Two-dimensional and Three-dimensional Image-guided Evaluation of Patient Positioning for Intensity-modulated Radiation Therapy of Head and Neck Cancer
Keywords:Cone-beam computed tomography, Set-up error, Image-guided patient positioning, Head and Neck Cancer, intensity-modulated radiation therapy
Patient positioning accuracy is critical in radiation therapy, especially in intensity-modulated radiation therapy (IMRT) for head and neck cancer (HNC), as it can affect treatment effectiveness and safety. This retrospective study aimed to evaluate the accuracy of patient positioning techniques and compare the effectiveness of using multiple image-guided (IG) methods for IG-IMRT of HNC. Cone-beam computed tomography (CBCT) and kV-planar imaging (OBI) collected 3240 treatment couch coordinates in three translational directions from 60 HNC patients undergoing IMRT. Inter-fraction errors were assessed by registering the scans to the planning CT, and the population systematic set-up error (Σ), random error (σ), and planning target volume (PTV) margin were calculated. The results between OBI and CBCT were analyzed and compared using one-way ANOVA. The findings demonstrated that more than 80% of the image-guided patient positioning set-ups were acceptable. The mean couch displacement for image-guided techniques was negligible in all translational directions using OBI and CBCT. However, the PTV margin for both methods was more than 0.5 cm, except for the CBCTA-P direction. This study highlights the effectiveness of OBI and CBCT as modalities for evaluating and improving the accuracy of IMRT in HNC patients. Determination of the systematic and random errors and calculating the optimal PTV margin without rematching images can help improve the precision of patient positioning and ultimately lead to better treatment outcomes.
Alfouzan, A.F. (2021). Radiation therapy in head and neck cancer. Saudi Medical Journal. 42(3), 247-254. https://doi.org/10.15537/SMJ.2021.42.3.20210660.
Anjanappa, M., Rafi, M., Bhasi, S., Kumar, R., Thommachan, K. C., Bhattacharya, T., & Ramadas, K. (2017). Set-up uncertainties and PTV margins at different anatomical levels in intensity-modulated radiotherapy for nasopharyngeal cancer. Reports of Practical Oncology and Radiotherapy, 22(5), 396-401.
Atwell, D., Elks, J., Cahill, K., Hearn, N., Vignarajah, D., Lagopoulos, J., & Min, M. (2020). A review of modern radiation therapy dose escalation in locally advanced head and neck cancer. Clinical Oncology, 32(5), 330-341.
Azizah Ab. M., Nor Saleha I.T., Noor Hashimah A., Asmah Z.A. & Mastulu W. (2016). Malaysian National Cancer Registry Report 2007-2011. National Cancer Institute, Ministry of Health Malaysia. Available from: https://www.crc.gov. my/wp-content/uploads/documents/report/MNCRRrepor2007-2011.pdf.
Biswas, P., Lahiri, D., Roy, S., Maji, T., Bhadra, K., Ray, D. K., ... & Mohanta, B. K. (2020). Prospective observational study to estimate set-up errors and optimize PTV margins in patients undergoing IMRT for head and neck cancers from a Government cancer center in Eastern India. Journal of Radiotherapy in Practice, 19(1), 52-58. Doi: 10.1017/S1460396919000487.
Bozec, A., Culié, D., Poissonnet, G., Demard, F., & Dassonville, O. (2021). Current therapeutic strategies in patients with oropharyngeal squamous cell carcinoma: Impact of the tumor HPV status. Cancers, 13(21), 5456.
Cho, B. (2018). Intensity-modulated radiation therapy: A review with a physics perspective. Radiation Oncology Journal, 36(1), 1.
Delishaj, D., Ursino, S., Pasqualetti, F., Matteucci, F., Cristaudo, A., Soatti, C. P., ... & Paiar, F. (2018). Set-up errors in head and neck cancer treated with IMRT technique assessed by cone-beam computed tomography: A Feasible Protocol: Radiation Oncology Journal, 36(1), 54.
Divneet, M., Quoc-Anh, H., Betsy, W., Gia, J., Denise, R., Christopher, W., & Sun, K. Y. (2018). Comparison of two thermoplastic immobilization mask systems in daily volumetric image-guided radiation therapy for head and neck cancers. Biomedical Physics & Engineering Express, 4(5), 055007.
Djordjevic, M., Sjöholm, E., Tullgren, O. & Sorcini, B. (2014). Assessment of residual set-up errors for anatomical sub-structures in image-guided head-and-neck cancer radiotherapy in image-guided head-and-neck cancer radiotherapy. Acta Oncologica, 53, 646-653.
Figen, M., Çolpan Öksüz, D., Duman, E., Prestwich, R., Dyker, K., Cardale, K. ... & Şen, M. (2020). Radiotherapy for head and neck cancer: evaluation of triggered adaptive replanning in routine practice. Frontiers in Oncology, 10, 2427.
Gurjar, O., Mishra, S., Bhandari, V., Pathak, P., Pant, S. & Patel, P. (2014). A study on the necessity of kV ‑ CBCT imaging compared to kV ‑ Orthogonal portal imaging based on set-up errors: Considering other socioeconomical factors. Journal of Cancer Research and Therapeutics, 10(3), 583-586.
Johnson, D. E., Burtness, B., Leemans, C. R., Lui, V. W. Y., Bauman, J. E. & Grandis, J. R. (2020). Head and neck squamous cell carcinoma. Nature Reviews Disease Primers, 6(1), 1-22.
Kapanen, M., Laaksomaa, M., Tulijoki, T., Kellokumpu-Lehtinen, P. L., & Hyödynmaa, S. (2015). Effects of remedies made in patient set-up process on residual set-up errors and margins in head and neck cancer radiotherapy based on 2D image guidance. Reports of Practical Oncology and Radiotherapy, 20(4), 292-298.
Kearney, M., Coffey, M. & Leong, A. (2020). A review of image guided radiation therapy in head and neck cancer from 2009–2019 – Best practice recommendations for RTTs in the clinic. Technical Innovations and Patient Support in Radiation Oncology, 14, 43-50.
Kucha, N., Soni, T. P., Jakhotia, N., Patni, N., Singh, D. K., Gupta, A. K., ... & Goyal, J. (2020). A prospective, comparative analysis of acute toxicity profile between three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in locally advanced head and neck cancer patients. Cancer Treatment and Research Communications, 25, 100223.
Lai, Y. L., Yang, S. N., Liang, J. A., Wang, Y. C., Yu, C. Y., Su, C. H., & Chen, S. W. (2014). Impact of body-mass factors on set-up displacement in patients with head and neck cancer treated with radiotherapy using daily online image guidance. Radiation Oncology, 9, 1-8.
Leech, M., Coffey, M., Mast, M., Moura, F., Osztavics, A., Pasini, D., & Vaandering, A. (2017). ESTRO ACROP guidelines for positioning, immobilisation and position verification of head and neck patients for radiation therapists. Technical Innovations & Patient Support in Radiation Oncology, 1, 1-7.
Liu, J., Lyman, K.M., Ding, Z. & Zhou, L. (2019). Assessment of the therapeutic accuracy of cone beam computed tomography-guided nasopharyngeal carcinoma radiotherapy. Oncology Letters, 18(2), 1071-1080.
Mu, G., Wang, J., Liu, Z., Zhang, H., Zhou, S., Xiang, Q., & Cui, Y. (2021). Association between smokeless tobacco use and oral cavity cancer risk in women compared with men: A systematic review and meta-analysis. BMC Cancer, 21(1), 1-12. https://doi.org/10.1186/s12885-021-08691-x.
Nekhlyudov, L., Lacchetti, C., Davis, N. B., Garvey, T. Q., Goldstein, D. P., Nunnink, J. C., ... & Siu, L. L. (2017). Head and neck cancer survivorship care guideline: American Society of Clinical Oncology clinical practice guideline endorsement of the American Cancer Society guideline. Journal of Clinical Oncology, 35(14), 1606-1621.
Ohnleiter, T., Antoni, D., Lefebvre, F., Truntzer, P., Schultz, P., Burgy, M., … Noël, G. (2018). Factors improving the outcome of patients re-irradiated with intensity-modulated radiotherapy (IMRT) for relapse or new head and neck cancer developed in Irradiated Areas. Chinese Clinical Oncology, 7(6), 1-9. https://doi.org/10.21037/cco.2018.06.07.
Okekpa, S. I., Mydin, R. B. S., Mangantig, E., Azmi, N. S. A., Zahari, S. N. S., Kaur, G. & Musa, Y. (2019). Nasopharyngeal carcinoma (NPC) risk factors: A systematic review and meta-analysis of the association with lifestyle, diets, socioeconomic and sociodemographic in Asian region. Asian Pacific Journal of Cancer Prevention: APJCP, 20(11), 3505.
Osman, A. F., & Maalej, N. M. (2021). Applications of machine and deep learning to patient‐specific IMRT/VMAT quality assurance. Journal of Applied Clinical Medical Physics, 22(9), 20-36.
Stoll, M., Stoiber, E. M., Grimm, S., Debus, J., Bendl, R., & Giske, K. (2016). Comparison of safety margin generation concepts in image-guided radiotherapy to account for daily head and neck pose variations. Plos One, 11(12), e0168916.
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal For Clinicians, 71(3), 209-249.
Thornberry, D., McLauchlam, R., & Gujral, D. M. (2018, April). Cone beam computed tomography for radical head and neck radiotherapy. In Radiotherapy and Oncology (Vol. 127). Elsevier House, Brookvale Plaza, East Park Shannon, Co, Clare, 00000, Ireland: Elsevier Ireland Ltd.
Van Herk, M. (2004). Errors and Margins in Radiotherapy. Seminars in Radiation Oncology, 14(1), 52-64.
Zhong, R., Song, Y., Yan, Y., Wang, X., Li, S., Zhou, J., ... & Bai, S. (2018). Analysis of which local set-up errors can be covered by a 5-mm margin for cone-beam CT-guided radiotherapy for nasopharyngeal carcinoma. The British Journal of Radiology, 91(1088), 20160849.
Copyright (c) 2023 Zul Iskandar Johari, Nor Aniza Azmi, Nur Fa’izah Ab Muin, Rukiah A Latiff, Muhammad Safwan Ahmad Fadzil, Rosmizan Ahmad Razali
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.