Optimization of High Dose Conformal Therapy

描述（由申请人提供）：该项目的总体目标是通过超出简单解剖的个体化治疗来改善癌症的高剂量适形放射治疗。先前的资助研究了计划优化，适形剂量分布，患者相关的几何不确定性和运动，以及治疗限制正常组织的剂量/体积公差边界，同时进行肿瘤剂量递增而不增加并发症。随着对整个治疗过程中的运动和设置不确定性的了解越来越多，以及新的成像技术导致反应和毒性的早期预测，我们现在有机会通过在整个治疗过程中纳入事件来优化和个性化每个患者的治疗。因此，该计划项目将致力于个性化和优化患者的整个计划/交付过程。 第一个项目将开发和评估全面的自适应优化方法，以便在整个治疗过程中优化计划，并在获得信息和事件时纳入这些信息和事件。第二个项目将研究在整个治疗过程中的几何和剂量测定患者模型的个性化，从基于人群的几何建模转向个性化模型，以适应治疗。第三个项目将继续进行脑和头颈部肿瘤的临床研究，采用剂量雕刻技术，使用放化疗和改进的成像研究反应的早期预测因子。第四个项目将继续使用剂量递增、放化疗和成像进行肝脏和肺部研究，以预测反应。这些项目得到了核心-行政和统计支持，核心-适应性治疗，核心-定量图像使用和核心-计算机软件支持的支持。研究人员拥有独特的技能和经验，这将导致这项工作的成功执行，在临床3-D治疗计划，适形治疗以及剂量递增和正常组织并发症的临床研究方面有18年的经验。

DESCRIPTION (provided by applicant): The overall objective of this program project is to improve high dose conformal radiation treatments for cancer by individualizing therapy beyond simple anatomy. The previous grant studied plan optimization, conformal dose distributions, patient related geometrical uncertainties and motion, and dose/volume tolerance boundaries for treatment limiting normal tissues while performing tumor dose escalation without increasing complications. With increasing knowledge of motion and setup uncertainty throughout treatment, and new imaging techniques leading to early predictors of response and toxicity, we now have the opportunity to optimize and individualize each patient's treatment by incorporating events throughout the treatment course. Thus, this program project will work to individualize and optimize the entire planning/delivery process for the patient. tThe first project will develop and evaluate comprehensive adaptive optimization methods, enabling optimization of plans for the entire treatment course incorporating information and events whenever they become available. The second project will study individualization of geometric and dosimetric patient models throughout the treatment course, moving from population-based geometric modeling to individualized models for adaptive treatment delivery. The third project will continue clinical studies of brain and head/neck tumors treated with dose-sculpting techniques, using chemoradiation and improved imaging studying early predictors of response. The fourth project will continue liver and lung studies using dose escalation, chemoradiation, and imaging for predictors of response. The projects are supported by Core - administrative and statistical support, Core - adaptive therapy, Core - quantitative image use, and Core - computer software support. The investigators possess a unique combination of skills and experience which will lead to successful performance of this work, with 18 years experience in clinical 3-D treatment planning, conformal therapy, and clinical studies of dose escalation and normal tissue complications.