OPTIMIZATION OF HIGH DOSE CONFORMAL THERAPY

本计划项目的总体目标是继续研究和改进癌症的高剂量适形放射治疗方法。之前的计划项目研究了计划优化、适形剂量传递技术、患者相关的几何不确定性，并帮助定义了治疗限制正常组织的剂量/体积耐受性边界，同时表明适形治疗允许显著提高肿瘤剂量而不会增加并发症。目前，越来越复杂的工具(自动优化软件、调强放射治疗(IMRT)、患者和目标体积定位的改进方法以及开始更全面地描述组织对辐射的反应的模型)可用于利用上一笔赠款的进展，进一步优化个别患者的治疗。因此，该计划项目将致力于优化整个治疗计划和交付过程。项目1将审查和评价增强的自动化优化能力，其中开始包括规划/交付过程的所有相关部分。项目2将调查和评估不同优化策略和调强放射治疗交付能力的剂量学影响和限制。项目3将研究和评估将患者相关的几何不确定性纳入到共形剂量分布的计算、汇编和处理中的益处。项目4将治疗患者达到前所未有的高剂量水平，因为它完成了脑、肝和肺的正常组织耐受剂量递增试验，完成了头/颈和前列腺的正常组织剂量减少研究，并进入第二阶段(肺、肝、脑)和头/颈和前列腺递增试验。这些项目得到核心A(行政和统计支助)、核心B(自动化治疗提供过程)、核心C(优化治疗计划/提供过程的质量保证)和核心D(计算机软件支持)的支持。研究人员拥有成功完成这项工作的独特能力组合，基于超过14年的临床3-D治疗计划、适形治疗、剂量递增和计算机控制治疗交付方面的经验。

DESCRIPTION (Applicant's Description) The overall objective of this program project is to continue the study and improvement of high dose conformal radiation therapy treatments for cancer. The previous program project studied plan optimization, conformal dose delivery techniques, patient related geometrical uncertainties, and helped define the dose/volume tolerance boundaries of treatment limiting normal tissues while showing that conformal therapy allowed significantly higher tumor doses to be delivered without increasing complications. Currently, increasingly sophisticated tools (automated optimization software, intensity modulated radiation therapy (IMRT), improved methods for patient and target volume localization and models to begin to more fully characterize the response of tissues to irradiation) are available to leverage the progress of the previous grant toward further optimization of individual patient treatments. Thus, this program project will work to optimize the entire treatment planning and delivery process. Project 1 will examine and evaluate enhanced automated optimization capabilities which begin to include all relevant parts of the planning/delivery process. Project 2 will investigate and evaluate the dosimetric impact and limitations of different optimization strategies and IMRT delivery capabilities. Project 3 will research and evaluate the benefits of inclusion of patient-related geometric uncertainties into the calculation, compilation and treatment of conformal dose distributions. Project 4 will treat patients to unprecedented high dose levels as it completes normal tissue tolerance dose escalation trials in the brain, liver, and lung, finishes normal tissue dose reduction studies in the head/neck and prostate, and moves on to Phase II (lung, liver, brain) and head/neck and prostate escalation trials. The projects are supported by Core A (administrative and statistical support), Core B (automated treatment delivery process), Core C (quality assurance for an optimized treatment planning/delivery process), and Core D (computer software support). The investigators possess a unique combination of capabilities to successfully perform this work, based on more than 14 years experience in clinical 3-D treatment planning, conformal therapy, dose escalation, and computer-controlled treatment delivery.