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A prospective randomised controlled clinical trial to evaluate three immobilisation devices for intra-thoracic radiation therapy

Published online by Cambridge University Press:  07 July 2010

Evelyn O'Shea ,
John Armstrong ,
Charles Gillham ,
Roisin McCloy ,
Rachel Murrells ,
Tom O'Hara ,
Angela Clayton-Lea ,
Michael Murphy ,
Patricia Browne  and
Catherine Booth
...Show all authors
Evelyn O'Shea*
Affiliation:
Radiotherapy Department, St. Luke’s Hospital, Dublin, Ireland
John Armstrong
Affiliation:
Radiotherapy Department, St. Luke’s Hospital, Dublin, Ireland
Charles Gillham
Affiliation:
Radiotherapy Department, St. Luke’s Hospital, Dublin, Ireland
Roisin McCloy
Affiliation:
Radiotherapy Department, St. Luke’s Hospital, Dublin, Ireland
Rachel Murrells
Affiliation:
Radiotherapy Department, St. Luke’s Hospital, Dublin, Ireland
Tom O'Hara
Affiliation:
Infosight Training & Consultancy, Athlone, Ireland
Angela Clayton-Lea
Affiliation:
Radiotherapy Department, St. Luke’s Hospital, Dublin, Ireland
Michael Murphy
Affiliation:
Radiotherapy Department, St. Luke’s Hospital, Dublin, Ireland
Patricia Browne
Affiliation:
Radiotherapy Department, St. Luke’s Hospital, Dublin, Ireland
Catherine Booth
Affiliation:
Radiotherapy Department, St. Luke’s Hospital, Dublin, Ireland
Pierre Thirion
Affiliation:
Radiotherapy Department, St. Luke’s Hospital, Dublin, Ireland
*
Correspondence to: Evelyn O'Shea, Radiotherapy Research & Development Manager, Radiotherapy Department, St. Luke’s Hospital, Rathgar, Dublin 6, Ireland. Email: Evelyn.O'Shea@slh.ie
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Abstract

Purpose: To determine the optimal of three immobilisation devices for lung radiotherapy in terms of set-up reproducibility, patient comfort, radiation therapists’ (RTs) satisfaction and cost-effectiveness.

Materials and methods: A total of 30 lung CRT patients were randomised to one of three immobilisation techniques – Arm A, headsponge; Arm B, BreastBoard dedicated immobilisation device; and Arm C, LungBoard dedicated immobilisation device.

Results: Random errors were larger for Arm A versus C in all directions (p < 0.05). Random errors were larger for Arm A versus B for y and z directions (p < 0.05). When the data for the immobilisation devices (Arms B+C) were pooled and compared with Arm A (no dedicated device), the systematic errors were larger in the z direction for A (p < 0.05). Arm C was cheaper and was more comfortable for patients. Therapists preferred this device (Arm C) and treatment times were less (p < 0.05).

Conclusion: This is the first prospective randomised controlled lung immobilisation trial, based on 3-DCRT, that takes into account treatment accuracy, users satisfaction and resource implications. It suggests that the LungBoard immobilisation device is optimal.

Keywords

Conformal lung radiotherapyset-up errorslung immobilisationtreatment accuracy
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 9 , Issue 2 , June 2010 , pp. 65 - 75
Copyright
Copyright © Cambridge University Press 2010

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References

1.Essapen, S, Knowles, C, Norman, A, Tait, D. Accuracy of set-up of thoracic radiotherapy: prospective analysis of 24 patients treated with radiotherapy for lung cancer. Br J Radiol 2002; 75: 162–169.CrossRefGoogle ScholarPubMed
2.Schwarz, M, Alber, M, Lebesque, JV, Mijnheer, BJ, Damen, EM. Dose heterogeneity in the target volume and intensity-modulated radiotherapy to escalate the dose in the treatment of non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2005; 62: 561–570.CrossRefGoogle ScholarPubMed
3.Grills, ISYan, D, Martinez, AA, Vicini, FA, Wong, JW, Kestin, LL. Potential for reduced toxicity and dose escalation in the treatment of inoperable non-small-cell lung cancer: a comparison of intensity-modulated radiation therapy (IMRT), 3D conformal radiation, and elective nodal irradiation. Int J Radiat Oncol Biol Phys 2003; 57: 875–890.CrossRefGoogle ScholarPubMed
4.de Boer, HC, van Sörnsen de Koste, JR, Senan, S, Visser, AG, Heijmen, BJ. Analysis and reduction of 3D systematic and random setup errors during the simulation and treatment of lung cancer patients with CT-based external beam radiotherapy dose planning. Int J Radiat Oncol Biol Phys 2001; 49: 857–868.CrossRefGoogle ScholarPubMed
5.Engelsman, M, Remeijer, P, van Herk, M, Lebesque, JV, Mijnheer, BJ, Damen, EM. Field size reduction enables iso-NTCP escalation of tumor control probability for irradiation of lung tumors. Int J Radiat Oncol Biol Phys 2001; 51: 1290–1298.CrossRefGoogle ScholarPubMed
6.McGibney, C, Holmberg, O, McClean, B, Williams, C, McCrea, P, Sutton, P, Armstrong, J. Dose escalation of chart in non-small cell lung cancer: is three-dimensional conformal radiation therapy really necessary? Int J Radiat Oncol Biol Phys 1999; 45: 339–350.CrossRefGoogle ScholarPubMed
7.Armstrong, JG. Target volume definition for three-dimensional conformal radiation therapy of lung cancer. Br J Radiol 1998; 71: 587–594.CrossRefGoogle ScholarPubMed
8.Armstrong, JG, Burman, C, Leibel, S, Fontenla, D, Kutcher, G, Zelefsky, M, Fuks, Z. Three-dimensional conformal radiation therapy may improve the therapeutic ratio of high dose radiation therapy for lung cancer. Int J Radiat Oncol Biol Phys 1993; 26: 685–689.CrossRefGoogle ScholarPubMed
9.Rosenthal, SA, Roach, M 3rd, Goldsmith, BJ, Doggett, EC, Pickett, B, Yuo, HS, Soffen, EM, Stern, RL, Ryu, JK. Immobilization improves the reproducibility of patient positioning during six-field conformal radiation therapy for prostate carcinoma. Int J Radiat Oncol Biol Phys 1993; 27: 921–926.CrossRefGoogle ScholarPubMed
10.Schwarz, M, Van der Geer, J, Van Herk, M, Lebesque, JV, Mijnheer, BJ, Damen, EM. Impact of geometrical uncertainties on 3D CRT and IMRT dose distributions for lung cancer treatment. Int J Radiat Oncol Biol Phys 2006; 65: 1260–1269.CrossRefGoogle ScholarPubMed
11.van Herk, M. Errors and margins in radiotherapy. Semin Radiat Oncol 2004; 14: 52–64.CrossRefGoogle ScholarPubMed
12.Hurkmans, CW, Remeijer, P, Lebesque, JV, Mijnheer, BJ. Set-up verification using portal imaging; review of current clinical practice. Radiother Oncol 2001; 58: 105–120.CrossRefGoogle ScholarPubMed
13.van Herk, M, Remeijer, P, Rasch, C, Lebesque, JV. The probability of correct target dosage: dose-population histograms for deriving treatment margins in radiotherapy. Int J Radiat Oncol Biol Phys 2000; 47: 1121–1135.CrossRefGoogle ScholarPubMed
14.McKenzie, AL, van Herk, M, Mijnheer, B. The width of margins in radiotherapy treatment plans. Phys Med Biol 2000; 45: 3331–3342.CrossRefGoogle ScholarPubMed
15.Stroom, JC, de Boer, HC, Huizenga, H, Visser, AG. Inclusion of geometrical uncertainties in radiotherapy treatment planning by means of coverage probability. Int J Radiat Oncol Biol Phys 1999; 43: 905–919.CrossRefGoogle ScholarPubMed
16.Erridge, SC, Seppenwoolde, Y, Muller, SH, van Herk, M, De Jaeger, K, Belderbos, JS, Boersma, LJ, Lebesque, JV. Portal imaging to assess set-up errors, tumor motion and tumor shrinkage during conformal radiotherapy of non-small cell lung cancer. Radiother Oncol 2003; 66: 75–85.CrossRefGoogle ScholarPubMed
17.Bentel, GC, Marks, LB, Krishnamurthy, R. Impact of cradle immobilization on setup reproducibility during external beam radiation therapy for lung cancer. Int J Radiat Oncol Biol Phys 1997; 38: 527–531.CrossRefGoogle ScholarPubMed
18.Van de Steene, J, Van den Heuvel, F, Bel, A et al. Electronic portal imaging with on-line correction of setup error in thoracic irradiation: clinical evaluation. Int J Radiat Oncol Biol Phys 1998; 40: 967–976.CrossRefGoogle ScholarPubMed
19.Ekberg, L, Holmberg, O, Wittgren, L, Bjelkengren, G, Landberg, T. What margins should be added to the clinical target volume in radiotherapy treatment planning for lung cancer? Radiother Oncol 1998; 48: 71–77.CrossRefGoogle Scholar
20.Samson, MJ, van Sörnsen de Koste, JR, de Boer, HC, Tankink, H, Verstraate, M, Essers, M, Visser, AG, Senan, S. An analysis of anatomic landmark mobility and setup deviations in radiotherapy for lung cancer. Int J Radiat Oncol Biol Phys 1999; 43: 827–832.CrossRefGoogle ScholarPubMed
21.Halperin, R, Roa, W, Field, M, Hanson, J, Murray, B. Setup reproducibility in radiation therapy for lung cancer: a comparison between T-bar and expanded foam immobilization devices. Int J Radiat Oncol Biol Phys 1999; 43: 211–216.CrossRefGoogle ScholarPubMed
22.Negoro, Y, Nagata, Y, Aoki, T, Mizowaki, T, Araki, N, Takayama, K, Kokubo, M, Yano, S, Koga, S, Sasai, K, Shibamoto, Y, Hiraoka, M. The effectiveness of an immobilization device in conformal radiotherapy for lung tumor: reduction of respiratory tumor movement and evaluation of the daily setup accuracy. Int J Radiat Oncol Biol Phys 2001; 50: 889–898.CrossRefGoogle ScholarPubMed
23.Remeijer, P, Geerlof, E, Ploeger, L, Gilhuijs, K, van Herk, M, Lebesque, JV. 3-D portal image analysis in clinical practice: an evaluation of 2-D and 3-D analysis techniques as applied to 30 prostate cancer patients. Int J Radiat Oncol Biol Phys 2000; 46: 1281–1290.CrossRefGoogle ScholarPubMed
24.O'Shea, E, Thirion, P, Downes, A et al. “Electronic Portal Imaging Devices”. J Irish Inst Radiogr 2002; 6: 166–168.Google Scholar
25.Cox, J, Davison, A. Comfort as a determiner of treatment position in radiotherapy of the male pelvis. Radiography 2005; 11: 109–115.CrossRefGoogle Scholar