Better correlation of outcomes with MC dose calculation

描述（由申请人提供）：使用更精确的剂量计算算法进行放射治疗计划的临床效用尚未在许多临床地点得到证实。尽管越来越复杂和精确的剂量计算方法，如蒙特卡罗和卷积/叠加在过去十年中越来越多地用于临床研究，但尚未对这些算法获得的更准确的剂量分布在改善临床患者预后方面的有用性进行直接研究。在本研究中，我们将使用两项适形治疗研究（头颈部腮腺保护和非小细胞肺癌剂量递增）的临床结果来研究使用更精确的蒙特卡罗方法计算的剂量分布是否会改善临床患者结果与计算剂量分布之间的相关性。由于两项临床研究的临床并发症和局部控制都有很好的记录，并且这些方案的患者可以获得完整的3-D患者解剖和治疗信息，因此这些数据提供了一个独特的机会，可以通过回顾性研究来评估由于改进剂量计算而导致的临床改善的潜力。为实现上述目标，我们必须：(a)对与相关临床几何形状非常相似的幻影测量进行必要的算法验证，(b)使用经过验证的准确计算方法重新评估在头颈部和肺部进行的适形治疗试验中给予患者的剂量分布。并确定临床结果（并发症和局部控制）与更精确的计算结果的相关性是否优于与原始结果的相关性。

DESCRIPTION (provided by applicant): The clinical utility of the use of more accurate dose calculation algorithms for radiotherapy treatment planning has not yet been shown for many clinical sites. Although increasingly sophisticated and accurate dose calculation methods such as Monte Carlo and convolution/superposition have over the past decade become increasingly available for clinical study, direct study of the usefulness of the more accurate dose distributions obtained with these algorithms in terms of improving clinical patient outcomes has not been performed. In this study, we will use the clinical outcomes from two conformal therapy treatment studies (parotid-sparing in the head/neck and dose escalation for non-small cell lung cancer) to investigate whether dose distributions calculated with the more accurate Monte Carlo method will improve the correlation between the clinical patient outcomes and the calculated dose distributions. Since both clinical complications and local control for the two clinical studies are well-documented, and the full 3-D patient anatomy and treatment information is available for the patients on those protocols, these data provide a unique opportunity to evaluate the potential for clinical improvements due to improved dose calculations with a retrospective study. To accomplish the proposed goal, we must: (a) perform the necessary algorithmic verification against measurements made in phantoms that closely resemble the relevant clinical geometries, and (b) use the validated and accurate calculational method to re-evaluate the dose distributions delivered to patients treated on the conformal therapy trials performed in the head/neck and lung, and determine if the clinical outcomes (complications and local control) are better correlated with the more accurate calculational results than with the original results.