Image Guided Intergrated Active Breath Hold Radiotherapy

描述（由申请人提供）：控制原发性肿瘤是癌症放射治疗的主要目标。增加递送至肿瘤的剂量提供了改善局部控制的方法。特别是对于肺癌患者，化疗诱导的器官运动阻碍了安全剂量递增。近年来，已经开发了补偿这种运动或抑制肿瘤的方法。然而，这些新技术的应用并没有与能够实现剂量递增的降低幅度相一致，因为缺乏表征放射性诱导器官运动的不确定性的数据。关键是要确定与肿瘤固定相关的不确定性，以便能够使用适当的边缘。我们的假设是，图像引导技术和集成主动屏气放疗的组合将使表征和减少的几何不确定性，由于解剖学诱导的器官运动。主动呼吸控制（ABC）已被证明是一种安全有效的乳腺癌患者肿瘤固定方法，可以减少心脏和肺等正常组织结构的剂量。然而，对于肺癌患者，ABC技术必须适应于增加具有肺顺应性问题的患者的顺应性。此外，图像引导技术与ABC放射治疗的集成使得能够表征和减少日常设置变化和固定不确定性。本计画的具体目标为：（1）量测整合式主动屏气放射治疗肿瘤固定的随机与系统不确定度。(2)评估模型图像引导策略是否存在这些不确定性，并设计治疗裕度以补偿这些不确定性。(3)量化少量患者中的残余摆位误差。

DESCRIPTION (provided by applicant): Control of the primary tumor is a major goal of radiotherapy for cancer. Escalating the dose delivered to the tumor provides a method to improve local control. For lung cancer patients in particular, respiratory-induced organ motion has impeded safe dose escalation. Methods to compensate for this motion or to immobilize the tumor have been developed in recent years. However, these new technologies have not been applied in concert with reduced margins that would enable dose escalation due to the lack of data characterizing uncertainty in respiratory-induced organ motion. It is critical to characterize the uncertainties associated with tumor immobilization to enable the use of appropriate margins. It is our hypothesis that the combination of image guidance techniques and integrated active breath hold radiotherapy will enable characterization and reduction of the geometric uncertainties due to respiratory-induced organ motion. Active breathing control (ABC) has been shown to be a safe and effective means of tumor immobilization for breast cancer patients which allows for the reduction of the dose to normal tissue structures such as the heart and lungs. For lung cancer patients, however, the ABC technique must be adapted to increase compliance for patients with pulmonary compliance issues. Furthermore, the integration of image guidance techniques with ABC radiotherapy enables the characterization and reduction of daily setup variation and immobilization uncertainty. The specific aims of this project are to (1) Measure the random and systematic uncertainties of tumor immobilization for integrated active breath hold radiotherapy. (2) Evaluate a model image-guidance strategy with respect to the presence of these uncertainties and to design a treatment margin to compensate for these uncertainties. (3) Quantify residual setup error in a small population of patients.