INDIVIDUALIZING IMRT TREATMENT IN BRAIN AND HEAD/NECK CA

University Of Michigan At Ann Arbor, Ann Arbor MI

Investigators

Linked publications & trials

Abstract

In our previous research we developed highly conformal radiation treatment for head/neck and brain tumors using[unreadable] sculpted dose distributions and demonstrated the ability to escalate tumor dose with minimal complications[unreadable] (brain), and maintain high control rates while decreasing a major complication (xerostomia) for head/neck cancers.[unreadable] Our long-term goal is to increase tumor control and reduce complication rates by individualizing the timing and[unreadable] intensity of therapy based on innovative imaging. We propose to intensify treatment for glioblastoma by escalating[unreadable] the daily fraction doses while also utilizing effective chemotherapy (temozolomide). We will test the hypothesis[unreadable] that diffusion MRI (dMRI), which may predict tumor response early after therapy is started, will be a useful basis[unreadable] for re-optimization during the course of treatment, allowing the escalation of dose to non-responding parts of the[unreadable] tumor. We will also make use of our preliminary MRI results which suggest that radiation can open the bloodtumor-[unreadable] barrier (BTB) to chemotherapeutic and radiosensitizing agents (like gemitabine). We will test whether[unreadable] concurrent conformal radiation and gemcitabine (administered after the BTB is opened) will be safer and improve[unreadable] response rates for grade 3 gliomas, and whether we can improve the outcome by escalating the doses to the parts of[unreadable] the tumor demonstrating lack of increased permeability of the BTB early after the start of therapy. In head and[unreadable] neck cancer, we will test strategies that promise to decrease treatment-related late dysphagia and aspiration. We[unreadable] will test if reducing dose to the swallowing structures can reduce the severity of late dysphagia, and test the utility of[unreadable] innovative imaging (FLT-PET, and dMRI) to predict (early after the start of therapy) which tumors are likely to fail[unreadable] treatment, as well as directing individualized dose intensification using re-optimization plans. We expect that[unreadable] the Project will show improving non-complicated tumor control rates in brain and head and neck cancer by[unreadable] customizing treatment intensity following analysis of possible early predictors of response.