So meta.

What most rad oncs look for when evaluating a dose-volume histogram (DVH) are certain landmarks along the curve associated with certain rates of toxicity, such as a maximum dose or a volume receiving a particular dose cutoff. In reality, these are all gross oversimplifications of a continuous spectrum of dose, volume, and toxicity risk. If you’ve ever dabbled in treatment planning optimization, you’ll know that it basically involves morphing DVH lines into the shape you’re looking for. But what does this shape really mean? This analysis analyzes our dose analysis. It systematically reviews late toxicity dose tolerances from prostate radiation to ultimately create a meta-DVH (figure 4) drawing from 33 studies with late GI toxicity data on >30K patients. This meta-curve has low, average, and high risk lines plus specific cutoffs that were the most sensitive for specific toxicities. TBL: Using meta-DVH data may provide a better way of optimizing and evaluating radiation dose distributions for spectrums of toxicity risk. | Olsson, Int J Radiat Oncol Biol Phys 2018