Image Guided Integrated Active Breath Hold Radiotherapy

描述（由申请人提供）：控制原发肿瘤是癌症放射治疗的主要目标。增加给肿瘤的剂量提供了一种改善局部控制的方法。特别是对于肺癌患者，呼吸诱导的器官运动阻碍了安全剂量的增加。补偿这种运动或固定肿瘤的方法近年来得到了发展。然而，由于缺乏表征呼吸诱导器官运动不确定性的数据，这些新技术的应用并没有减少边际，从而使剂量增加。表征与肿瘤固定相关的不确定性，以便使用适当的切缘是至关重要的。我们的假设是，结合图像引导技术和综合主动屏气放疗将能够表征和减少由于呼吸诱导的器官运动引起的几何不确定性。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手段，可以减少对正常组织结构（如心脏和肺部）的剂量。然而，对于肺癌患者，ABC技术必须适应，以增加患者的肺顺应性问题。此外，图像引导技术与ABC放射治疗的集成能够表征和减少日常设置变化和固定不确定性。本项目的具体目的是：(1)测量综合主动屏气放疗中肿瘤固定的随机和系统不确定性。(2)就这些不确定性的存在评估模型图像引导策略，并设计一个处理余量来补偿这些不确定性。(3)量化小群体患者的残差设置误差。

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.