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Open Access Research

Assessment of shoulder position variation and its impact on IMRT and VMAT doses for head and neck cancer

Emily Neubauer1, Lei Dong1, David S Followill1, Adam S Garden2, Laurence E Court1, R Allen White3 and Stephen F Kry1*

Author Affiliations

1 Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX, 77030 USA

2 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX, 77030 USA

3 Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX, 77030 USA

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Radiation Oncology 2012, 7:19  doi:10.1186/1748-717X-7-19

Published: 8 February 2012

Abstract

Background

For radiotherapy of the head and neck, 5-point mask immobilization is used to stabilize the shoulders. Still, the daily position of the shoulders during treatment may be different from the position in the treatment plan despite correct isocenter setup. The purpose of this study was to determine the interfractional displacement of the shoulders relative to isocenter over the course of treatment and the associated dosimetric effect of this displacement.

Methods

The extent of shoulder displacements relative to isocenter was assessed for 10 patients in 5-point thermoplastic masks using image registration and daily CT-on-rails scans. Dosimetric effects on IMRT and VMAT plans were evaluated in Pinnacle based on simulation CTs modified to represent shoulder shifts between 3 and 15 mm in the superior-inferior, anterior-posterior, and right-left directions. The impact of clinically observed shoulder shifts on the low-neck dose distributions was examined.

Results

Shoulder motion was 2-5 mm in each direction on average but reached 20 mm. Superior shifts resulted in coverage loss, whereas inferior shifts increased the dose to the brachial plexus. These findings were generally consistent for both IMRT and VMAT plans. Over a course of observed shifts, the dose to 99% of the CTV decreased by up to 101 cGy, and the brachial plexus dose increased by up to 72 cGy.

Conclusions

he position of the shoulder affects target coverage and critical structure dose, and may therefore be a concern during the setup of head and neck patients, particularly those with low neck primary disease.

Keywords:
Head and Neck; shoulder shifts; IMRT; VMAT; setup; shoulder