Does weight loss predict accuracy of setup in head and neck cancer patients treated with Intensity-Modulated Radiation Therapy?

Bari, Berardino De; Erraisse, M. Ait; Chekrine, T.; Rabilloud, M.; Shakir, I. Shakir; Lebras, Laure; Favrel, V.

doi:10.1007/s11547-011-0765-7

Cited by 11 publications

(5 citation statements)

References 23 publications

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“…On the baseline (BL) day of CT simulation we recorded: anxiety [18] and pain [19–24], before starting the simulation procedure (more on the measurements scales below); patient’s weight and height [25, 26]; intent of radiation therapy; variable influencing patient positioning such as shoulders forced down, scoliosis or kyphosis; some patient and environment variables such as presence of mobile dental prosthesis, use of bite for locking of the jaw, tracheostomy, voluminous beard, voluminous hair, room temperature of the CT room and temperature of the water used for shaping the thermoplastic mask; type of standard neck supports used and the eventual addition of customized neck support; number of radiation therapy team members who worked together to shape the thermoplastic mask and temporary removal of the mask before the acquisition of CT simulation. On the first day of every week of treatment we measured the patient’s weight.…”

Section: Methodsmentioning

confidence: 99%

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Setup errors in patients with head-neck cancer (HNC), treated using the Intensity Modulated Radiation Therapy (IMRT) technique: how it influences the customised immobilisation systems, patient’s pain and anxiety

Contesini

Guberti

Saccani³

et al. 2017

Radiat Oncol

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BackgroundIn patients with head-neck cancer treated with IMRT, immobility of the upper part of the body during radiation is maintained by means of customised immobilisation devices.The main purpose of this study was to determine how the procedures for preparation of customised immobilisation systems and the patients characteristics influence the extent of setup errors.MethodsA longitudinal, prospective study involving 29 patients treated with IMRT. Data were collected before CT simulation and during all the treatment sessions (528 setup errors analysed overall); the correlation with possible risk factors for setup errors was explored using a linear mixed model.ResultsSetup errors were not influenced by the patient’s anxiety and pain. Temporary removal of the thermoplastic mask before carrying out the CT simulation shows statistically borderline, clinically relevant, increase of setup errors (+24.7%, 95% CI: −0.5% - 55.8%). Moreover, a unit increase of radiation therapists who model the customised thermoplastic mask is associated to a −18% (−29.2% - -4.9%) reduction of the errors.The setup error is influenced by the patient’s physical features; in particular, it increases both in patients in whom the treatment position is obtained with ‘Shoulder down’ (+27.9%, 2.2% - 59.7%) and in patients with ‘Scoliosis/kyphosis’ problems (+65.4%, 2.3% - 164.2%). Using a ‘Small size standard plus customized neck support device’ is associated to a −52.3% (−73.7% - -11.2%) reduction.The increase in number of radiation therapists encountered during the entire treatment cycle does not show associations. Increase in the body mass index is associated with a slight reduction in setup error by (−2.8%, −5% - -0.7%).ConclusionThe position of the patient obtained by forcing the shoulders downwards, clinically significant scoliosis or kyphosis and the reduction of the number of radiation therapists who model the thermoplastic mask are found to be statistically significant risk factors that can cause an increase in setup errors, while the use of ‘Small size’ neck support device and patient BMI can diminish them.

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Section: Methodsmentioning

confidence: 99%

“…Pain was measured using the Numeric Pain Rating Scale, [19–24] a numeric scale that describes the intensity of pain, ranging from 0 (no pain) to 10 (max value of pain); the measurement was performed directly by the patients themselves in the waiting rooms.…”

Section: Methodsmentioning

confidence: 99%

Setup errors in patients with head-neck cancer (HNC), treated using the Intensity Modulated Radiation Therapy (IMRT) technique: how it influences the customised immobilisation systems, patient’s pain and anxiety

Contesini

Guberti

Saccani³

et al. 2017

Radiat Oncol

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“…Two prior studies retrospectively looking at the effect of weight loss did not find a significant correlation between weight loss and set-up errors. 48,49 Another study, however, found a higher set-up shift with larger PTV requirements for patients with weight loss and laryngeal cancer. 7 In another study, the systematic errors were slightly higher in the lateral and antero-posterior direction in patients whose weight loss was >5%, but the required PTV margins for set-up error were within 5 mm.…”

Section: Discussionmentioning

confidence: 98%

Prospective observational study to estimate set-up errors and optimise PTV margins in patients undergoing IMRT for head and neck cancers from a Government cancer centre of Eastern India

Biswas

Lahiri

et al. 2019

J Radiother Pract

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Background:The head and neck cancers as a whole are the most common cancers among males in India. Technological advancements have led to an improvement in radiation therapy (RT) techniques with subsequent reduction in normal tissue complications. To correct patient set-up errors, an off-line correction method like no action level (NAL) protocol may be used as a preferred protocol particularly for a busy department. The objectives of the study were to measure the translational set-up errors using kV cone-beam computed tomography (CBCT) in patients undergoing intensity modulated radiotherapy (IMRT) in head and neck cancers and also to optimise clinical target volume (CTV) to planning target volume (PTV) margin using NAL protocol.Material and methods:On the first 5 days of RT, patient’s position was verified by kV-CBCT and then weekly during the course of treatment. The comparison between the reference and kV-CBCT images was performed, and the shifts measured and recorded. The mean error from the initial five consecutive fractions was corrected on the sixth daily fraction. Displacements in all the directions were measured. The population systematic and random errors were determined and used to estimate PTV margins according to the van Herk formula.Results:A total of 322 images were analysed. Before correction, 15, 12 and 9% patients had systematic error ≥3 mm on X, Y and Z axes, but after correction this was reduced to 9, 0 and 0%. The total percentage of patients whose set-up margin was ≥5 mm before correction was 5, 6·25, 3·75%, but after correction it reduced to 1·88, 0, and 0·63%. The margins of total population were reduced to 63, 65 and 56% after correction on X, Y and Z axes, respectively.Conclusion:A simple off-line NAL protocol can correct the set-up errors without daily on-line imaging in patients undergoing IMRT and hence acting as a resource sparing alternative. Five millimetre margin to CTVs was adequate and safe to overcome the problem of set-up errors in head and neck IMRT.

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“…The correlations between ΔBW and Δ(inter) were significant in several studies [23,24], although some studies reported contrasting results [25,26]. Hou et al [23] reported that patients with nasopharyngeal cancer with weight loss of >5% had significantly larger ΔAP(inter).…”

Section: Discussionmentioning

confidence: 99%

Prospective assessment of inter- or intra-fractional variation according to body weight or volume change in patients with head and neck cancer undergoing radiotherapy

Kim

Yea

et al. 2019

PLoS ONE

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This study aimed to prospectively investigate the association between body weight (ΔBW) or body volume variations (ΔBV) and inter- or intra-fractional variations (Δ(inter) or Δ(intra)) in patients with head and neck cancer (HNC) undergoing radiotherapy (RT). This study enrolled patients with HNC from December 2015 to December 2017. All patients underwent curative intensity-modulated RT (IMRT) either as definitive or adjuvant treatment. Six-dimensional inter- and intra-fractional variations (Δ(inter) and Δ(intra)) were obtained with ExacTrac (BrainLAB, Feldkirchen, Germany) system. BV was measured 7.5 cm cranio-caudally from the centre using cone beam computed tomography. The BW, BV, and Δ(inter) were calculated based on the value obtained on the first treatment day after each simulation. Both Δ(inter) and Δ(intra) were considered in calculating the optimal margins for planning target volume (PTV), which was calculated using van Herk’s formula. In total, 678 fractions with 39 simulations in 22 patients were analysed. The average ΔBW and ΔBV was -0.43±1.90 kg (range, -7.3 to 5.0) and -24.34±69.0 cc (range, -247.15 to 214.88), respectively. In correlation analysis, Δ(intra) was more associated with ΔBW or ΔBV than Δ(inter). Receiver operating characteristic analysis showed Δ(intra) could differentiate ΔBW from ΔBV, while Δ(inter) could not. The optimal margins for PTV considering both Δ(inter) and Δ(intra) were 3.70 mm, 4.52 mm, and 5.12 mm for the right-left, superior-inferior, and anterior-posterior directions, respectively. In conclusion, the PTV margin of 6 mm for anterior-posterior direction and 5 mm for the other directions were needed. ΔBW or ΔBV correlated with Δ(intra) rather than Δ(inter). Therefore, ΔBW or ΔBV should be assessed for accurate IMRT in patients with HNC.

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Does weight loss predict accuracy of setup in head and neck cancer patients treated with Intensity-Modulated Radiation Therapy?

Abstract: Weight loss is not a good clinical parameters for predicting an increase of setup errors. Other clinical and/or anthropometrical features should be prospectively evaluated in order to assess the need for re-planning.

Cited by 11 publications

References 23 publications

Setup errors in patients with head-neck cancer (HNC), treated using the Intensity Modulated Radiation Therapy (IMRT) technique: how it influences the customised immobilisation systems, patient’s pain and anxiety

Setup errors in patients with head-neck cancer (HNC), treated using the Intensity Modulated Radiation Therapy (IMRT) technique: how it influences the customised immobilisation systems, patient’s pain and anxiety

Prospective observational study to estimate set-up errors and optimise PTV margins in patients undergoing IMRT for head and neck cancers from a Government cancer centre of Eastern India

Prospective assessment of inter- or intra-fractional variation according to body weight or volume change in patients with head and neck cancer undergoing radiotherapy

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