Better correlation of outcomes with MC dose calculation

描述（由申请人提供）：许多临床研究中心尚未显示使用更准确的剂量计算算法进行放射治疗计划的临床效用。尽管在过去的十年中，越来越复杂和准确的剂量计算方法，如蒙特卡罗和卷积/叠加，已越来越多地用于临床研究，直接研究的有用性，更准确的剂量分布获得这些算法在改善临床患者的结果还没有进行。在本研究中，我们将使用两项适形治疗研究（头颈部腮腺保留和非小细胞肺癌剂量递增）的临床结果来研究使用更准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的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详细记录，并且这些方案中的患者可获得完整的3-D患者解剖结构和治疗信息，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评价由于改进剂量计算而导致的临床改善潜力。为实现拟议目标，我们必须：（a）针对在体模中进行的非常类似于相关临床几何形状的测量进行必要的算法验证，以及（B）使用经验证的准确计算方法重新评估输送给在头部/颈部和肺部进行的适形治疗试验中治疗的患者的剂量分布，并确定临床结果（并发症和局部控制）是否与更准确的计算结果比与原始结果更好地相关。

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.