4D IMRT: Stereotactic body radiotherapy for lung cancer

描述（由申请人提供）： 肺癌患者管理有几个趋势，所有这些趋势都导致接受立体定向体部放疗（SBRT）治疗的患者数量增加。这些趋势是：（1）通过筛查计划增加肺癌检测;（2）使用当前技术和工艺的肺SBRT试验的有希望的结果;以及（3）SBRT与可手术患者手术的结果相当，导致开放II期和III期试验。肺SBRT是一种新兴的技术，利用高精度和大辐射剂量消融肺肿瘤组织。尽管在大多数研究中有很好的局部控制，但在当前的放射治疗技术中使用消融性辐射剂量的成本是发病率，在某些情况下是死亡率。这项研究的目的是通过几项技术开发和相关研究来显着降低肺SBRT的毒性。首先，我们将与优化专家合作解决四维约束治疗计划问题;通过将随时间的解剖学变化作为优化中的额外自由度来创建改进的治疗计划。其次，我们将结合联合收割机两种治疗内成像模式，外部和内部，以获得整个放射治疗过程中目标运动的实时估计。第三，该位置估计将被用于将强度调制辐射的射束以真实的时间引导到移动的肿瘤，以提供前所未有的治疗适形性和正常组织剂量降低。第四，将与音乐家和设计专家合作开发呼吸视听生物反馈工具。该工具将改善肺部SBRT患者的呼吸规律性，从而减少PET/CT扫描上的PET/CT伪影和靶勾画误差，并促进放射输送期间改善治疗射束-肿瘤对准。这样一个全面的和多学科的方法来管理肿瘤的运动将提供放射肿瘤团队上级放射束肿瘤靶向和适形性的方法来治疗早期肺癌患者。我们预计这项研究最终将导致治疗结果的可衡量的改善，并对肺癌管理产生广泛的影响。 公共卫生相关性： 肺立体定向体部放射治疗（SBRT）是一种越来越多地用于治疗早期肺癌的治疗方法，因为有希望的局部控制和生存率。然而，使用现有技术会导致发病率，在某些情况下还会导致死亡率。这个综合性的多学科研究项目将开发改进的治疗计划，图像引导和治疗方法，以提供前所未有的放射束肿瘤靶向。因此，健康组织的辐射量和相关的治疗毒性将减少，从而改善肺癌患者的健康状况。

DESCRIPTION (provided by applicant): There are several trends in lung cancer patient management, all leading to an increase in the number of patients being treated with stereotactic body radiotherapy (SBRT). The trends are: (1) increased lung cancer detection through screening programs; (2) promising results of lung SBRT trials using current techniques and technology; and (3) comparable results of SBRT to surgery for medically operable patients leading to open phase II and III trials. Lung SBRT is an emerging technique utilizing high precision and large radiation doses to ablate lung tumor tissue. Despite excellent local control in most studies, the cost of using ablative radiation doses with current radiotherapy technology is morbidity, and in some cases mortality. The research proposed for this grant aims to significantly reduce the toxicity of lung SBRT through several technological developments and associated investigations. First we will solve the four-dimensional constrained treatment planning problem in collaboration with optimization experts; improved treatment plans will be created by including anatomic changes with time as an additional degree of freedom in the optimization. Second, we will combine two intra-treatment imaging modalities, external and internal, to obtain a real-time estimate of the target motion throughout the radiation treatment. Third, this position estimate will be used to direct beams of intensity modulated radiation to moving tumors in real time to offer unprecedented treatment conformality and normal tissue dose reduction. Fourth, a respiratory audiovisual biofeedback tool will be developed in collaboration with a musician and design expert. This tool will improve respiratory regularity for lung SBRT patients and thus decreasing PET/CT artifacts and target delineation errors on PET/CT scans and facilitating improved treatment beam-tumor alignment during radiation delivery. Such a comprehensive and multidisciplinary approach to manage tumor motion will offer the radiation oncology team superior radiation beam-tumor targeting and conformality methods to treat early stage lung cancer patients. We expect the research will ultimately result in a measurable improvement in treatment outcome and have a widespread impact on lung cancer management. PUBLIC HEALTH RELEVANCE: Lung stereotactic body radiotherapy (SBRT) is an increasingly used treatment for early stage lung cancer due to promising local control and survival rates. However, morbidity, and in some cases mortality, result using current technology. This comprehensive, multidisciplinary research program will develop improved treatment planning, image guidance and treatment delivery methods to offer unprecedented radiation beam-tumor targeting. Consequently the amount of healthy tissue irradiated and associated treatment toxicity will be reduced, resulting in improved health of lung cancer patients.