Comparative Radiobiological Evaluation of Radiotherapy Techniques Using Equivalent Uniform Dose, Tumor Control Probability, and Normal Tissue Complication Probability in Postmastectomy Breast Cancer

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Abstract Introduction: Postmastectomy radiotherapy plays a pivotal role in improving locoregional control and survival outcomes in early as well as in advanced-stage breast cancer patients. With the transition from conventional radiotherapy techniques to advanced intensity-modulated approaches, evaluation based solely on physical dose parameters is no longer sufficient. Radiobiological modelling provides a more clinically meaningful framework by quantifying tumor control and normal tissue complications. Objectives: The objective of this prospective study was to evaluate the radiobiological differences between three radiotherapy planning techniques, namely three-dimensional conformal radiotherapy (3DCRT), field-in-field forward planned intensity modulated radiotherapy (FIF-FP-IMRT), and inversely planned intensity modulated radiotherapy (IP-IMRT) in postmastectomy breast cancer patients. Materials and Methods: The present prospective study involved 150 postmastectomy breast cancer patients who have undergone chemotherapy treatment. Each patient was planned with three radiotherapy planning techniques, namely 3DCRT, FIF-FP-IMRT, and IP-IMRT for comparative radiobiological analysis. Radiobiological parameters, namely tumor control probability (TCP) and normal tissue complication probability (NTCP), were then calculated and compared for the three planning techniques. Results: The mean TCP values were comparable among all three techniques, with no statistically significant difference. However, significant differences were observed in most of the NTCP parameters ( P < 0.05). Conclusion: The present study demonstrates that advanced radiotherapy planning techniques provide significant radiobiological advantages over conventional techniques in postmastectomy breast cancer patients. Among the three evaluated techniques, IP-IMRT showed the most favorable radiobiological profile, followed by FIF-FP-IMRT, while 3DCRT showed comparatively higher NTCP.

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