Excess late subcutaneous fibrosis after irradiation of pig skin, consequent upon the application of the NSD formula

The development of subcutaneous fibrosis after X irradiation in courses of 1, 6 or 30 fractions has been studied quantitatively in the domestic pig. The NSD formula fails to predict the correct variation in dose for changes in the number of fractions so as to produce comparable levels of connective tissue damage even over the clinically used range from 6f./18d. to 3Of./39d.; the error in the prediction may amount to an excess dose of circa 30 per cent. The slope the iso-effect curve between 6 and 30 fractions is 0·46, compared with the combined fractionation and time factors of 0·33 in the NSD formula. The degree of late fibrosis did not correlate with the severity of the early skin reaction. The results suggest that the NSD formula is not suitable for use when planning new treatment schedules in which the number of dose fractions is reduced.