On using the linear-quadratic model in daily clinical practice

To facilitate its use in the clinic, Barendsen's formulation of the Linear-Quadratic (LQ) model is modified by expressing isoeffect doses in terms of the Standard Effective Dose, Ds, the isoeffective dose for the standard fractionation schedule of 2 Gy fractions given once per day, 5 days per week. For any arbitrary fractionation schedule, where total dose D is given in N fractions of size d in a total time T, the corresponding Standard Effective Dose, Ds, will be proportional to the total dose D and the proportionality constant will be called the Standard Relative Effectiveness, SRE, to distinguish it from Barendsen's Relative Effectiveness, RE. Thus, Ds = SRE.D. The constant SRE depends on the parameters of the fractionation schedule, and on the tumor or normal tissue being irradiated. For the simple LQ model with no time dependence, which is applicable to late reacting tissue, SRE = [(d + delta)/(2 + delta)], where d is the fraction size and delta = alpha/beta is the alpha/beta ratio for the tissue of interest, with both d and delta expressed in units of Gy. Application of this method to the Linear Quadratic model with a time dependence, the LQ + time model, and to low dose rate brachytherapy will be discussed. To clarify the method of calculation, and to demonstrate its simplicity, examples from the clinical literature will be used