneity of tumor-related and treatment-related factors which
may affect the dose required for tumor control.3
When tumor control rates lie between about 10% and 85%, a useful practical description of the
slope of the TCP curves is the percentage point change in TCP for a 1% change in tumor dose,
the -value. The -value is determined by clonogen radiosensitivity, the curve being steeper the
more sensitive the tumor cells. Tumor volume may influence tumor control, such as clonogenic
fraction, oxygenation or inter-cellular communication.4

References:
1- Maler A, Lutscher F. Cell-cycle times and the tumor control probability. Math Med Biol 2010.
27(4): 313-342. http://dx.doi.org/10.1093/imammb/dqp024
2- C.P. South, P.M. Evans, M. Partridge. Dose prescription complexity versus tumor control
probability in biologically conformal radiotherapy. Medical Physics, 36 (10) (2009), pp. 4379
4388. http://dx.doi.org/10.1118/1.3213519
3- Webb S. Optimum parameters in a model for tumor control probability including interpatient
heterogeneity. Phys Med Biol 1994;39:18951914. http://dx.doi.org/10.1088/00319155/39/11/007
4- Munro Tr, Gilbert CW. The relation between tumor lethal doses and the radiosensitivity of tumor
cells. Br J radiol 1961;34:24651. http://dx.doi.org/10.1016/0360-3016(93)90189-3