Optimization of High Dose Conformal Therapy

描述(申请人提供)：该计划项目的总体目标是通过超越简单解剖的个体化治疗来改进癌症的高剂量适形放射治疗。之前的拨款研究了计划优化、适形剂量分布、患者相关的几何不确定性和运动，以及剂量/体积耐受性边界，用于限制正常组织的治疗，同时在不增加并发症的情况下执行肿瘤剂量升级。随着对整个治疗过程中运动和设置不确定性的了解不断增加，以及新的成像技术导致对反应和毒性的早期预测，我们现在有机会通过将事件纳入整个治疗过程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适应性优化方法，以便能够在有信息和事件可用时优化整个治疗过程的计划。第二个项目将研究整个治疗过程中几何和剂量学患者模型的个性化，从基于人群的几何建模转向个性化模型，以适应治疗提供。第三个项目将继续使用剂量雕刻技术治疗脑肿瘤和头颈部肿瘤的临床研究，使用化学放射治疗和改进的成像研究早期反应的预测因素。第四个项目将继续进行肝脏和肺的研究，使用剂量递增、化疗和成像来预测反应。这些项目得到了核心管理和统计支持、核心适应治疗、核心定量图像使用和核心计算机软件支持。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，他们在临床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拥有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.