An audit of setup reproducibility in radiotherapy of head and neck cancers

Abstract

Background: The use of a customized immobilization thermoplastic mask is essential to compute clinical target volume (CTV) to planning target volume (PTV) margins. Purpose: The purpose of this study was to audit setup reproducibility in head and neck cancers (HNCs) since commencing an intensity modulated radiotherapy (IMRT) program. Patients and Methods: Patients for IMRT of HNC were immobilized using either a plain "S" type mask ("S") or with a customized reenforced support at nasion and chin ("S"-NC) or an extended "U" type mask ("U"- NC), for head (H) and neck (N) regions, following radiotherapy planning contrast-enhanced computed tomography scans used to generate digital reconstructed radiographs (DRRs) at 0° (anteroposterior [A-P]) and 270° (lateral) on which match structures were contoured. Orthogonal MV portal images (PIs), A-P, and lateral were obtained. PIs were matched with the DRRs to obtain the setup variations, and the systemic (∑) and random errors (σ) to calculate PTV margins using the van Herk formula (2.5∑ +0.7σ). Results: Thirty-three patients provided 226 paired PIs with matching done separately for HNC regions. PTV margins for mediolateral, A-P, and craniocaudal directions for the head region were 3, 4, and 5 mm for "S"; 3, 4, and 3 mm for "S"-NC; and 3, 2, and 2 mm for extended "U"- NC type masks, respectively. For neck region, PTV margins were 4, 8, and 5 mm for "S"; 3, 5, and 3 mm for "S"-NC; and 4, 5, and 2 mm for extended "U"- NC type masks. Conclusions: These audits provide the necessary confidence to decrease population-based CTV to PTV margins.

Keywords

• Head and neck cancer
• intensity-modulated radiotherapy
• radiotherapy