PMID- 29372290 OWN - NLM STAT- MEDLINE DCOM- 20180723 LR - 20191210 IS - 1439-099X (Electronic) IS - 0179-7158 (Linking) VI - 194 IP - 5 DP - 2018 May TI - Patient positioning in head and neck cancer : Setup variations and safety margins in helical tomotherapy. PG - 386-391 LID - 10.1007/s00066-018-1265-7 [doi] AB - 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. FAU - Leitzen, Christina AU - Leitzen C AUID- ORCID: 0000-0001-7397-8569 AD - Radiologische Klinik, FE Strahlentherapie, Universitatsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. christina.leitzen@ukbonn.de. FAU - Wilhelm-Buchstab, Timo AU - Wilhelm-Buchstab T AD - Radiologische Klinik, FE Strahlentherapie, Universitatsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. FAU - Mudder, Thomas AU - Mudder T AD - Radiologische Klinik, FE Strahlentherapie, Universitatsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. FAU - Heimann, Martina AU - Heimann M AD - Radiologische Klinik, FE Strahlentherapie, Universitatsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. FAU - Koch, David AU - Koch D AD - Radiologische Klinik, FE Strahlentherapie, Universitatsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. FAU - Schmeel, Christopher AU - Schmeel C AD - Radiologische Klinik, FE Strahlentherapie, Universitatsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. FAU - Simon, Birgit AU - Simon B AD - Radiologische Klinik, FE Strahlentherapie, Universitatsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. FAU - Stumpf, Sabina AU - Stumpf S AD - Radiologische Klinik, FE Strahlentherapie, Universitatsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. FAU - Vornholt, Susanne AU - Vornholt S AD - Radiologische Klinik, FE Strahlentherapie, Universitatsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. FAU - Garbe, Stephan AU - Garbe S AD - Radiologische Klinik, FE Strahlentherapie, Universitatsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. FAU - Rohner, Fred AU - Rohner F AD - Radiologische Klinik, FE Strahlentherapie, Universitatsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. FAU - Schoroth, Felix AU - Schoroth F AD - Radiologische Klinik, FE Strahlentherapie, Universitatsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. FAU - Schild, Hans Heinz AU - Schild HH AD - Radiologische Klinik, FE Strahlentherapie, Universitatsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. FAU - Schuller, Heinrich AU - Schuller H AD - Radiologische Klinik, FE Strahlentherapie, Universitatsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. LA - eng PT - Journal Article TT - Patientenlagerung bei Kopf-Hals-Tumoren : Lageungenauigkeiten und Sicherheitsabstande bei helikaler Tomotherapie. DEP - 20180125 PL - Germany TA - Strahlenther Onkol JT - Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] JID - 8603469 SB - IM MH - Adenocarcinoma/pathology/*radiotherapy MH - Adult MH - Aged MH - Aged, 80 and over MH - Carcinoma, Squamous Cell/pathology/*radiotherapy MH - Dose Fractionation, Radiation MH - Female MH - Humans MH - Lymphatic Metastasis/pathology/radiotherapy MH - Male MH - Middle Aged MH - Neoplasm Staging MH - Otorhinolaryngologic Neoplasms/pathology/*radiotherapy MH - Outcome and Process Assessment, Health Care MH - Patient Positioning/*methods MH - Radiotherapy Planning, Computer-Assisted/*methods MH - Radiotherapy, Intensity-Modulated/*methods MH - Retrospective Studies OTO - NOTNLM OT - Head and neck cancer OT - IMRT OT - Safety margin OT - Tomotherapy EDAT- 2018/01/27 06:00 MHDA- 2018/07/24 06:00 CRDT- 2018/01/27 06:00 PHST- 2017/10/09 00:00 [received] PHST- 2018/01/05 00:00 [accepted] PHST- 2018/01/27 06:00 [pubmed] PHST- 2018/07/24 06:00 [medline] PHST- 2018/01/27 06:00 [entrez] AID - 10.1007/s00066-018-1265-7 [pii] AID - 10.1007/s00066-018-1265-7 [doi] PST - ppublish SO - Strahlenther Onkol. 2018 May;194(5):386-391. doi: 10.1007/s00066-018-1265-7. Epub 2018 Jan 25.