Enhancing Native American Participation in RT Trials

描述（由申请人提供）：位于南达科他州拉皮德城的癌症护理研究所（CCI）为来自三个保留地的大约10万名印第安人提供服务。一些病人住在离癌症中心4小时路程的地方。研究人员将对阻止印第安人出现早期癌症，或在某些情况下根本不会出现癌症的障碍进行调查。研究人员将随机选取未患癌症的印第安人，对他们进行问卷调查。第二份调查问卷将发给癌症患者，并解决类似的问题，但重点放在肿瘤学相关的其他问题上。据推测，一个主要的障碍是地理上的错位，远离家乡附近的文化/社区根源。传统的放射治疗包括6至8周的疗程和每日治疗。这种治疗方法可能是一个主要障碍。随着调强放疗和近距离放疗等先进技术的应用，治疗过程可缩短至1至4周。因此，为了解决这一障碍，已经开展了缩短治疗时间的临床试验。一系列的II期研究提出了常见于美洲原住民的恶性肿瘤：转移性疾病，非小细胞肺（NSCLC），乳腺癌，前列腺癌和头颈部（H和N）癌。对于I期和II期乳腺癌患者，高剂量率（HDR）近距离放疗将取代常规的外束放疗。晚期前列腺癌患者将接受为期2周的适形外束放射治疗，随后HDR植入联合雄激素消融。建议对转移性疾病、局部晚期H&N和非小细胞肺癌患者进行试验性ct治疗试验。最终的试点试验将调查单独使用HDR近距离治疗早期前列腺癌。可能存在一种基因环境，使印第安人对辐射更敏感。因此，通过外周血淋巴细胞HPLC测定的AT （ataxia-毛细血管扩张症）基因是否具有更高的突变率，我们将进行实验室研究。通过患者教育、筛查、评估医疗保健的潜在障碍和创新的治疗策略，希望美洲原住民最终能在他们的疾病过程中更早出现。

DESCRIPTION (provided by applicant): The Cancer Care Institute (CCI) in Rapid City, South Dakota, serves approximately 100,000 Native Americans from three reservations. Some patients live up to four hours from the cancer center. Identifying barriers which prevent Native Americans from presenting with earlier stages of cancer, or in some circumstances not at all, will be investigated. A culturally responsive questionnaire will be administered to randomly selected Native Americans on the reservation who do not have cancer. A second questionnaire will be given to cancer patients, and address similar issues, but concentrate on additional questions of oncologic relevance. It is hypothesized that a major barrier is geographic dislocation from cultural/community roots close to home. Traditional radiotherapy involves a 6 to 8 week course and daily treatments. This treatment approach may represent a major barrier. With the use of advanced technologies such as intensity modulated radiotherapy and brachytherapy, the treatment course can be shortened to 1 to 4 weeks. Therefore, to address this barrier, clinical trials have been developed which shorten treatment duration. A series of phase II studies are proposed for malignancies commonly seen among the Native Americans: metastatic disease, non-small cell lung (NSCLC), breast, prostate and head and neck (H and N) cancer. For patients with stage I and II breast cancer, high-dose-rate (HDR) brachytherapy will be substituted for a conventional course of external beam radiation. Patients with advanced prostate cancer will be treated with a 2 week course of conformal external beam radiation followed by an HDR implant in combination with androgen ablation. Pilot tomotherapy trials are proposed for patients with metastatic disease, locally advanced H&N, and NSCLC. The final pilot trial will investigate the use of HDR brachytherapy alone for early stage prostate cancer. A genetic milieu may exist which renders Native Americans more sensitive to radiation. Therefore, a laboratory study will be conducted to investigate whether Native Americans have a higher mutation rate of the AT (ataxia-telangiectasia) gene determined through HPLC of the peripheral blood lymphocytes. Through patient education, screening, assessing potential barriers to health care, and innovative treatment strategies, it is hoped that Native Americans will eventually present earlier in their disease process.