Applied Radiobiology and Bioeffect Planning

Author:  David Wigg
ISBN:  9781930524057      ISBN10:  1930524056
Published:  2001 | 486 | Hardcover



The Journal of the Royal Australasian College of Radiologists  |  March 2004

"The present review examines the book Applied Radiobiology and Bioeffect Planning by Dr. David Wigg from Adelaide from the point of view of a reader completely ignorant of the subject. This reviewer feels eminently qualified for that perspective.

"Dr. Wigg is an Adelaide radiation oncologist with a long interest in radiobiology and bioeffect planning. As many Australasian radiation oncologists will remember, he was the chief examiner in radiobiology for the FRANZCR Part 1 examinations. His book presents a method of bioeffect planning for radiation therapy with the aim of encouraging further development of the subject until it can become a useful tool in the clinic.

"What is bioeffect planning? It is what radiation oncologists already do albeit in a crude and limited fashion. When examining an isodose distribution for a proposed treatment, radiation oncologists examine high and low dose areas to estimate the probability of complications and tumour control, respectively. It has long been recognized that high dose regions might have an even greater biological effect because the higher total dose is delivered in larger doses per fraction. The effect of volume is sometimes alluded to in qualitative terms. In the planning room, radiation oncologists can be seen writing out linear quadratic formulae on scrap paper to try to estimate the biological effect of variations in absolute dose.

"Dr. Wigg suggests that these calculations should be performed routinely to give bioeffect dose distributions as an adjunct to the evaluation of absolute isodose distributions. In his detailed book he examines the history and limitations of existing models of radiation effect under the title of 'wrong but useful.' He then covers the volume effect, fractionation, hyperfractionation, the combination of chemotherapy and radiotherapy, treatment time effects and plausible parameters for the models. The aim is to build a methodological framework for the implementation of a bioeffect planning system. The Adelaide planning system is discussed, with examples from clinical practice.

"Nobody should question whether bioeffect planning has a place in the day-to-day practice of radiotherapy. We currently practice a very crude form. As an initial step, Dr. Wigg proposes that at the very least we should examine an isodose plot of the doses per fraction that would convey a sense of the variation in bioeffective dose.

"Dr. Wigg provides an exhaustive mathematical exploration of the models, parameters, applications and limitations from which to develop bioeffect planning. The limited mathematical skills of this reviewer preclude a discussion of their accuracy. However, advanced mathematical skills are not required to appreciate the logic and usefulness of his approach. The chapter that compares example plans, with and without bioeffective isodoses, beautifully illustrates the advantages of incorporating radiobiological modeling into the evaluation of treatment plans.

"As Dr. Wigg repeatedly cautions, the application of more sophisticated models requires great caution. Models are like road maps, good for getting from A to B but no substitute for keeping one's eye on the road. Bioeffect planning should be validated against clinical outcomes in a wide variety of clinical situations before it can be a part of routine practice.

"Dr. Wigg's book is an excellent exposition of the topic. A copy of Applied Radiobiology and Bioeffect Planning should be a standard resource in every radiation oncology department involved in training. It will also interest physicists and others of a mathematical bent."

Michael Barton