Four-dimensional Adaptive Thoracic Radiotherapy

四维适应性胸部放射治疗

• 批准号: 7806514
• 负责人: PAUL J KEALL
• 金额: $ 30.52万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-04-16 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7806514
• 关键词: Abdomen; Accounting; Address; Affect; Algorithms; Anatomic Models; Anatomy; Biological; Breathing; Bronchi; Chest; Classification; Clinical; Clinical Data; Clinical Research; Clinical Trials; Collaborations; Cost-Benefit Analysis; Data; Data Collection; Development; Dose; Ensure; Esophagus; Four-dimensional; Fractionation; Goals; Heart; Image; Imaging Techniques; Imaging technology; Intensity-Modulated Radiotherapy; Intervention; Location; Lung; Lung Neoplasms; Malignant neoplasm of lung; Measures; Methods; Metric; Modeling; Morphologic artifacts; Motion; Non-Small-Cell Lung Carcinoma; Optics; Outcome; Patient Representative; Patients; Phase; Positioning Attribute; Process; Radiation; Radiation therapy; Relative (related person); Research Infrastructure; Research Personnel; Residual state; Respiration; Safety; Sampling; Shapes; Signal Transduction; Site; Source; Surface; System; Techniques; Testing; Therapeutic; Time; Tissue Model; Tissues; Toxic effect; Treatment Protocols; Uncertainty; Variant; X-Ray Computed Tomography; base; cancer radiation therapy; clinical application; cohort; cone-beam computed tomography; data acquisition; design; image reconstruction; image registration; improved; process optimization; programs; reconstruction; respiratory; response; simulation; skeletal; soft tissue; tool; treatment planning; tumor; vector; virtual

Recent clinical data demonstrates a clear dose-tumor response relationship for both conventional fractionation and hypofractionated nonsmall-cell lung cancer radiotherapy; several large studies confirm the dose-toxicity relationship for lung, esophagus, heart and bronchus. However, lung tumors move with respiration, change position with respect to skeletal anatomy from day to day, and generally decrease in volume during a course of radiotherapy. These anatomic changes hinder the accurate imaging, planning and delivery of thoracic radiotherapy and, hence, impede our ability to maximize the therapeutic window between local control/survival and treatment-induced complications. Developments in respiratory gating, breath-hold radiotherapy and four-dimensional (4D) radiotherapy account for some of the respiratory motion issues, however, these techniques have introduced additional problems that have yet to be addressed. For example, respiratory irregularities in the 4D CT acquisition process manifest themselves as image artifacts and subsequently as systematic errors throughout the entire treatment course. Temporal variations between anatomy motion and the respiratory signal used as a surrogate for this motion introduce significant errors, since the correlation between the surrogate and anatomy motion is location-dependent, and anatomy and surrogate motions vary from cycle to cycle and day today. The overall goal of the project is to systematically quantify anatomic variations throughout a course of radiotherapy for a representative patient cohort, develop strategies to mitigate the effect of the variations, and, thereby, minimize their clinical impact whilst rigorously accounting for the residual uncertainties. To achieve the goal the specific aimsare: (1) To conduct a clinical imaging study to quantify the magnitude and distribution of inter- and intrafraction anatomic variations, including the temporal stability of the tumor/respiration signal correlation. (2) To improve the acquisition and reconstruction of 4D CT images by (a) advancing the 4D CT data collection process and (b) evaluating 4D CT image reconstruction using different respiratory inputs, in addition to quantifying the uncertainty of deformable image-registration algorithms, a core tool for 4D IGART. (3) To develop and investigate the efficacy of inter- and intrafraction probabilistic-based 4D IGART strategies for clinical application and to perform simulation studies to determine the dosimetric and biological improvement gains from the 4D IGART system. The culmination of the project is the clinical implementation of 4D IGART safety and efficacy studies.

最近的临床数据表明，两种传统药物均具有明确的剂量-肿瘤反应关系。 分割和大分割非小细胞肺癌放疗；几项大型研究证实 肺、食道、心脏和支气管的剂量毒性关系。然而，肺部肿瘤会随着移动 呼吸，每天改变相对于骨骼解剖结构的位置，并且通常会减少 放射治疗过程中的体积。这些解剖学变化阻碍了准确的成像、规划 和胸部放射治疗的实施，因此阻碍了我们最大化治疗窗口的能力 局部控制/生存与治疗引起的并发症之间的关系。 呼吸门控、屏气放射治疗和四维（4D）放射治疗的进展 解释了一些呼吸运动问题，但是，这些技术引入了额外的 尚未解决的问题。例如，4D CT 采集中的呼吸不规则 过程表现为图像伪影，随后表现为整个过程中的系统错误 疗程。解剖运动和用作呼吸信号的时间变化 该动议的替代项会引入重大错误，因为替代项和 解剖运动取决于位置，并且解剖运动和替代运动因周期而异，并且 日复一日。 该项目的总体目标是系统地量化整个过程中的解剖变化 对代表性患者队列进行放射治疗，制定减轻变化影响的策略， 从而最大限度地减少其临床影响，同时严格考虑剩余的不确定性。到 实现目标的具体目标是： (1) 进行临床影像学研究以量化内部和外部的大小和分布 分次内解剖变化，包括肿瘤/呼吸信号相关性的时间稳定性。 (2) 通过 (a) 推进 4D CT 数据来改进 4D CT 图像的采集和重建 收集过程和（b）使用不同的呼吸输入评估 4D CT 图像重建， 除了量化可变形图像配准算法的不确定性之外，它也是一个核心工具 4D IGART。 (3) 开发和研究基于分次间和分次内概率的 4D IGART 的功效 临床应用策略并进行模拟研究以确定剂量学和生物学 4D IGART 系统的改进收益。 该项目的高潮是 4D IGART 安全性和有效性研究的临床实施。