4D IMRT: Stereotactic body radiotherapy for lung cancer

描述(由申请人提供)： 在肺癌患者管理方面有几个趋势，所有这些都导致接受立体定向全身放射治疗(SBRT)的患者数量增加。趋势是：(1)通过筛查计划增加肺癌的发现；(2)使用当前技术和技术的肺SBRT试验有希望的结果；(3)对于医学上可操作的患者，SBRT的结果与手术相似，从而导致开放的II期和III期试验。肺SBRT是一种利用高精度、大剂量辐射消融肺肿瘤组织的新兴技术。尽管在大多数研究中局部控制都很好，但在目前的放射治疗技术中使用消融性放射剂量的成本是发病率，在某些情况下是死亡率。为这笔赠款提出的研究旨在通过几项技术发展和相关研究显著降低肺SBRT的毒性。首先，我们将与优化专家合作解决四维约束治疗规划问题；通过将解剖随时间的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，我们将结合两种治疗内成像方式，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，这一位置估计将被用来将强度调制的射线实时引导到移动的肿瘤上，以提供前所未有的治疗一致性和正常组织剂量的减少。第四，将与一名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伪影和PET/CT扫描中的目标描绘错误，并有助于在放射治疗期间改善治疗束与肿瘤的对准。这种管理肿瘤运动的综合和多学科方法将为放射肿瘤学团队提供更好的放射束肿瘤靶向和整合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，并对肺癌的治疗产生广泛的影响。 公共卫生相关性： 肺立体定向全身放射治疗(SBRT)因其良好的局部控制率和生存率而日益成为早期肺癌的治疗手段。然而，发病率，以及在某些情况下的死亡率，是使用现有技术造成的。这一综合性、多学科的研究计划将开发改进的治疗计划、图像指导和治疗交付方法，以提供前所未有的放射束肿瘤靶向。因此，照射的健康组织的数量和相关的治疗毒性将会减少，从而改善肺癌患者的健康。

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.