Clinical Evaluation of Real-Time MV/kV Image Guided Prostate Radiation Therapy

实时 MV/kV 图像引导前列腺放射治疗的临床评价

• 批准号: 8005321
• 负责人: Lei Xing
• 金额: $ 33.2万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8005321
• 关键词: Adverse effects; Affect; Algorithms; Cancer Patient; Clinical; Clinical Research; Devices; Discipline; Disease; Dose; Goals; Gold; Hybrids; Image; Imaging Device; Imaging Techniques; Implant; Intensity-Modulated Radiotherapy; Investigation; Lead; Location; Malignant neoplasm of prostate; Methods; Modification; Monitor; Motion; Movement; Nature; Noise; Normal tissue morphology; Organ; Outcome; Patient Care; Patients; Probability; Problem Solving; Prostate; Protocols documentation; Radiation; Radiation Oncology; Radiation therapy; Recruitment Activity; Research; Research Ethics Committees; Series; Shapes; System; Techniques; Testing; Time; Uncertainty; Work; base; clinical efficacy; clinical practice; efficacy evaluation; imaging modality; improved; innovation; irradiation; novel; public health relevance; research clinical testing; research study; simulation; statistics; tool; tumor

DESCRIPTION (provided by applicant): Intra-fractional organ motion is a predominant limiting factor for the maximum exploitation of modern prostate intensity modulated radiation therapy (IMRT) or volumetric modulated radiation therapy (VMAT). Adverse influence of the organ motion is further aggravated in hypofractionated treatment because of protracted dose delivery. In this project we will develop a real-time fiducial tracking strategy using a combined MV and kV imaging to solve the problem of intra-fraction prostate movement. The underlying hypothesis of this work is that real-time image guided prostate radiation therapy will greatly reduce the uncertainty in beam targeting and provide substantially improved dose distributions required to achieve greater local tumor control while reducing the probability of normal tissue complications. Specific aims of the project are to (1) Refine a hybrid MV/kV image acquisition protocol for IMRT and VMAT; (2) Evaluate the potential clinical impact of the hybrid image guidance technique through a pilot clinical study. Successful completion of this investigation will provide radiation oncology discipline a critically needed means to treat prostate cancer, and afford a powerful way for us to safely and reliably escalate the radiation dose using IMRT/VMAT. Given its significant promise to optimally cater for intra-fractional uncertainties, successful completion of the project should lead to substantial improvement in prostate cancer patient care. PUBLIC HEALTH RELEVANCE: In current prostate intensity modulated radiation therapy (IMRT) or volumetric modulated radiation therapy (VMAT), the adverse effect of intra-fractional prostate motion is compensated by introducing a large PTV margin, which leads to irradiation of adjacent critical organs and limits the prostate dose escalation. With the goal of rapidly deploying a previously developed kV/MV real-time tumor tracking technique into routine clinical practice, in this R21 application we plan to conduct a series of evaluations of the efficacy and clinical potential of the real-time image guidance strategy for prostate radiation therapy. Successful completion of this investigation will provide a critically needed means for treating prostate cancer and afford a powerful way for us to safely and reliably escalate radiation dose using IMRT.

描述（由申请人提供）：分次内器官运动是最大限度利用现代前列腺调强放射治疗（IMRT）或体积调强放射治疗（VMAT）的主要限制因素。在大分割治疗中，由于剂量输送延长，器官运动的不良影响进一步加重。在这个项目中，我们将开发一个实时基准跟踪策略，使用MV和kV成像相结合，以解决部分内前列腺运动的问题。这项工作的基本假设是，实时图像引导的前列腺放射治疗将大大降低射束靶向的不确定性，并提供大幅改善的剂量分布，以实现更大的局部肿瘤控制，同时降低正常组织并发症的概率。该项目的具体目标是（1）完善IMRT和VMAT的混合MV/kV图像采集协议;（2）通过试点临床研究评价混合图像引导技术的潜在临床影响。 这项研究的成功完成将为放射肿瘤学学科提供一种治疗前列腺癌的急需手段，并为我们提供一种强有力的方法来安全可靠地使用IMRT/VMAT逐步增加辐射剂量。鉴于其重要的承诺，以最佳地满足部分内的不确定性，该项目的成功完成应导致前列腺癌患者护理的实质性改善。 公共卫生相关性：在当前的前列腺调强放射治疗（IMRT）或体积调强放射治疗（VMAT）中，通过引入大的PTV裕度来补偿分次内前列腺运动的不利影响，这导致对相邻关键器官的照射并限制前列腺剂量递增。为了将先前开发的kV/MV实时肿瘤跟踪技术快速部署到常规临床实践中，在本R21应用中，我们计划对前列腺放射治疗的实时图像引导策略的有效性和临床潜力进行一系列评价。这项研究的成功完成将为前列腺癌的治疗提供一种急需的手段，并为我们提供一种安全可靠的方法来提高IMRT的辐射剂量。