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Research Organization Document

Phase I
The Research Basics lecture identified the following steps in beginning the research process:
1. Select a philosophical foundation
2. Determine group interest
3. Research your interests and develop a research problem
4. Find a supporting problem/develop a theory base (literature review)
5. Develop scientific question/query and select a research design
In the discussion forum, you should have narrowed down your interests into a single topic. This
document will help you apply these essential steps to your capstone project topic.

1. What philosophical foundation are you pursuing? Why?

Logical Positivism. We will be quantitatively comparing plan outcomes to determine if

widely accepted dose objectives were met or not, and will be using this information to determine

if a plan is acceptable.

2. What is your group interest? (This would be the high-level idea that you listed/
discussed in the discussion forum).

Dose to the Left Anterior Descending artery (LAD).

There is more cardiac risk in patients with NSCLC, but there is uncertainty around the current

heart constraints in place and if they are effective at predicting and preventing major adverse

cardiac events. Recent evidence suggests that dose to the LAD is more closely related to the

development of cardiotoxicities in NSCLC patients, so how is this evaluated in these patients

receiving radiation? How effectively can plans be created that spare the LAD while continuing to

minimize dose to other OAR?

3. Find a problem/develop a theory base. These concepts are combined because both
concepts support the idea that you need to determine what’s out there on your particular
interest/topic.
• What is the research problem? Your working problem statements below.
The problem is that there is an increased risk for major adverse cardiac events and coronary heart

disease for medial, left-sided upper lobe lung VMAT patients when the volume of the LAD

receiving 15 Gy exceeds 10%.

• What knowledge exists on your interests and the problems you’ve come up with?
• Conduct a literature review on your topics. If You’ve identified a potential high-level
problem to solve but how do you know that someone else hasn’t already researched this
problem? This is the purpose of a literature review. You need to find peer-reviewed
scholarly articles that support the need for your proposed research. The pertinent articles
that you find will be used to confirm or refute the results of your study so the research
must be current (5 years old at the most). The only circumstance in which older articles
should be used is in the case of task group reports, QUANTEC or similar monumental
articles. List the most pertinent articles that you intend to use to support your research in
AMA formatting in this document. Refer to this list often. (Note: you will be providing
summaries of these articles in a later assignment so it’s a good idea to hold on to notes
about each article now).

Emerging evidence suggests that increasing dose to the LAD leads to an increased risk of major

adverse cardiac events (MACE) and coronary heart disease (CHD) in non-small cell lung cancer

(NSCLC) patients; however, dose to this OAR is not closely followed during treatment

planning. While the V15 Gy ≥10% to the LAD has been shown to predict an almost 10%

increase in risk of a cardiac events occurring, it has not been followed systematically in instances

of lung cancer.1,2 This further stresses the need to evaluate planning techniques that better spare

the LAD by looking at dose received to this structure planned without consideration of the dose

the LAD and comparing these to replanned treatments that are planned when the LAD dose is

considered. Once previously thought to be a side effect that occurs many years after radiation

treatment, recent evidence suggests that the onset of CHD develops an average of 20 months

after treatment in NSCLC patients without prior history of disease, further suggesting the need

for dose constraints to the LAD.2-5

References
1. Atkins KM, Chaunzwa TL, Lamba N, et al. Association of left anterior descending

coronary artery radiation dose with major adverse cardiac events and mortality in patients

with non–small cell lung cancer. JAMA Oncol. 2021;7(2):206–219. https://doi.org/

10.1001/jamaoncol.2020.6332

2. Reshko LB, Kalman NS, Hugo GD, Weiss E. Cardiac radiation dose distribution, cardiac

events and mortality in early-stage lung cancer treated with stereotactic body radiation

therapy (SBRT). J Thorac Dis. http://doi.org/10.21037/jtd.201

3. Atkins KM, Bhupendra R, Tafadzwa CL, et al. Cardiac radiation dose, cardiac disease,

and mortality in patients with lung cancer. J Am Coll Cardiol. 2019;73(23):2976-2978.

https://doi.org/10.1016/j.jacc.2019.03.500

4. Atkins KM, Bitterman DS, Chaunzwa TL, et al. Mean heart dose is an inadequate

surrogate for left anterior descending coronary artery dose and the risk of major adverse

cardiac events in lung cancer radiation therapy. Int J Radiat Oncol Biol Phys.

2021;110(5):1473-1479. https://doi.org/10.1016/j.ijrobp.2021.03.005

5. Yegya-Raman N, Wang, K, Kin S, et al. Dosimetric Predictors of symptomatic cardiac

events after conventional-dose chemoradiation therapy for inoperable NSCLC. J Thorac

Oncol. 2018;13(10)1508-1518. https://doi.org/10.1016/j.jtho.2018.05.028

4. What is the purpose of your study? This naturally falls in-line with the other questions
as you complete your literature review. What do you hope to find out after you complete
this research? What is the aim? These are all questions you should ask yourselves.
The purpose of this study is to compare dose to the LAD in VMAT plans optimized with and

without an LAD PRV in medial, left-sided, upper lobe non-small cell lung patients to evaluate

dose sparing of the LAD while maintaining 95% coverage of the prescribed PTV dose.

5. What are your supporting questions? Develop some key questions that your reader
will know the answer to after reading your research paper that support your research
problem. These questions should require elaboration (a simply stated yes/no answer
question is not permitted). For example:
• Research Question: Where should our next coffee shop location be?
• Supporting Questions: What customer base are we seeking?

What are the current suggested constraints surrounding dose to the LAD?

• How do these relate to constraints for the heart?

• Are other substructures of the heart also considered? If so, what are they and should we

consider them?

For patients treated with VMAT, how closely are heart constraints met?

• What area of the heart receives the greatest dose?

• How does this constraint relate to tumor location?

When replanning treatment for NSCLC treatment, does the application of a PRV to the LAD

result in better sparing of this OAR while maintaining PTV coverage?

• What PRV margin is more effective than others, if any?

• How does planning with a LAD PRV shift dose to other OAR? Are these changes

acceptable?

• Does the addition of a LAD PRV result in better or worse PTV outcomes?

For patients with prior history of CHD, there is a greater risk of disease progression and MACE

associated with LAD dose. Should more strict parameters regarding dose to the LAD be

considered for this population?

• Can we plan effective treatments that completely avoid the LAD in these cases?

6. What type of research design are you interested in pursuing with this topic? Some
very basic information on each type (experimental/quantitative or naturalistic/qualitative)
was provided at the end of this week’s lecture. You will get more into the research design
in the coming weeks but you should determine which design you are going to pursue
now.
Quantitative: Experimental-type

Submit this document to the appropriate assignment area when instructed.