Radiation Dose-Volume Effects in Radiation-Induced Rectal Injury

Jeff M. Michalski, Hiram Gay, Andrew Jackson, Susan L. Tucker, Joseph O. Deasy

Research output: Contribution to journalArticlepeer-review

573 Scopus citations


The available dose/volume/outcome data for rectal injury were reviewed. The volume of rectum receiving ≥60Gy is consistently associated with the risk of Grade ≥2 rectal toxicity or rectal bleeding. Parameters for the Lyman-Kutcher-Burman normal tissue complication probability model from four clinical series are remarkably consistent, suggesting that high doses are predominant in determining the risk of toxicity. The best overall estimates (95% confidence interval) of the Lyman-Kutcher-Burman model parameters are n = 0.09 (0.04-0.14); m = 0.13 (0.10-0.17); and TD50 = 76.9 (73.7-80.1) Gy. Most of the models of late radiation toxicity come from three-dimensional conformal radiotherapy dose-escalation studies of early-stage prostate cancer. It is possible that intensity-modulated radiotherapy or proton beam dose distributions require modification of these models because of the inherent differences in low and intermediate dose distributions.

Original languageEnglish
Pages (from-to)S123-S129
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number3 SUPPL.
StatePublished - Mar 1 2010


  • NTCP
  • Radiation injury
  • Rectum


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