INDIVIDUALIZING IMRT TREATMENT IN BRAIN AND HEAD/NECK CA

在我们之前的研究中，我们开发了用于头/颈部和脑肿瘤的高度适形放射治疗，使用 绘制了剂量分布，并展示了以最小的并发症升级肿瘤剂量的能力 (大脑)，并保持较高的控制率，同时减少头颈部癌症的主要并发症(口干症)。 我们的长期目标是通过个体化的时机和方法来提高肿瘤控制和降低并发症发生率 基于创新成像的治疗强度。我们建议通过升级来加强对胶质母细胞瘤的治疗。 每日分次剂量，同时使用有效的化疗(替莫唑胺)。我们将检验这一假设 弥散磁共振成像(Dmri)可以在治疗开始后早期预测肿瘤反应，这将是一个有用的基础。 在治疗过程中重新优化，允许将剂量递增到无反应的部分 肿瘤。我们还将利用我们的初步核磁共振结果，这些结果表明辐射可以打开血瘤- 对化疗和放射增敏剂(如吉他滨)的屏障。我们将测试一下 同时适形放疗和吉西他滨(在BTB打开后给予)将更安全和改善 3级胶质瘤的有效率，以及我们是否可以通过将剂量增加到以下部分来改善结果 肿瘤在治疗开始后早期表现为缺乏血小管通透性的增加。在头部和头部 对于宫颈癌，我们将测试承诺减少与治疗相关的晚期吞咽困难和误吸的策略。我们 将测试减少吞咽结构的剂量是否可以减轻晚期吞咽困难的严重程度，并测试 创新的成像(Flt-PET和dMRI)，以预测(治疗开始后早期)哪些肿瘤可能失败 治疗，以及使用重新优化计划指导个体化剂量强化。我们期待着 该项目将通过以下方式提高脑癌和头颈癌的非复杂肿瘤控制率 在分析可能的早期反应预测因素后，定制治疗强度。

In our previous research we developed highly conformal radiation treatment for head/neck and brain tumors using sculpted dose distributions and demonstrated the ability to escalate tumor dose with minimal complications (brain), and maintain high control rates while decreasing a major complication (xerostomia) for head/neck cancers. Our long-term goal is to increase tumor control and reduce complication rates by individualizing the timing and intensity of therapy based on innovative imaging. We propose to intensify treatment for glioblastoma by escalating the daily fraction doses while also utilizing effective chemotherapy (temozolomide). We will test the hypothesis that diffusion MRI (dMRI), which may predict tumor response early after therapy is started, will be a useful basis for re-optimization during the course of treatment, allowing the escalation of dose to non-responding parts of the tumor. We will also make use of our preliminary MRI results which suggest that radiation can open the bloodtumor- barrier (BTB) to chemotherapeutic and radiosensitizing agents (like gemitabine). We will test whether concurrent conformal radiation and gemcitabine (administered after the BTB is opened) will be safer and improve response rates for grade 3 gliomas, and whether we can improve the outcome by escalating the doses to the parts of the tumor demonstrating lack of increased permeability of the BTB early after the start of therapy. In head and neck cancer, we will test strategies that promise to decrease treatment-related late dysphagia and aspiration. We will test if reducing dose to the swallowing structures can reduce the severity of late dysphagia, and test the utility of innovative imaging (FLT-PET, and dMRI) to predict (early after the start of therapy) which tumors are likely to fail treatment, as well as directing individualized dose intensification using re-optimization plans. We expect that the Project will show improving non-complicated tumor control rates in brain and head and neck cancer by customizing treatment intensity following analysis of possible early predictors of response.