/**
 * Multimodal Oncology - Radiation and Surgical Oncology Integration
 *
 * ╔═══════════════════════════════════════════════════════════════════════════════╗
 * ║  MULTIMODAL ONCOLOGY - RADIATION AND SURGICAL TREATMENT INTEGRATION          ║
 * ╠═══════════════════════════════════════════════════════════════════════════════╣
 * ║  This module provides:                                                        ║
 * ║  - Radiation oncology protocols and dose calculations                        ║
 * ║  - Surgical oncology decision support                                        ║
 * ║  - Multimodal treatment sequencing                                           ║
 * ║  - Toxicity prediction and management                                        ║
 * ║  - Re-irradiation considerations                                             ║
 * ╚═══════════════════════════════════════════════════════════════════════════════╝
 */
export interface RadiationProtocol {
    indication: string;
    intent: 'Curative' | 'Adjuvant' | 'Neoadjuvant' | 'Palliative' | 'Definitive';
    technique: RadiationTechnique;
    fractionation: FractionationScheme[];
    targetVolumes: TargetVolume[];
    organAtRiskConstraints: OARConstraint[];
    combinationTherapy?: ConcurrentTherapy;
    expectedOutcomes: RadiationOutcome;
    toxicityProfile: RadiationToxicity;
}
export interface RadiationTechnique {
    modality: 'Photon EBRT' | 'IMRT' | 'VMAT' | 'SBRT/SABR' | 'SRS' | 'Proton' | 'Carbon Ion' | 'Brachytherapy' | 'TBI';
    deliveryMethod: string;
    imagingGuidance: string[];
    motionManagement?: string;
}
export interface FractionationScheme {
    name: string;
    totalDose: number;
    fractions: number;
    dosePerFraction: number;
    schedule: string;
    indication: string;
    biologicalEquivalentDose?: number;
}
export interface TargetVolume {
    name: 'GTV' | 'CTV' | 'PTV' | 'ITV';
    description: string;
    margin: string;
    dose: number;
}
export interface OARConstraint {
    organ: string;
    constraint: string;
    toxicityEndpoint: string;
    priority: 'Hard' | 'Soft';
}
export interface ConcurrentTherapy {
    agent: string;
    schedule: string;
    rationale: string;
    precautions: string[];
}
export interface RadiationOutcome {
    localControl: string;
    survivalBenefit: string;
    evidenceBasis: string;
}
export interface RadiationToxicity {
    acute: ToxicityEvent[];
    late: ToxicityEvent[];
    managementStrategies: string[];
}
export interface ToxicityEvent {
    type: string;
    incidence: string;
    severity: string;
    timing: string;
    management: string;
}
export declare const RADIATION_PROTOCOLS: Record<string, RadiationProtocol[]>;
export interface SurgicalProcedure {
    name: string;
    indication: string;
    intent: 'Curative' | 'Debulking' | 'Palliative' | 'Diagnostic' | 'Prophylactic';
    approach: SurgicalApproach[];
    oncologicPrinciples: string[];
    margins: MarginRequirement;
    lymphNodeAssessment: LymphNodeProtocol;
    perioperativeConsiderations: PerioperativeProtocol;
    outcomes: SurgicalOutcome;
}
export interface SurgicalApproach {
    technique: 'Open' | 'Laparoscopic' | 'Robotic' | 'Endoscopic' | 'Percutaneous';
    advantages: string[];
    disadvantages: string[];
    patientSelection: string[];
}
export interface MarginRequirement {
    recommended: string;
    minimum: string;
    impactOfPositiveMargin: string;
}
export interface LymphNodeProtocol {
    type: 'Sentinel Node' | 'Regional Dissection' | 'Sampling' | 'None';
    minimumNodes?: number;
    technique: string;
    indication: string;
}
export interface PerioperativeProtocol {
    preoperativeOptimization: string[];
    erpsProtocol: boolean;
    vteProhylaxis: string;
    antibioticProphylaxis: string;
    nutritionalConsiderations: string;
    neoadjuvantOptions?: string;
    adjuvantOptions?: string;
}
export interface SurgicalOutcome {
    mortality: string;
    morbidity: string;
    hospitalStay: string;
    oncologicOutcome: string;
}
export declare const SURGICAL_PROTOCOLS: Record<string, SurgicalProcedure[]>;
export interface MultimodalSequence {
    cancerType: string;
    stage: string;
    sequence: TreatmentPhase[];
    rationale: string;
    evidence: string;
}
export interface TreatmentPhase {
    phase: string;
    modality: 'Surgery' | 'Radiation' | 'Chemotherapy' | 'Targeted Therapy' | 'Immunotherapy' | 'Hormone Therapy';
    timing: string;
    details: string;
}
export declare const MULTIMODAL_SEQUENCES: MultimodalSequence[];
export declare class MultimodalOncologyEngine {
    getRadiationProtocol(site: string): RadiationProtocol[];
    getSurgicalProtocol(cancerType: string): SurgicalProcedure[];
    getMultimodalSequence(cancerType: string, stage: string): MultimodalSequence | undefined;
    calculateBED(totalDose: number, fractions: number, alphabeta?: number): number;
    assessOperability(performanceStatus: number, comorbidities: string[], cancerType: string): {
        operable: boolean;
        approach: string;
        considerations: string[];
    };
    getAllRadiationSites(): string[];
    getAllSurgicalSites(): string[];
}
export declare const multimodalOncologyEngine: MultimodalOncologyEngine;
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