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Efficacy of Thermoformable Vacuum Head Cushion on Set-up Accuracy in IMRT of Head & Neck and Brain Tumors

Year 2021, Volume: 12 Issue: 2, 131 - 139, 20.08.2021
https://doi.org/10.22312/sdusbed.810408

Abstract

Aim: An effective immobilization is warranted to minimize set up deviations while treating head & neck (HN) and brain tumors with intensity modulated radiotherapy (IMRT).
In this study we evaluated the effectiveness of thermoformable vacuum head cushion (TVHC) on immobilization of these patients via weekly electronic digital port films (EDPF).
Material and Method: Twenty patients treated with IMRT for HN and Brain tumors were enrolled in the study. Thermoplastic mask with additional standard plastic head rest (n:10) in Group A or TVHC supporting the head and neck region (n:10) in Group B were used for immobilization. Weekly EDPF images were obtained on the linear accelerator. Set-up displacements in latero-medial, anteroposterior and cranio-caudal directions in these images were compared with variation data of first treatment.
Results: When each group was analyzed in terms of deviations in all 3 directions, deviations calculated in anteroposterior and craniocaudal directions were significantly higher for TVHC group (p:0.039 and p:0.002 respectively). Deviations >4mm in all three directions were also analyzed and similarly, higher rates of >4mm deviations were recorded for TVHC group in anteroposterior and craniocaudal directions (p:0.023 and p:<0.001 respectively) which of both were also statistically significant.
Conclusion:
We found that TVHC utilization in HN and brain IMRT for immobilization leads to significantly higher set-up deviations so future investigations with larger patient populations and evaluating set up accuracy via more sensitive alignments are needed to suggest TVHC for utilization in daily clinical practice.

References

  • 1. Webb S. Intensity-modulated radiation therapy. Bristol (UK): Institute of Physics Publishing; 2001.
  • 2. Palta JR, Mackie TR, editors. Intensity-modulated radiation therapy—the state of the art. Madison (WI): Medical Physics Publishing; 2003.
  • 3. Boda-Heggemann J, Walter C, Rahn A, et al. Repositioning accuracy of two different mask systems-3D revisited: Comparison using true 3D/3D matching with cone-beam CT. Int J Radiat Oncol Biol Phys 2006;66:1568–1575.
  • 4. Hong TS, Tome WA, Chappell RJ, et al. The impact of Daily setup variations on head-and neck intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 2005;61:779–788.
  • 5. Prisciandaro JI, Frechette CM, Herman MG, et al. A methodology to determine margins by EPID measurements of patient setup variation and motion as applied to immobilization devices. Med Phys 2004;31:2978–2988.
  • 6. Hatherly KE, Smylie JC, Rodger A, et al. A double exposed portal image comparison between electronic portal imaging hard copies and port films in radiation therapy treatment setup confirmation to determine its clinical application in radiotherapy center. Int J Radiat Oncol Biol Phys 2001;49:191–198.
  • 7. Brock KK, McShan DL, Balter JM. A comparison of computer controlled versus manual on-line patient setup adjustment. J Appl Med Phys 2002;3:241–247.
  • 8. de Boer HC, van Sornsen de Koste JR, et al. Electronic portal image assisted reduction of systematic set-up errors in head and neck irradiation. Radiother Oncol 2001;61:299–308.
  • 9. Pisani L, Lockman D, Jaffray D, et al. Setup error in radiotherapy: On-line correction using electronic kilovoltage and megavoltage radiographs. Int J Radiat Oncol Biol Phys 2000;47: 825–839.
  • 10. Navarro-Martin A, Cacicedo J, Leaman O, et al. Comparative analysis of thermoplastic masks versus vacuum cushions in stereotactic body radiotherapy. Radiat Oncol 2015; 10: 176.
  • 11. White P, Yee CK, Shan LC, Chung LW, Man NH, Cheung YS. A comparison of two systems of patient immobilization for prostate radiotherapy. Radiat Oncol 2014; 22: 29.
  • 12. Han K, Cheung P, Basran PS, Poon I, Yeung L, Lochray F. A comparison of two immobilization systems for stereotactic body radiation therapy of lung tumors. Radiother Oncol 2010; 95: 103–8.
  • 13. Zeidan OA, Langen KM, Meeks SL, et al. Evaluation of image guidance protocols in the treatment of head and neck cancers. Int J Radiat Oncol Biol Phys 2007;67:670–677.
  • 14. Zhang L, Garden AS, Lo J, et al. Multiple regions-of-interest analysis of setup uncertainties for head-and-neck cancer radiotherapy. Int J Radiat Oncol Biol Phys 2006;64:1559–1569.
  • 15. O’Daniel JC, Dong L, Zhang L, et al. Dosimetric comparison of four target alignment methods for prostate cancer radiotherapy. Int J Radiat Oncol Biol Phys 2006;66:883–891.
  • 16. Borst GR, Sonke JJ,BetgenA, et al.Kilo-voltage cone-beam computed tomography setup measurements for lung cancer patients; first clinical results and comparisonwith electronic portal-imaging device. Int J Radiat Oncol Biol Phys 2007;68:555–561
  • 17. Li H, Zhu XR, Zhang L, et al. Comparison of 2D radiographic images and 3D cone beam computed tomotherapy for positioning head and neck radiotherapy patients. Int J Radiat Oncol Biol Phys 2008; 71: 916–25.
  • 18. Ost P, De Gersem W, De Potter B, Fonteyne V, De Neve W, De Meerleer G. A comparison of the acute toxicity profile between two-dimensional and three-dimensional image-guided radiotherapy for postoperative prostate cancer. Clin Oncol 2011; 23: 344–9.
  • 19. Mubata CD, Bidmead AM, Ellingham LM, et al. Portal imaging protocol for radical dose-escalated radiotherapy treatment of prostate cancer. Int J Radiat Oncol Biol Phys 1998;40:221–231
  • 20. Lin CG, Xu SK, Yao WY, Wu YQ, Fang JL, Wu VWC. Comparison of set up accuracy among three common immobilisation systems for intensity modulated radiotherapy of nasopharyngeal carcinoma patients. J Med Radiat Sci. 2017;64(2):106-113. doi:10.1002/jmrs.189
  • 21. Neubauer E, Dong L, Followill DS, et al. Assessment of shoulder position variation and its impact on IMRT and VMAT doses for head and neck cancer. Radiat Oncol 2012;8: 19.
  • 22. Lin CG, Lin LW, Liu BT, Liu XM, Li GW. A study of the positioning errors of head and neck in the process of intensity modulated radiation therapy of nasopharyngeal carcinoma. Chin J Radiat Oncol 2011; 20: 322–5.
  • 23. Cheng KF, Wu VWC. Comparison of the effectiveness of different immobilisation system in different body regions using daily megavoltage computed tomography in helical tomotherapy. Br J Radiol 2014; 87: 20130494.
  • 24. Hansen CR, Christiansen RL, Nielsen TB, Bertelsen AS, Johansen J, Brink C. Comparison of three immobilisation systems for radiation therapy in head and neck cancer. Acta Oncol 2014; 53: 423–7.

Baş-Boyun ve Beyin Tümörü IMRT Uygulamasında Vakumlu Boyun Yastığı (VBY)’ nın Set Up Doğruluğuna Katkısı

Year 2021, Volume: 12 Issue: 2, 131 - 139, 20.08.2021
https://doi.org/10.22312/sdusbed.810408

Abstract

Amaç: Baş-boyun ve beyin tümörlerinde uygulanacak lokal radyoterapi sırasında eşlik eden kritik normal dokulara verilebilecek zararın en aza indirilmesi açısından özel planlama tekniklerine ve ideal sabitleme ekipmanlarına gerek duyulmaktadır.
Çalışmamızda baş-boyun ve beyin tümörü tanısı ile radyoterapi uygulanan hastalarda ek sabitleme ekipmanı olarak kullandığımız Vakumlu Boyun Yastığı (VBY)‘nın etkinliğinin tedavi süresince alınan haftalık port filmleri ile değerlendirilmesi amaçlandı.
Materyal Metod: Kliniğimizde baş-boyun veya beyin tümörü tanısıyla uygulanan küratif/adjuvan radyoterapi sırasında VBY kullanılan ve kullanılmayan 10 hastanın haftalık portları VBY kullanılan (Grup A) ve kullanılmayan (Grup B) olmak üzere iki gruba ayrılarak değerlendirildi. Her hastanın 7 port görüntüsünde longitudinal, lateral ve vertikal eksendeki verisinin set-up değerlerine göre farkları mutlak değer olarak kaydedildi. Her iki gruptaki kaydırma değerleri ve >4mm kaydırma yüzdeleri değerlendirildi.
Bulgular: Çalışmaya dahil edilen toplam 20 hastanın tanıları 14 nazofarenks, 2 GBM, 2 dil, 1 larenks, 1 sert damak tümörü şeklinde idi. Her iki grup kaydırma miktarları açısından değerlendirildiğinde vertikal ve longitudinal eksendeki kaydırma düzeylerinin VBY kullanılan hastalarda anlamlı oranda yüksek olduğu saptandı (sırasıyla p:0,039 ve p:0,002). Hastalarda > 4mm düzeyindeki kayma oranları da yine vertikal ve longitudinal eksende VBY kullanılan hastalarda anlamlı oranda yüksek olduğu saptandı (sırasıyla p:0,023 ve p:<0001). Her iki gruptaki fark oranları ve p değerleri Tablo 1 de gösterilmiştir.
Sonuç: Hastalarımızda ek sabitleme ekipmanı olarak VBY kullanımının standart yastık kullanımına göre istatistiksel anlamlı oranda daha yüksek kaydırma değerleri ve daha fazla > 4mm kaydırma yüzdesine neden olduğu saptanmıştır. Sonuç olarak baş-boyun ve beyin tümörü radyoterapisinde VBY kullanımının immobilizasyona katkısı gösterilememiştir.

References

  • 1. Webb S. Intensity-modulated radiation therapy. Bristol (UK): Institute of Physics Publishing; 2001.
  • 2. Palta JR, Mackie TR, editors. Intensity-modulated radiation therapy—the state of the art. Madison (WI): Medical Physics Publishing; 2003.
  • 3. Boda-Heggemann J, Walter C, Rahn A, et al. Repositioning accuracy of two different mask systems-3D revisited: Comparison using true 3D/3D matching with cone-beam CT. Int J Radiat Oncol Biol Phys 2006;66:1568–1575.
  • 4. Hong TS, Tome WA, Chappell RJ, et al. The impact of Daily setup variations on head-and neck intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 2005;61:779–788.
  • 5. Prisciandaro JI, Frechette CM, Herman MG, et al. A methodology to determine margins by EPID measurements of patient setup variation and motion as applied to immobilization devices. Med Phys 2004;31:2978–2988.
  • 6. Hatherly KE, Smylie JC, Rodger A, et al. A double exposed portal image comparison between electronic portal imaging hard copies and port films in radiation therapy treatment setup confirmation to determine its clinical application in radiotherapy center. Int J Radiat Oncol Biol Phys 2001;49:191–198.
  • 7. Brock KK, McShan DL, Balter JM. A comparison of computer controlled versus manual on-line patient setup adjustment. J Appl Med Phys 2002;3:241–247.
  • 8. de Boer HC, van Sornsen de Koste JR, et al. Electronic portal image assisted reduction of systematic set-up errors in head and neck irradiation. Radiother Oncol 2001;61:299–308.
  • 9. Pisani L, Lockman D, Jaffray D, et al. Setup error in radiotherapy: On-line correction using electronic kilovoltage and megavoltage radiographs. Int J Radiat Oncol Biol Phys 2000;47: 825–839.
  • 10. Navarro-Martin A, Cacicedo J, Leaman O, et al. Comparative analysis of thermoplastic masks versus vacuum cushions in stereotactic body radiotherapy. Radiat Oncol 2015; 10: 176.
  • 11. White P, Yee CK, Shan LC, Chung LW, Man NH, Cheung YS. A comparison of two systems of patient immobilization for prostate radiotherapy. Radiat Oncol 2014; 22: 29.
  • 12. Han K, Cheung P, Basran PS, Poon I, Yeung L, Lochray F. A comparison of two immobilization systems for stereotactic body radiation therapy of lung tumors. Radiother Oncol 2010; 95: 103–8.
  • 13. Zeidan OA, Langen KM, Meeks SL, et al. Evaluation of image guidance protocols in the treatment of head and neck cancers. Int J Radiat Oncol Biol Phys 2007;67:670–677.
  • 14. Zhang L, Garden AS, Lo J, et al. Multiple regions-of-interest analysis of setup uncertainties for head-and-neck cancer radiotherapy. Int J Radiat Oncol Biol Phys 2006;64:1559–1569.
  • 15. O’Daniel JC, Dong L, Zhang L, et al. Dosimetric comparison of four target alignment methods for prostate cancer radiotherapy. Int J Radiat Oncol Biol Phys 2006;66:883–891.
  • 16. Borst GR, Sonke JJ,BetgenA, et al.Kilo-voltage cone-beam computed tomography setup measurements for lung cancer patients; first clinical results and comparisonwith electronic portal-imaging device. Int J Radiat Oncol Biol Phys 2007;68:555–561
  • 17. Li H, Zhu XR, Zhang L, et al. Comparison of 2D radiographic images and 3D cone beam computed tomotherapy for positioning head and neck radiotherapy patients. Int J Radiat Oncol Biol Phys 2008; 71: 916–25.
  • 18. Ost P, De Gersem W, De Potter B, Fonteyne V, De Neve W, De Meerleer G. A comparison of the acute toxicity profile between two-dimensional and three-dimensional image-guided radiotherapy for postoperative prostate cancer. Clin Oncol 2011; 23: 344–9.
  • 19. Mubata CD, Bidmead AM, Ellingham LM, et al. Portal imaging protocol for radical dose-escalated radiotherapy treatment of prostate cancer. Int J Radiat Oncol Biol Phys 1998;40:221–231
  • 20. Lin CG, Xu SK, Yao WY, Wu YQ, Fang JL, Wu VWC. Comparison of set up accuracy among three common immobilisation systems for intensity modulated radiotherapy of nasopharyngeal carcinoma patients. J Med Radiat Sci. 2017;64(2):106-113. doi:10.1002/jmrs.189
  • 21. Neubauer E, Dong L, Followill DS, et al. Assessment of shoulder position variation and its impact on IMRT and VMAT doses for head and neck cancer. Radiat Oncol 2012;8: 19.
  • 22. Lin CG, Lin LW, Liu BT, Liu XM, Li GW. A study of the positioning errors of head and neck in the process of intensity modulated radiation therapy of nasopharyngeal carcinoma. Chin J Radiat Oncol 2011; 20: 322–5.
  • 23. Cheng KF, Wu VWC. Comparison of the effectiveness of different immobilisation system in different body regions using daily megavoltage computed tomography in helical tomotherapy. Br J Radiol 2014; 87: 20130494.
  • 24. Hansen CR, Christiansen RL, Nielsen TB, Bertelsen AS, Johansen J, Brink C. Comparison of three immobilisation systems for radiation therapy in head and neck cancer. Acta Oncol 2014; 53: 423–7.
There are 24 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Emine Elif Özkan 0000-0001-9168-3756

Alper Özseven 0000-0001-6128-6426

Zümrüt Arda Kaymak 0000-0002-7284-008X

Publication Date August 20, 2021
Submission Date October 14, 2020
Published in Issue Year 2021 Volume: 12 Issue: 2

Cite

Vancouver Özkan EE, Özseven A, Kaymak ZA. Efficacy of Thermoformable Vacuum Head Cushion on Set-up Accuracy in IMRT of Head & Neck and Brain Tumors. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi. 2021;12(2):131-9.

SDÜ Sağlık Bilimleri Dergisi, makalenin gönderilmesi ve yayınlanması dahil olmak üzere hiçbir aşamada herhangi bir ücret talep etmemektedir. Dergimiz, bilimsel araştırmaları okuyucuya ücretsiz sunmanın bilginin küresel paylaşımını artıracağı ilkesini benimseyerek, içeriğine anında açık erişim sağlamaktadır.