Beyond the linear quadratic model: Intraoperative radiotherapy and normal tissue tolerance

Bahman Emami*, Gayle E Woloschak, William Small

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations


Objective: In recent years increasing number of patients are treated with intraoperative, high dose-low energy radiotherapy. The purpose of this review is to evaluate whether the linear-quadratic model (L-Q model) is appropriate for predictive modeling and relative biological effectiveness (RBE) calculations of this new radiation. Methods: All pertinent literature addressing radiobiological aspects of L-Q formulism on high dose-high energy hypofractions [including one fraction intraoperative radiotherapy (IORT)] and high dose-low energy radiation was reviewed and analyzed with regard to clinical utility. Results: Due to the lack of inclusion and experimental verification of a significant number of factors, biological (i.e., no SLD repair, no cell repopulation between fractions, no reoxygenation, long delivery time and steeper dose fall off which affects RBE)/physiological and systemic (i.e., effects on immune systems), which impact on the effectiveness of high dose-low energy radiation, would make the L-Q model inappropriate for predictive modeling of normal tissue complications. Conclusions: L-Q model is inappropriate to model biological effect of either high dose-high energy or high dose-low energy radiation.

Original languageEnglish (US)
Pages (from-to)140-147
Number of pages8
JournalTranslational Cancer Research
Issue number2
StatePublished - Apr 1 2015


  • High dose-high energy radiation
  • High dose-low energy radiation
  • Intraoperative radiotherapy (IORT)
  • Linear-quadratic model (L-Q model)

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


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