Lung Sparing for SBRT with beam's-eye-view images and real time tumor tracking

SBRT 的肺保留，具有射束视野图像和实时肿瘤跟踪

• 批准号: 8191279
• 负责人: Ross I. Berbeco
• 金额: $ 23.28万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-06 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8191279
• 关键词: Adverse effects; Algorithms; Cancer Patient; Clinical; Clinical Research; Collimator; Colon Carcinoma; Complex; Conformal Radiotherapy; Coupled; Data; Detection; Diagnosis; Disease; Dose; Early Diagnosis; Engineering; Eye; Goals; Health; Human; Image; Implant; Incidence; Institutes; Knowledge; Lead; Linear Accelerator Radiotherapy Systems; Location; Lung; Lung Neoplasms; Malignant neoplasm of lung; Malignant neoplasm of prostate; Measurable; Measurement; Measures; Methods; Metric; Mind; Modeling; Monitor; Motion; National Institute of Biomedical Imaging and Bioengineering; Non-Small-Cell Lung Carcinoma; Normal tissue morphology; Optics; Outcome; Output; Patients; Physicians; Probability; Process; Radiation; Radiation therapy; Rectal Cancer; Relative (related person); Risk; Rotation; Shapes; Site; Staging; Structure; System; Techniques; Technology; Testing; Therapeutic; Time; Tissues; Toxic effect; Translating; Validation; Weight; base; clinically significant; cost; design; falls; implantation; improved; innovation; irradiation; malignant breast neoplasm; novel; patient population; phase 2 study; physical science; prospective; research and development; tool; treatment planning; tumor

DESCRIPTION (provided by applicant): More people in the U.S. die from lung cancer than from prostate, breast, colon and rectum cancers combined. Of the estimated 187,000 people in the U.S. who were diagnosed with non-small cell lung cancer (NSCLC) in 2009, over 37,000 of them presented with localized or early stage disease. This fraction is expected to grow as methods of early detection improve and become more widely disseminated. Stereotactic body radiation therapy (SBRT) has been shown to provide excellent local control (85%-95%) for early-stage lung cancer patients. However, a recent phase II study found Grade 3 or greater toxicities in a significant fraction of the patients, particularly those with centrally located tumors. Studies have shown that decreases in SBRT margins can significantly reduce the probability of normal tissue complications. As SBRT is increasingly becoming the therapy of choice for early-stage, localized non-small cell lung cancer, reducing the harmful side effects becomes increasingly important. We are proposing a novel failsafe technology to reduce toxicity while retaining local control for this growing population of patients. Our hypothesis is that tracking lung tumors directly during SBRT, using beam's-eye-view (BEV) imaging coupled with a dynamic multileaf collimator (DMLC), will lead to clinically significant normal tissue sparing. The current proposal is the first to employ an advanced multi- template marker-less BEV tracking algorithm to derive the real-time tumor location for DMLC delivery. Clinical benefits of the multi-template marker-less innovation include 1) automatic selection of relevant landmarks, 2) continuous tracking during deformations, rotations and partial obscurations, 3) no additional imaging dose to the patient, 4) direct imaging of the entire tumor, and 5) no need for invasive fiducial implantations and the associated adverse effects. This represents a substantial improvement over previous techniques. The therapeutic advantage will be quantified experimentally in an anthropomorphic phantom system under clinical conditions. The end result will be an integrated real-time target tracking and dynamic delivery system for radiation therapy as well as quantification of the anticipated clinical benefits. Clinical integration with the DMLC tracking is a challenging engineering problem with a measurable positive impact on human health on a large scale. This project represents well the ideals of the NIBIB to support research and development in the physical sciences and engineering for the improvement of human health. PUBLIC HEALTH RELEVANCE: The goal of this project is to quantify the potential clinical benefits of tracking early stage lung tumors with the therapeutic radiation beam in order to avoid over irradiation of healthy tissues during treatment. Our proposed method is the safest, least intrusive to have been proposed. If found to be successful, the technique could be applied to other anatomical sites, providing better outcomes for a very large number of cancer patients.

描述（由申请人提供）：美国死于肺癌的人多于前列腺，乳房，结肠和直肠癌的组合。 2009年，在美国估计有187,000人被诊断出患有非小细胞肺癌（NSCLC）的人中，其中37,000多人出现了局部或早期疾病。预计随着早期检测方法的改善并变得更广泛地传播，该部分将会增长。立体定向的身体放射疗法（SBRT）已被证明可为早期肺癌患者提供出色的局部控制（85％-95％）。但是，最近的II期研究发现，在很大一部分患者中，尤其是患有中央肿瘤的患者中，有3级或更高的毒性。研究表明，SBRT边缘的降低可以显着降低正常组织并发症的可能性。随着SBRT越来越成为早期阶段的选择疗法，局部的非小细胞肺癌，减少有害副作用变得越来越重要。我们提出了一种新型的故障安全技术，以降低毒性，同时为不断增长的患者保留局部控制。我们的假设是，在SBRT期间直接跟踪肺部肿瘤，使用与动态多eaF准直仪（DMLC）结合的束的视图（BEV）成像，将导致临床上显着的正常组织保留。当前的提案是第一个采用高级多模板标记的BEV跟踪算法来得出DMLC传递的实时肿瘤位置的提案。多型板块无标记的创新的临床益处包括1）自动选择相关地标，2）在变形，旋转和部分遮挡过程中连续跟踪，3）3）不对患者进行额外的成像剂量，4）4）直接对整个肿瘤的直接成像，5）5）不需要对不可察证的烦躁植入和相关的不利影响。这代表了对先前技术的实质性改进。治疗优势将在临床条件下在拟人化幻影系统中实验进行实验量化。最终结果将是用于放射治疗的集成实时目标跟踪和动态输送系统，以及对预期的临床益处的量化。与DMLC跟踪的临床整合是一个具有挑战性的工程问题，对人类健康对人类健康的影响很大。该项目很好地代表了尼比布的理想，以支持物理科学和工程学的研究和发展，以改善人类健康。 公共卫生相关性：该项目的目的是量化使用治疗辐射束跟踪早期肺部肿瘤的潜在临床益处，以避免治疗期间过度对健康组织的照射。我们提出的方法是提出的最安全，最不侵入性的方法。如果发现成功，该技术可以应用于其他解剖部位，为大量癌症患者提供更好的结果。