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Patient positioning in head and neck cancer

Setup variations and safety margins in helical tomotherapy

Patientenlagerung bei Kopf-Hals-Tumoren

Lageungenauigkeiten und Sicherheitsabstände bei helikaler Tomotherapie

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Abstract

Objective

To evaluate the interfractional variations of patient positioning during intensity-modulated radiotherapy (IMRT) with helical tomotherapy in head and neck cancer and to calculate the required safety margins (sm) for bony landmarks resulting from the necessary table adjustments.

Materials and methods

In all, 15 patients with head and neck cancer were irradiated using the Hi-Art II tomotherapy system between April and September 2016. Before therapy sessions, patient position was frequently checked by megavolt computed tomography (MV-CT). Necessary table adjustments (ta) in the right-left (rl), superior-inferior (si) and anterior-posterior (ap) directions were recorded for four anatomical points: second, fourth and sixth cervical vertebral body (CVB), anterior nasal spine (ANS). Based upon these data sm were calculated for non-image-guided radiotherapy, image-guided radiotherapy (IGRT) and image guidance limited to a shortened area (CVB 2).

Results

Based upon planning CT the actual treatment required ta from –0.05 ± 1.31 mm for CVB 2 (ap) up to 2.63 ± 2.39 mm for ANS (rl). Considering the performed ta resulting from image control (MV-CT) we detected remaining ta from –0.10 ± 1.09 mm for CVB 4 (rl) up to 1.97 ± 1.64 mm for ANS (si). After theoretical adjustment of patients position to CVB 2 the resulting ta ranged from –0.11 ± 2.44 mm for CVB6 (ap) to 2.37 ± 2.17 mm for ANS (si). These data imply safety margins: uncorrected patient position: 3.63–9.95 mm, corrected positioning based upon the whole target volume (IGRT): 1.85–6.63 mm, corrected positioning based upon CVB 2 (IGRT): 3.13–6.66 mm.

Conclusions

The calculated safety margins differ between anatomic regions. Repetitive and frequent image control of patient positioning is necessary that, however, possibly may be focussed on a limited region.

Zusammenfassung

Zielsetzung

Ziel war die Erfassung von interfraktionellen Abweichungen der Patientenlagerung während einer intensitätsmodulierten Strahlentherapie (IMRT) mittels helikaler Tomotherapie bei Kopf-Hals-Tumoren und die Berechnung der erforderlichen Sicherheitssäume (sm) aus den notwendigen Tischverschiebungen (ta).

Material und Methoden

Zwischen April und September 2016 wurden 15 Patienten mit Kopf-Hals-Tumoren mit der Hi-Art-II-Tomotherapy bestrahlt. Die prätherapeutische Patientenlagerung wurde regelmäßig anhand einer Megavolt-Computertomographie (MV-CT) beurteilt. Die notwendigen ta in Rechts-Links- (rl), superior-inferiorer (si) und anterior-posteriorer (ap) Richtung wurden für vier anatomische Punkte bestimmt: zweiter, vierter und sechster Halswirbelkörper (CVB), Spina nasalis anterior (ANS). Aus diesen Verschiebungen wurden die sm für nichtbildgestützte und bildgestützte (IGRT) Strahlentherapie sowie für IGRT basierend auf einem kürzeren MV-CT im Bereich CVB 2 berechnet.

Ergebnisse

Basierend auf dem Vergleich zum Planungs-CT ergab sich eine notwendige ta von –0,05 ± 1,31 mm für CVB 2 (ap) und bis zu 2,63 ± 2,39 mm für ANS (rl). Unter Beachtung der durchgeführten ta, die aus dem MV-CT resultierten, verblieb eine ta von –0,10 ± 1,09 mm für CVB 4 (rl) und bis zu 1,97 ± 1,64 mm für ANS (si). Nach theoretischer Optimierung der Patientenposition basierend auf CVB 2 verblieb eine ta von –0,11 ± 2,44 mm für CVB 6 (ap) und bis zu 2,37 ± 2,17 mm für ANS (si). Aus diesen Daten errechnete sm: nichtkorrigierte Patientenposition 3,63–9,95 mm, korrigierte Patientenposition basierend auf gesamtem Zielvolumen (IGRT) 1,85–6,63 mm, korrigierte Patientenposition basierend auf CVB 2 (IGRT) 3,13–6,66 mm.

Schlussfolgerung

Die errechneten sm unterscheiden sich zwischen anatomischen Regionen. Wiederholte und regelmäßige Kontrollen der Patientenposition sind notwendig, können allerdings eventuell auf eine Region begrenzt werden.

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Authors and Affiliations

  1. Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    Christina Leitzen, Timo Wilhelm-Buchstab, Thomas Müdder, Martina Heimann, David Koch, Christopher Schmeel, Birgit Simon, Sabina Stumpf, Susanne Vornholt, Stephan Garbe, Fred Röhner, Felix Schoroth, Hans Heinz Schild & Heinrich Schüller

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  1. Christina Leitzen
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  2. Timo Wilhelm-Buchstab
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Correspondence to Christina Leitzen.

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Conflict of interest

C. Leitzen, T. Wilhelm-Buchstab, T. Müdder, M. Heimann, D. Koch, C. Schmeel, B. Simon, S. Stumpf, S. Vornholt, S. Garbe, F. Röhner, F. Schoroth, H.H. Schild and H. Schüller declare that they have no competing interests.

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This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Christina Leitzen and Timo Wilhelm-Buchstab contributed equally to the manuscript.

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Leitzen, C., Wilhelm-Buchstab, T., Müdder, T. et al. Patient positioning in head and neck cancer. Strahlenther Onkol 194, 386–391 (2018). https://doi.org/10.1007/s00066-018-1265-7

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  • DOI: https://doi.org/10.1007/s00066-018-1265-7

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