Early-Stage Clinical Trial of AI-Driven CBCT-Guided Adaptive Radiotherapy for Lung Cancer

项目摘要 立体定向放射治疗是治疗早期非小细胞肺癌的有效方法 癌症，但其准确性可能受到多种因素的影响。在模拟和 在治疗的第一天，目标和危险器官的大小和位置可能会在一个过程中发生变化， 治疗过程中，胸腔处于恒定的多维运动中。自适应辐射可以提高精度 的SBRT，但实施它的工作流程中的一个忙碌繁忙的放射肿瘤诊所目前需要重新- 模拟和重新规划，耗费宝贵的部门时间和资源。锥形束计算机 在递送每个部分之前，每天获得断层扫描（CBCT）扫描，但是它们用于自适应成像的实用性。 放射治疗受到其图像质量的限制。处理时间也仍然是一个重大障碍， 基于实时深度学习的方法。因此，我们提出的研究目标是开发， 在早期临床试验中验证和测试使用我们的两部分锥形束计算机断层扫描的可行性- 基于深度学习的剂量验证方法，基于快速准确生成高质量 合成CT和多器官分割。在这个项目中，我们将追求两个具体目标：1）开发 改进基于CBCT的合成CT，以提高CBCT质量; 2）评估临床可行性 我们的合成CT剂量验证早期临床试验将前瞻性招募早期- 接受明确SBRT的分期非小细胞肺癌。验证了该方法的可行性， 这是实现我们实施实时肺癌的长期目标的必要中间步骤 自适应辐射，这将允许增加对靶体积的较高剂量和对靶体积的较低剂量的准确性。 危及器官，从而改善局部控制并降低患者的辐射相关风险和毒性 非小细胞肺癌

PROJECT SUMMARY Stereotactic body radiation therapy (SBRT) is a highly effective treatment for early-stage non-small cell lung cancer, but its accuracy can be compromised by multiple factors. There is an interval between simulation and the first day of treatment, the size and position of targets and organs at risk can shift over a course of treatment, and the thorax is in constant multidimensional motion. Adaptive radiation can improve the accuracy of SBRT, but implementing it within the workflow of a busy radiation oncology clinic currently requires re- simulation and re-planning, costing valuable departmental time and resources. Cone beam computed tomography (CBCT) scans are obtained daily prior to the delivery of each fraction, but their utility for adaptive radiation therapy has been limited by their image quality. Processing time also remains a significant barrier for real-time deep learning-based methodologies. The objective of our proposed research is therefore to develop, validate, and test in an early clinical trial the feasibility of using our two-part cone-beam computed tomography- based deep learning method for dose verification based on rapid and accurate generation of high quality synthetic CTs and multi-organ segmentation. In this project, we will pursue two Specific Aims: 1) to develop and refine CBCT-based synthetic CTs for CBCT quality improvement, and 2) to evaluate the clinical feasibility of our synthetic CT-based dose verification. The early clinical trial will prospectively enroll patients with early- stage non-small cell lung cancer receiving definitive SBRT. Validation of the feasibility of this method is a necessary intermediate step towards our longer-term goal of the implementation of real-time lung cancer adaptive radiation, which will allow for increased accuracy of higher dose to target volumes and lower doses to organs at risk, thereby improving local control and decreasing radiation-related risks and toxicities for patients with non-small cell lung cancer.