Research Organization Document

Section 1
The purpose of this document is to organize your ideas and keep in mind the key research
components as you begin working through your research. Please refer to this document often so
that you remember the key questions you are answering and to update the research components
as you research them.

First, you will outline the 3 key components to selecting a research topic: a problem that
needs to be solved, evidence of gap in the literature (a summary of different journal articles that
support a similar topic or a journal article that says further research should be conducted on the
topic you are interested in researching), an active “references” page that you update continuously
to keep track of your research information.

For the “problem that needs to be solved section,” you need to decide what the problem is
for your research. This includes addressing a set of 5-7 questions that you need to refer to often
in your research to make sure that you are staying on topic. Key questions should be your active
research questions. When you have finished writing your research paper, you reader should be
able to address and answer these questions easily.

For the “evidence of gap in the literature section,” you should include a paragraph written
in your own words with referenced superscripts to the references page so that the instructor can
look at the article you are using to support your research.

The “references to support your research section” should include all of the references you
have used for your research in AMA formatting. Use this as a place to keep track of your articles
and update this often as you get into your research. This shouldn’t necessarily include all of the
references that you sent to the instructor for the conference call. Since your topic was likely
tweaked during the conference call, only include the references that pertain directly to your topic.
This is important because there is a limit to the number of references you can have depending on
the type of paper you decide to write.

Finally, you will indicate the title of your official research topic. This may change as you
begin your research so it is important that you keep your topic updated so that the instructor may
track your progress through the research paper progression.

For most groups, this information was decided in the conference call with the instructor
so it should be easy to answer these questions.
Problem that needs to be solved:
1. Does V5 constraint decrease the incidence of severe lung complications treated with
IMRT or VMAT?
2. Predictive factors considerations: irradiated lung volume, RT dose, RT number of
fractions, RT fraction size.
3. Does the location of the tumor correlate with the risk of developing lung complications in
receiving V20 or V5?
4. The impact of clinical factors: tobacco use, chemotherapy (Amifostine) on lung
complications.
5. Do age and tumor staging affect lung complications in patients receiving V20 or V5
6. Primary lung cancer vs mets

Key Questions that need to be answered:

Does VMAT produce significantly greater low dose exposure as PTV size increases compared to
static IMRT?

Evidence of a gap in the literature:

Article: https://doi.org/10.3109/0284186X.2015.1061216

IMRT resulted in an increase in the incidence of severe and fatal RP, however a new dose
constraint to the volume of lung receiving low doses reduced the incidence of lethal pneumonitis.

Future research: There were certain gaps within this research study, indicating the need to
compare VMAT vs Static IMRT plans in relation to low dose exposure for lung cases. The
article states the volume of lung receiving low dose is directly related to a decrease in RP. There
was no comparison of two different techniques to demonstrate this statement, which is where the
gap can be found for a future research study. This study can be conducted using a comparison of
VMAT and static IMRT plans to monitor the incidence of RP which relates to evaluating low
dose exposure in lung cases.

Article: https://doi.org/10.3892/ol.2018.7732

Dosimetric comparison between IMRT and VMAT in irradiation for peripheral and central lung
cancer.

Future research: The study did do a comparison of IMRT and VMAT plans for lung cases,
however there was a small sample of cases selected for the study. A future prospective study can
include a few more cases for better collection of results. In addition, this study could have been
approached or planned using more beams, which can be included in a future study.
Article: https://doi.org/10.1016/j.ijrobp.2010.08.056

A Dose–Volume Analysis of Radiation Pneumonitis in Non–Small Cell Lung Cancer Patients

Treated with Stereotactic Body Radiation Therapy

Future research: This research only evaluated non-small cell lung cancer using SBRT. A future
research study can be conducted using different planning techniques. In addition, this study was
conducted using various planning techniques. A future study may be limited to 1-3 treatment
planning systems to create less variability.

References to support your research:

1. Kristensen C, Nottrup T, Berthelsen A, et al. Pulmonary toxicity following IMRT after
extrapleural pneumonectomy for malignant pleural mesothelioma. Radiother Oncol.
2009;92(1):96-99.

https://doi.org/10.1016/j.radonc.2009.03.011

2. Barriger RB, Forquer JA, Brabham JG, et al. A dose-volume analysis of radiation
pneumonitis in non-small cell lung cancer patients with stereotactic body radiation
therapy. Int J Radiat Oncol Biol Phys. 2012;82(1): 457-462.

https://doi.org/10.1016/j.ijrobp.2010.08.056

3. Graham MV, Purdy JA, Emami B, et al. Clinical dose-volume histogram analysis for
pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat
Oncol Biol Phys. 1999;45(2): 323-329.

https://doi.org/10.1016/S0360-3016(99)00183-2

4. Rosca F, Kirk M, Soto D, Sall W, McIntyre J. Reducing the low-dose lung radiation for
central lung tumors by restricting the IMRT beams and arc arrangement. Med Dosim.
2012;37(3):280-286.

https://doi.org/10.1016/j.meddos.2011.10.003
5. Lievens Y, Nulens A, Gaber MA, et al. Intensity-modulated radiotherapy for locally
advanced non-small-cell lung cancer:a dose-escalation planning study. Int J Radiat Oncol
Biol Phys. 2011;80(1):306-313.

https://doi.org/10.1016/j.ijrobp.2010.06.025

6. Marks LB, Bentzen SM, Deasy JO, et al. Radiation dose-volume effects in the lung. Int J
Radiat Oncol Biol Phys. 2010;76(3 Suppl):S70-S76.
http://dx.doi.org/10.1016/j.ijrobp.2009.06.091
7. Miao J, Yan H, Tian Y, et al. (2017), Reducing dose to the lungs through loosing target
dose homogeneity requirement for radiotherapy of non small cell lung cancer. J Appl Clin
Med Phys. 2017;18: 169-176.

https://doi.org/10.1002/acm2.12200

8. Aaron A, Czerminska M, Jänne P, et al. Fatal pneumonitis associated with intensity-

modulated radiation therapy for mesothelioma. Int J Radiat Oncol Biol Phys. 2006;65(3):
640 – 645.

https://doi.org/10.1016/j.ijrobp.2006.03.012

9. Helen H, Jauregui M, Zhang X, et al. Beam angle optimization and reduction for
intensity-modulated radiation therapy of non–small-cell lung cancers. . Int J Radiat
Oncol Biol Phys. 2006;65(2): 561 – 572.

https://doi.org/10.1016/j.ijrobp.2006.01.033

10. Faught A, Miyasaka Y, Kadoya N, et al. Evaluating the toxicity reduction with computed
tomographic ventilation functional avoidance radiation therapy. Int J Radiat Oncol Biol
Phys. 2017;99(2): 325–333.

https://doi.org/10.1016/j.ijrobp.2017.04.024

11. Khalil A, Hoffmann L, Moeller D, et al. New dose constraint reduces radiation-induced
fatal pneumonitis in locally advanced non-small cell lung cancer patients treated with
intensity-modulated radiotherapy. Acta Oncologica. 2015;54(9): 1343-1349.

https://doi.org/10.3109/0284186X.2015.1061216

12. Makimoto T, Tsuchiya S, Hayakawa K, et al. Risk factors for severe radiation
pneumonitis in lung cancer. Jpn J Clin Oncol. 1999;29(4):192-197.

https://doi.org/10.1093/jjco/29.4.192

13. Li Y, Wang J, Tan L, et al. Dosimetric comparison between IMRT and VMAT in
irradiation for peripheral and central lung cancer. Oncol Lett. 2018;15(3):3735-3745.
 https://doi.org/10.3892/ol.2018.7732

Research Topic: A comparison of VMAT vs static IMRT plans to compare V5 low dose
exposure in centrally located lung tumors.

Research approach
Section 2
The next section of your research organization document contains your research template to
follow as you begin your data collection. This section will change often but it will help you to
follow your goals closely as you progress and for the instructor to track your progress.

Study Details:
Retrospective vs. Prospective

Do any group members need to obtain additional IRB approval? No

Number of patients - 20

Type of study - Research

Roles of each group member (some members may have multiple roles)

Group Leader- (someone who will keep the group on track, make sure group
members are adhering to deadlines, be the direct point of contact for the
instructor with overall questions, update the research organization document
throughout the course of research)

Data Collector(s) (someone who will be doing the data collection and data
reporting in excel; maintaining journal entries)

Data analysis (someone who will be responsible for analyzing the raw data,
running any statistical tests and providing conclusive data for the writer)

Writer (someone who is responsible for writing the outline (later in the course)
and the paper; usually the best writer of the group takes this role)
 Editor (someone who is responsible for checking each draft for errors and
providing feedback and corrections to writer)

Amber: Writer, Group Leader

Jenny: Data Collector

Ruha: Data Collector, Editor

Andrew: Data Collector, Data Analysis

Data Collection Approach:

Indicate here what data you are looking to collect and your approach to collection:

Number of clinical sites for data collection

What information are you interested in (if a planning study, list structures for evaluation;
if a study survey, list your study questions)

V5 lung dose, and percent of totally lung that the PTV represents.

Are you interested in completing a statistical analysis on this data? If so, what parameters
will you be analyzing? (p-value, mean, t-test ect.).

Analysis of covariance (Ancova)

What resources (in addition to the literature search) are available for you to use?

Past patient treatment information. Support from facilities dosimetrist, doctors, and
physicists. Guidance from UW lacrosse professors.

Previous research study that will be used for data analysis (ex: RTOG study constraints):

RTOG 0920 and RTOG 0623.

 Description of your data collection approach (Please provide the instructor with the
details you intend to use in your research and use the example to be your guide). Example: We
will be analyzing how dose conformity changes comparing 3DCRT to IMRT. We will look at
pancreatic cases with tumor sizes between 200 and 500 cc to limit variability. All plan
comparisons will receive a total dose of 50 Gy in 25 fractions at 200cGy/day. We will analyze
dose coverage to the PTV, CTV and GTV structures including maximum dose, minimum dose
and the parameter of 100% of prescription dose covering 95% of the PTV, a constraint listed in
the RTOG 1234 trial. We will also analyze the following OR constraints: stomach: V10<70%;
V50<30%; small bowel: maximum dose of 50Gy, 0.03cc<47 Gy; total kidney: V20<40%,
V10<60%.

We will be comparing V5 dose for Static IMRT and VMAT plans. Lung cases with
centrally located volumes between 40 and 400 cc, treated to 65GY with standard
fractionation will be retroactively taken from three clinical sites. These cases will be
replanted using whatever planning modality was not used for treatment. To establish that
the quality of the replans are similar, PTV coverage will be compared. The meeting of the
following dose constraints from Quantec will also be considered: Lung V30<20%; lung
mean <20Gy, Spinal cord maximum dose of 50G; esophagus V35<50%. RTOG 0920 and
RTOG 0623 study constraints will be used for reference. The experimental evaluation will
be the difference in V5 Lung dose. This will be analyzed in relation to the normalized PTV
volume. An analysis of covariance (Ancova) will be performed to determine if there is a
significant between the two planning types.

Additional details: