1
|
Choi HS, Jeong BK, Jeong H, Ha IB, Choi BH, Kang KM. Target movement according to cervical lymph node level in head and neck cancer and its clinical significance. Radiat Oncol J 2023; 41:283-291. [PMID: 38185933 PMCID: PMC10772595 DOI: 10.3857/roj.2023.00787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE To evaluate set-up error for head and neck cancer (HNC) patients according to each neck lymph node (LN) level. And clinical factors affecting set-up error were analyzed. MATERIALS AND METHODS Reference points (RP1, RP2, RP3, and RP4) representing neck LN levels I to IV were designated. These RP were contoured on simulation computed tomography (CT) and cone-beam CT of 89 HNC patients with the same standard. After image registration was performed, movement of each RP was measured. Univariable logistic regression analyses were performed to analyze clinical factors related to measured movements. RESULTS The mean value of deviation of all axes was 1.6 mm, 1.3 mm, 1.8 mm, and 1.5 mm for RP1, RP2, RP3, and RP4, respectively. Deviation was over 3 mm in 24 patients. Movement of more than 3 mm was observed only in RP1 and RP3. In RP1, it was related to bite block use. Movement exceeding 3 mm was most frequently observed in RP3. Primary tumor and metastatic LN volume change were clinical factors related to the RP3 movement. CONCLUSION Planning target volume margin of 4 mm for neck LN level I, 3 mm for neck LN level II, 5 mm for neck LN level III, and 3 mm for neck LN level IV was required to include all movements of each LN level. In patients using bite block, changes in primary tumor volume, and metastatic LN volume were related to significant movement.
Collapse
Affiliation(s)
- Hoon Sik Choi
- Department of Radiation Oncology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Bae Kwon Jeong
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hojin Jeong
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - In Bong Ha
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Bong-Hoi Choi
- Department of Nuclear Medicine and Molecular Imaging, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ki Mun Kang
- Department of Radiation Oncology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| |
Collapse
|
2
|
Song H, Hu J, He J, Ma G, Cheng L, Li X. Dosimetric impact of hollow intraoral stents for head and neck cancer radiotherapy: A phantom study. J Appl Clin Med Phys 2023; 24:e14101. [PMID: 37477628 PMCID: PMC10647986 DOI: 10.1002/acm2.14101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023] Open
Abstract
PURPOSE To investigate the dosimetric impact of the calculation boundaries and dose calculation algorithms of radiotherapy in head and neck cancer patients with an opened oral cavity connected to the exterior by a hollow intraoral positioning stent. METHODS AND MATERIALS A homemade silicone phantom with an opened oral cavity was placed in a CIRS head phantom to model head and neck cancer patients with a hollow intraoral positioning stent. 3D-CRT plans were designed on CT images of the phantom in Monaco and Pinnacle3 treatment planning systems (TPSs) with the same beam parameters. The default boundary and manually extrapolated boundary were both adopted in these two TPSs to explore the dosimetric impact on treatment plans. The nanoDot™ optically stimulated luminescence dosimeters (OSLDs) were chosen to measure the planned dose surrounding the oral cavity of the head phantom after calibration. RESULT The doses in the air cavity and two measuring points at the joint area were dramatically changed from 0.0, 92.4 and 148.8 cGy to 177.8, 244.2 and 244.1 cGy in Monaco after adopting the extrapolated boundary. While the calculated doses at the same place were changed from 61.2, 143.7 and 198.3 cGy to 175.4, 234.7 and 233.2 cGy in Pinnacle3 with a similar calculation boundary. For the Monaco TPS, the relative errors compared to the OSLD measured doses were 2.94 ± 1.93%, 0.53 ± 8.64%, 2.65 ± 1.87% and 3.93 ± 1.69% at 4 measuring positions. In contrast, the relative errors 4.03 ± 1.93%, 4.85 ± 8.64%, 7.61 ± 1.87% and 5.61 ± 1.69% were observed in Pinnacle3 . CONCLUSION The boundary setting of an opened oral cavity in TPSs has a significant dosimetric impact on head and neck cancer radiotherapy. An extrapolated boundary should be manually set up to include the whole oral cavity in the dose calculation domain to avoid major dose deviations.
Collapse
Affiliation(s)
- Hongbing Song
- Department of RadiotherapyRenmin Hospital of Wuhan UniversityWuhanHubeiChina
| | - Jian Hu
- Department of RadiotherapyRenmin Hospital of Wuhan UniversityWuhanHubeiChina
| | - Junxiang He
- Department of RadiotherapyRenmin Hospital of Wuhan UniversityWuhanHubeiChina
| | - Guangdong Ma
- Department of RadiotherapyRenmin Hospital of Wuhan UniversityWuhanHubeiChina
| | - Lan Cheng
- Department of RadiologyUnion HospitalTongJi Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Xiangpan Li
- Department of RadiotherapyRenmin Hospital of Wuhan UniversityWuhanHubeiChina
| |
Collapse
|
3
|
Jung S, Kim B, Lee SY, Chang WI, Son J, Park JM, Choi CH, Lee JH, Wu HG, Kim JI, Kim JH. Novel tongue-positioning device to reduce tongue motions during radiation therapy for head and neck cancer: Geometric and dosimetric evaluation. PLoS One 2023; 18:e0291712. [PMID: 37733674 PMCID: PMC10513285 DOI: 10.1371/journal.pone.0291712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
This study aimed to assess the performance of a tongue-positioning device in interfractional tongue position reproducibility by cone-beam computed tomography (CBCT). Fifty-two patients treated with radiation therapy (RT) while using a tongue positioning device were included in the study. All patients were treated with 28 or 30 fractions using the volumetric modulated arc therapy technique. CBCT images were acquired at the 1st, 7th, 11th, 15th, 19th, 23th, and 27th fractions. Tongues on planning computed tomography (pCT) and CBCT images were contoured in the treatment planning system. Geometric differences in the tongue between pCT and CBCT were assessed by the Dice similarity coefficient (DSC) and averaged Hausdorff distance (AHD). Two-dimensional in vivo measurements using radiochromic films were performed in 13 patients once a week during sessions. The planned dose distributions were compared with the measured dose distributions using gamma analysis with criteria of 3%/3 mm. In all patients, the mean DSC at the 1st fraction (pCT versus 1st CBCT) was 0.80 while the mean DSC at the 27th fraction (pCT versus 27th CBCT) was 0.77 with statistical significance (p-value = 0.015). There was no statistically significant difference in DSC between the 1st fraction and any other fraction, except for the 27th fraction. There was statistically significant difference in AHD between the 1st fraction and the 19th, 23th, and 27th fractions (p-value < 0.05). In vivo measurements showed an average gamma passing rate of 90.54%. There was no significant difference between measurements at the 1st week and those at other weeks. The tongue geometry during RT was compared between pCT and CBCT. In conclusion, the novel tongue-positioning device was found to minimize interfractional variations in position and shape of the tongue.
Collapse
Affiliation(s)
- Seongmoon Jung
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Nuclear Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Bitbyeol Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung Young Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Won Ick Chang
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jaeman Son
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Heon Choi
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-in Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
4
|
Sakamoto M, Konishi K, Ohira K, Hirata M, Wakabayashi K, Aramaki S, Kokubo R, Nakamura K. A newly developed patient fixation system using a dedicated mouthpiece and dental impression materials for head and neck radiotherapy: a preliminary study. JOURNAL OF RADIATION RESEARCH 2022; 63:749-757. [PMID: 35818301 PMCID: PMC9494543 DOI: 10.1093/jrr/rrac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/21/2022] [Indexed: 06/15/2023]
Abstract
We evaluated the basic characteristics and efficacy of our newly developed patient fixation system for head and neck radiotherapy that uses a dedicated mouthpiece and dental impression materials. The present investigation demonstrated that with this system, the changes in the absorbed dose to water depending on the material of the mouthpiece were small, with a maximum of 0.32% for a 10-MV photon beam. For the dental impression material, we selected a silicone material with the lowest Hounsfield unit (HU) value that had little effect on the generation of artifacts and the quality of the X-ray beam. Multiphase magnetic resonance imaging (MRI) revealed that the head-up and -down motions in the thermoplastic shell without the mouthpiece were 5.76 ± 1.54 mm, whereas the motion with the mouthpiece decreased significantly to 1.72 ± 0.92 mm (P = 0.006). Similarly, the head-left and -right motion displacement decreased from 6.32 ± 1.86 mm without the mouthpiece to 1.80 ± 0.42 mm with the mouthpiece (P = 0.003). Regarding the tongue depressor function of the mouthpiece, the median distance from the hard palate to the surface of the tongue was 28.42 mm. The present results indicate that the new immobilization device developed herein that uses a mouthpiece and a thermoplastic shell is useful for suppressing patients' head motions and tongue positions.
Collapse
Affiliation(s)
- Masataka Sakamoto
- Corresponding author. Department of Radiology, Hamamatsu University Hospital, Handayama 120-1, Higashi-ku, Hamamatsu 431-3192, JAPAN. Tel: +81-053-435-2111; E-mail:
| | - Kenta Konishi
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Keiichi Ohira
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Masanori Hirata
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kohei Wakabayashi
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Shuhei Aramaki
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Ryo Kokubo
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Katsumasa Nakamura
- Department of Radiology, Hamamatsu University Hospital, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| |
Collapse
|
5
|
Zhang C, Hu W, Zhou Q, He J, Wang H, Qiu K, Wang L, Li X. The possibility of developing customized 3D-printed silicone hydrogel bolus for post-mastectomy radiotherapy. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2021. [DOI: 10.1080/16878507.2021.1962629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Caixun Zhang
- Department of Radiotherapy, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Weiguo Hu
- Department of Oncology Center, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Qing Zhou
- Department of Ultrasound, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Junxiang He
- Department of Radiotherapy, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Hao Wang
- Department of Ultrasound, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Kehu Qiu
- Department of Oncology Center, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Luzhou Wang
- Department of Radiotherapy, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Xiangpan Li
- Department of Radiotherapy, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| |
Collapse
|
6
|
Alves LDB, Menezes ACS, Pereira DL, Santos MTC, Antunes HS. Benefits of intraoral stents in patients with head and neck cancer undergoing radiotherapy: Systematic review. Head Neck 2021; 43:1652-1663. [PMID: 33527582 DOI: 10.1002/hed.26620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/28/2020] [Accepted: 01/15/2021] [Indexed: 12/24/2022] Open
Abstract
Intraoral stents aim to reduce the oral complications associated with head and neck cancers radiotherapy. The aim of this study is to determine the benefits associated with these devices. A systematic review was conducted in PubMed, Web of Science, and Scopus databases selecting full articles published in English, Portuguese, or Spanish until June 6, 2020 (PROSPERO registration: CRD42020185065). The studies were evaluated by Hadorn and Somerfield criteria and guidelines were established. Nineteen studies were identified suggesting the use of intraoral stent for radiotherapy for patients with cancer on/near the mandible to reduce oral mucositis, trismus, xerostomia (LoE III), and dose in healthy structures (LoE IV) and for cancer on/near the maxilla to reduce oral mucositis and dose in healthy structures (LoE IV). Despite the limited scientific evidence, several benefits associated with the use of intraoral stent for radiotherapy of the head and neck neoplasia have been reported.
Collapse
Affiliation(s)
- Lísia D B Alves
- Multi-Professional Residency, Dentistry Section, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Ana C S Menezes
- Multi-Professional Residency, Dentistry Section, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Débora L Pereira
- Clinical Research Division, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Marco T C Santos
- Multi-Professional Residency, Radiation Oncology Service, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Héliton S Antunes
- Clinical Research Division, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| |
Collapse
|