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?
The philosophical foundation we are pursuing is logical positivism. Experimental type research
will be conductive using deductive reasoning. A hypothesis will be generated and formally
tested.

2. What is your group interest? (This would be the high-level idea that you
listed/discussed in the discussion forum).
Lattice radiation therapy vs. Quad Shot radiation therapy.
 Lattice radiation therapy is a spatially fractionated stereotactic body radiation therapy
where a 3D configuration of high dose regions are placed within a tumor volume. Since
this technique has evolved, additional research needs to be done to evaluate its
effectiveness on reducing dose to organs at risk in comparison to Quad Shot radiation
therapy.

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.
a. What is the research problem? Your working problem statements below.
The problem is that patients undergoing reirradiation for head and neck cancer recurrence are at
risk of carotid blowout syndrome due to previous IMRT treatment.
b. What knowledge exists on your interests and the problems you’ve come
up with?
 i. 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).
Intensity modulated radiation therapy (IMRT) has been the standard of treatment used over the
years to treat head and neck cancers. With this advanced technology, patients are living longer
after their diagnosis and experiencing recurrence in their primary site. Quad Shot radiation has
been an effective treatment option offered twice a day over two consecutive days totaling 14 to
14.8 Gy. It is repeated weeks later if tumor regression occurs. VMAT GRID therapy may be a
superior treatment technique that can achieve lower doses to the carotid artery while maintaining
proper tumor control by delivering 20 Gy in one fraction.
References:
1. Leboucher A, Sotton S, Gambin Flandrin I, Magne N. Head and Neck radiotherapy-induced
carotid toxicity: pathophysiological concepts and clinical syndromes. ScienceDirect.
2022;129. https://doi.org/10.1016/j.oraloncology.2022.105868
2. Jong Kil W. Rapid and durable symptom palliation with quad shot radiation therapy to
nonosseous metastatic/recurrent cancer in elderly or frail patients in a rural community clinic.
ScienceDirect. 2021;7(2). https://doi.org/10.1016/j.adro.2021.100871
3. Jong Kil W, Camphausen K, Hye Cho I. Clinical and radiobiological consideration of
cyclical hypofractionated radiation therapy also known as QUAD Shot for neglected skin
cancer disfiguring the face of a non-compliant patient who was refusing surgery and
protracted radiation therapy: case report. ROJ. 2019;37(2):143-148.
https://doi.org/10.3857/roj.2019.00248
4. De Jong M, Candanedo C, Gross M, Cohen J. Intervening in the acute phase of postradiation
carotid blowout syndrome. Int Arch Otorhonongol. 2019;23(02): 172-177. DOI: 10.1055/s-
0038-1676660
5. Van Aken ES, van der Laan HP, Bijl HP, et al. Risk of ischaemic cerebrovascular events in
head and neck cancer patients is associated with carotid artery radiation dose. Radiother
Oncol. 2021;157:182-187. https://doi.org/10.1016/j.radonc.2021.01.026
6. Ling D, Vargo JA, Gebhardt BJ, et al. Dose response modeling the risk of carotid bleeding
events after stereotactic body radiation therapy for previously irradiated head and neck
cancer. J Radiosurg SBRT. 2019;6(2):83-89. PMID:3164545.
7. Embring A, Onjukka E, Mercke C, et al. Re-irradiation for head and neck cancer: Cumulative
dose to organs at risk and late side effects. Cancers. 2021:13(3):3173.
https://doi.org/10.3390/cancers13133173
8. Gebhardt BJ, Vargo JA, Ling D, et al. Carotid dosimetry and the risk of carotid blowout
syndrome after reirradiation with head and neck stereotactic body radiation therapy. Int J
Radiat Oncol, Biol, Phys. 2018;101(1):195-200. https://doi.org/10.1016/j.ijrobp.2017.11.045

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 research is to determine if GRID therapy can reduce dose to the carotid artery
in comparison to quad shot therapy.
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:
a. Research Question: Where should our next coffee shop location be?
b. Supporting Questions: What customer base are we seeking?

1. How does Lattice radiation therapy affect the dose delivered to the carotid artery in
comparison to quad shot therapy?
a. Will Spatially fractionated radiation therapy (Lattice) decrease dose to the
cumulative carotid artery dose (D0.1cc) to < 47.6 Gy compared to Quad Shot
radiation therapy by utilizing a non-uniform dose to the tumor?
2. What grid spacing will need to be used in a lattice technique for H/N to spare OARs and
create adequate coverage?
3. Could the treatment technique prescribed have an impact on those with lower
socioeconomic status? (Quad Shot BID for 4 fractions with potential need to come back
if 50% tumor regression occurs? vs Lattice RT only needing 1 fraction)
4. Lattice is traditionally used with tumors greater than 4.5 cm. If the tumor in the H/N is
smaller, will lattice be an option if smaller spheres are used with closer configurations?
Research shows spheres can be as small as 0.5cm placed 1.5cm apart.
5. Will Lattice plans using 6FFF provide better sparing between the high dose regions?
6. What is the max dose at which carotid artery bleeding has been observed?
7. What dose to the carotid artery is a high prognostic factor for injury?
 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.
This is a quantitative-experiment type study where a Quasi-experimental Design will be used.
Previous patients who have been candidates for Quad Shot radiation therapy (control) will be
replanned with both Quad Shot and Lattice. These plans will be manipulated with a new Quad
Shot plan following specific planning parameters. The same patients will be planned with
specific Lattice parameters and compared.

Submit this document to the appropriate assignment area when instructed.