OPTIMIZATION OF HIGH DOSE CONFORMAL THERAPY

这个项目的总体目标是研究几个主要的 大剂量适形治疗的组成部分，以优化我们的 计划和提供这种治疗的能力。只有在 适形治疗涉及的技术和临床问题有 了解和优化将正式的临床疗效测试 有可能。这里提出的项目将使我们的能力优化到1) 计划和评估适形计划，2)创建复杂的剂量 分布，3)提高我们处理的几何精度 患者，以及4)确定肿瘤的临床剂量限制和 用于这些适形治疗的正常组织剂量。 密歇根大学有独特的能力来完成这项工作， 基于其六年的临床三维治疗计划经验 和使用静态适形疗法的剂量递增， 几台电脑控制的适形治疗机，四年 关于提供适形治疗所使用的方法学的工作。 在项目1中，我们将开发几种方法来优化 用于计算机控制适形治疗的治疗计划 技术，包括交互、体积和计算机自动化 优化技术，然后执行临床治疗计划 评价这些技术在临床中的应用价值的研究 在项目4中研究的处理地点。在项目2中，我们将开发 几种技术可以优化我们的能力，创造出想要的东西 剂量分布，通过使用共形场整形和束流 强度调制，并随后评估临床 限制了各种技术的局限性和有用性。在项目3中，我们 将研究患者定位和目标的精确度 可以实现批量验证，并将制定方法将其降至最低 必须使用的几何边距。在项目4中，我们使用了一系列 前列腺、脑、肝和肺的临床剂量递增试验 癌症，以及头颈部正常组织剂量减少的研究 面积，试图获得肿瘤和正常组织的耐受剂量 允许优化剂量分布的限制，该剂量分布 应该为这些不同的疾病提供。所有四个项目都是 由三个核心支持：核心A，支持管理和 计划项目的统计数据；核心B，提供临床 物理、治疗计划和剂量学支持；以及核心C，它 支持需要的计算机编程和数字图像支持 各种各样的项目。

The overall objective of this program project is to study several major components of high dose conformal therapy in order to optimize our ability to plan and deliver this kind of therapy. Only after the technical and clinical issues involved in conformal therapy are understood and optimized will formal tests of the clinical efficacy be possible. The projects proposed here will optimize our ability to 1) plan and evaluate conformal plans, 2) create sophisticated dose distributions, 3) improve the geometrical precision with which we treat patients, and 4) determine the clinical dose constraints for tumor and normal tissue doses which will be used for these conformal treatments. The University of Michigan has a unique ability to perform this work, based on its six years of experience with clinical 3-D treatment planning and dose escalation using static conformal therapy, the availability of several computer-controlled conformal therapy machines, and four years of work on the methodology to be used for conformal treatment delivery. In Project 1, we will develop several methods for optimization of treatment plans for use with computer-controlled conformal therapy techniques, including interactive, volumetric, and computer-automated optimization techniques, and then perform a clinical treatment planning study to evaluate the usefulness of the techniques in the clinical treatment sites studied in Project 4. In Project 2, we will develop several techniques which should optimize our ability to create desirable dose distributions, through the use of conformal field shaping and beam intensity modulation, and followed by evaluation of the clinical constrains and usefulness of the various techniques. In Project 3, we will study the precision with which patient localization, and target volume verification can be achieved, and will develop methods to minimize the geometric margins which must be used. In Project 4, we use a series of clinical dose escalation trials in prostate, brain, liver, and lung cancer, and a normal tissue dose reduction study in the head and neck area, to attempt to obtain the tumor and normal tissue tolerance dose limits which will allow the optimization of the dose distributions which should be delivered for these various diseases. All four projects are supported by three cores: Core A, which supports administration and statistics for the program project; Core B, which provides clinical physics, treatment planning and dosimetry support; and Core C, which supports computer programming and digital imaging support required by the various projects.