External beam radiation therapy is a major and effective treatment modality for prostate cancer. Despite the significant improvement over the past decades, tumor control rates and radiation induced complication rates have been suboptimal. One major cause is the geometrical and anatomical variations during the treatment course, such as patient setup and organ motion at each step of treatment process. To account for these uncertainties, margins are added during treatment planning to ensure adequate target coverage. The margins increase the irradiated volume which may encompass a significant portion of critical organs. To reduce margins safely, accurate information of patient anatomy under the treatment condition are required. Recent advancement in delivery system includes mounting a kV X-ray imaging system capable of cone-beam CT on board the linear accelerator. High spatial resolution CT images from the system have good soft tissue contrast to localize prostate gland accurately at treatment condition. However, the benefits of cone-beam CT in reducing uncertainties in clinical environment are unknown and no dosimetric evaluation has been performed in determining the optimal margin reduction using cone-beam CT. The hypothesis of this project is that, optimal and efficient use of the on-board imaging system, integrated with offline adaptive plan optimization and online treatment intervention, can significantly increase the dose gradient between the tumors and critical organs.
Three specific aims will be pursued. (1) Develop image guidance strategies for prostate cancer treatment that include online geometric treatment intervention (plan correction) and offline adaptive dosimetric plan re-optimization. The goal of online process is to eliminate uncertainties from setup and inter-fraction motion. The residues and intra-fraction motions are incorporated in the offline process. (2) Evaluate and optimize image guidance strategies through comparative planning studies against the current standard methods and validate cone-beam CT for image guidance. (3) Perform pre-clinical studies to test feasibility and efficiency of the image guidance strategies. The long-term goal of this project is to implement a clinical process of image guided radiotherapy of prostate cancer, in which geometric variations will be incorporated into treatment planning and delivery through image feedback. The adoption of image guidance will allow significantly increased local control and reduced radiation induced complications in prostate cancer patients. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA118037-03
Application #
7479195
Study Section
Radiation Therapeutics and Biology Study Section (RTB)
Program Officer
Deye, James
Project Start
2006-09-01
Project End
2009-05-31
Budget Start
2008-08-01
Budget End
2009-05-31
Support Year
3
Fiscal Year
2008
Total Cost
$198,206
Indirect Cost
Name
William Beaumont Hospital
Department
Type
DUNS #
076362110
City
Royal Oak
State
MI
Country
United States
Zip Code
48073
Liu, Han; Wu, Qiuwen (2012) A ""rolling average"" multiple adaptive planning method to compensate for target volume changes in image-guided radiotherapy of prostate cancer. J Appl Clin Med Phys 13:3697
Adamson, Justus; Wu, Qiuwen; Yan, Di (2011) Dosimetric effect of intrafraction motion and residual setup error for hypofractionated prostate intensity-modulated radiotherapy with online cone beam computed tomography image guidance. Int J Radiat Oncol Biol Phys 80:453-61
Liu, Han; Wu, Qiuwen (2011) Evaluations of an adaptive planning technique incorporating dose feedback in image-guided radiotherapy of prostate cancer. Med Phys 38:6362-70
Liu, Han; Wu, Qiuwen (2011) Dosimetric and geometric evaluation of a hybrid strategy of offline adaptive planning and online image guidance for prostate cancer radiotherapy. Phys Med Biol 56:5045-62
Ghilezan, Michel; Yan, Di; Martinez, Alvaro (2010) Adaptive radiation therapy for prostate cancer. Semin Radiat Oncol 20:130-7
Lei, Yu; Wu, Qiuwen (2010) A hybrid strategy of offline adaptive planning and online image guidance for prostate cancer radiotherapy. Phys Med Biol 55:2221-34
Wang, Weihu; Wu, Qiuwen; Yan, Di (2010) Quantitative evaluation of cone-beam computed tomography in target volume definition for offline image-guided radiation therapy of prostate cancer. Radiother Oncol 94:71-5
Adamson, Justus; Wu, Qiuwen (2010) Prostate intrafraction motion assessed by simultaneous kV fluoroscopy at MV delivery II: adaptive strategies. Int J Radiat Oncol Biol Phys 78:1323-30
Adamson, Justus; Wu, Qiuwen (2010) Prostate intrafraction motion assessed by simultaneous kilovoltage fluoroscopy at megavoltage delivery I: clinical observations and pattern analysis. Int J Radiat Oncol Biol Phys 78:1563-70
Adamson, Justus; Wu, Qiuwen (2009) Inferences about prostate intrafraction motion from pre- and posttreatment volumetric imaging. Int J Radiat Oncol Biol Phys 75:260-7

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