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01-01-2012 | Original article

Relocatable fixation systems in intracranial stereotactic radiotherapy

Accuracy of serial CT scans and patient acceptance in a randomized design

Authors: A. Theelen, J. Martens, BSc, G. Bosmans, PhD, R. Houben, MSc, J.J. Jager, MD PhD, I. Rutten, MD, P. Lambin, MD PhD, A.W. Minken, PhD, Dr. B.G. Baumert, MD PhD

Published in: Strahlentherapie und Onkologie | Issue 1/2012

Abstract

Purpose

The goal was to provide a quantitative evaluation of the accuracy of three different fixation systems for stereotactic radiotherapy and to evaluate patients’ acceptance for all fixations.

Methods

A total of 16 consecutive patients with brain tumours undergoing fractionated stereotactic radiotherapy (SCRT) were enrolled after informed consent (Clinical trials.gov: NCT00181350). Fixation systems evaluated were the BrainLAB® mask, with and without custom made bite-block (fixations S and A) and a homemade neck support with bite-block (fixation B) based on the BrainLAB® frame. The sequence of measurements was evaluated in a randomized manner with a cross-over design and patients’ acceptance by a questionnaire.

Results

The mean three-dimensional (3D) displacement and standard deviations were 1.16 ± 0.68 mm for fixation S, 1.92 ± 1.28 and 1.70 ± 0.83 mm for fixations A and B, respectively. There was a significant improvement of the overall alignment (3D vector) when using the standard fixation instead of fixation A or B in the craniocaudal direction (p = 0.037). Rotational deviations were significantly less for the standard fixation S in relation to fixations A (p = 0.005) and B (p = 0.03). EPI imaging with off-line correction further improved reproducibility. Five out of 8 patients preferred the neck support with the bite-block.

Conclusion

The mask fixation system in conjunction with a bite-block is the most accurate fixation for SCRT reducing craniocaudal and rotational movements. Patients favoured the more comfortable but less accurate neck support. To optimize the accuracy of SCRT, additional regular portal imaging is warranted.

Alheit H, Dornfeld S, Dawel M et al (2001) Patient position reproducibility in fractionated stereotactically guided conformal radiotherapy using the BrainLAB® Mask system. Strahlenther Onkol 177:264–268PubMedCrossRef

Ali I, Tubbs J, Hibbitts K et al (2010) Evaluation of the setup accuracy of a stereotactic radiotherapy head immobilization mask system using kV on-board imaging. J Appl Clin Med Phys 11:3192PubMed

Astner ST, Theodorou M, Dobrei-Ciuchendea M et al (2010) Tumor shrinkage assessed by volumetric MRI in the long-term follow-up after stereotactic radiotherapy of meningiomas. Strahlenther Onkol 186:423–429PubMedCrossRef

Balducci M, Apicella G, Manfrida S et al (2010) Single-arm phase II study of conformal radiation therapy and temozolomide plus fractionated stereotactic conformal boost in high-grade gliomas. Strahlenther Onkol 186:558–564PubMedCrossRef

Baumert BG, Egli P, Studer S et al (2005) Repositioning accuracy of fractionated stereotactic irradiation: assessment of isocentre alignment for different dental fixations by using sequential CT scanning. Radiother Oncol 74:61–66PubMedCrossRef

Bednarz G, Machtay M, Werner-Wasik M et al (2009) Report on a randomized trial comparing two forms of immobilization of the head for fractionated stereotactic radiotherapy. Med Phys 36:12–17PubMedCrossRef

Bel A, Herk M van, Bartelink H, Lebesque JV (1993) A verification procedure to improve patient set-up accuracy using portal images. Radiother Oncol 29:253–260PubMedCrossRef

Brada M, Bidmead M (2003) Geometric uncertainties in radiotherapy of the brain. In: Geometric uncertainties in radiotherapy. Defining the planning target volume. The British Institute of Radiology, London, pp 109–126

D’Agostino GR, Autorino R, Pompucci A et al (2011) Whole-brain radiotherapy combined with surgery or stereotactic radiotherapy in patients with brain oligometastases: long-term analysis. Strahlenther Onkol 187:421–425CrossRef

10.

Ezzell LC, Hansen EK, Quivey JM, Xia P (2007) Detection of treatment setup errors between tow CT scans for patients with head and neck cancer. Med Phys 34:3233–3242PubMedCrossRef

11.

Fokas E, Wacker U, Gross MW et al (2009) Hypofractionated stereotactic reirradiation of recurrent glioblastomas. A beneficial treatment option after high-dose radiotherapy? Strahlenther Onkol 185:235–240PubMedCrossRef

12.

Hamilton RJ, Kuchnir FT, Pelizzari CA et al (1996) Repositioning accuracy of a noninvasive head fixation system for stereotactic radiotherapy. Med Phys 23:1909–1917PubMedCrossRef

13.

Henzel M, Hamm K, Sitter H et al (2009) Comparison of stereotactic radiosurgery and fractionated stereotactic radiotherapy of acoustic neurinomas according to 3-D tumor volume shrinkage and quality of life. Strahlenther Onkol 185:567–573PubMedCrossRef

14.

Kalapurakal JA, Ilahi Z, Kepka AG et al (2001) Repositioning accuracy with the Laitinen frame for fractionated stereotactic radiation therapy in adult and pediatric brain tumours: preliminary report. Radiology 2218:157–161

15.

Karger CP, Jäkel O, Debus J et al (2001) Three-dimensional accuracy and interfractional reproducibility of patient fixation and positioning using a stereotactic head mask system. Int J Radiat Oncol Biol Phys 49:1493–1504PubMedCrossRef

16.

Kooy HM, Dunbar SF, Tarbell NJ et al (1994) Adaptation and verification of the relocatable Gill-Thomas-Cosman frame in stereotactic radiotherapy. Int J Radiat Oncol Biol Phys 30:685–691PubMed

17.

Kortmann RD, Becker G, Perelmouter J et al (1999) Geometric accuracy of field alignment in fractionated stereotactic conformal radiotherapy of brain tumors. Int J Radiat Oncol Biol Phys 43:921–926PubMedCrossRef

18.

Kumar S, Burke K, Nalder C et al (2005) Treatment accuracy of fractionated stereotactic radiotherapy. Radiother Oncol 74:53–59PubMedCrossRef

19.

Lopatta E, Liesenfeld SM, Bank P et al (2003) Verbesserte Lagerungsreproduzierbarkeit eines nichtinvasiven Hochpräzisions- maskensystems in der stereotaktischen Radiotherapie durch eine integrierte Kieferfixierung. Strahlenther Onkol 179:571–575PubMedCrossRef

20.

Masi L, Casamassima F, Polli C et al (2008) Cone beam CT image guidance for intracranial stereotactic treatments: comparison with a frame guided set-up. Int J Radiat Oncol Biol Phys 71:926–933PubMedCrossRef

21.

Minniti G, Valeriani M, Clarke E et al (2010) Fractionated stereotactic radiotherapy for skull base tumors: analysis of treatment accuracy using a stereotactic mask fixation system. Radiat Oncol 13(5):1CrossRef

22.

Miranpuri AS, Tome WA, Paliwal BR et al (2001) Assessment of patient-independent intrinsic error for a noninvasive frame for fractionated stereotactic radiotherapy. Int J Cancer 20:320–325CrossRef

23.

Peng LC, Kahler D, Samant S et al (2010) Quality assessment of frameless fractionated stereotactic radiotherapy using cone beam computed tomography. Int J Radiat Oncol Biol Phys 78:1586–1593PubMedCrossRef

24.

Rosenthal ST, Gall KP, Jackson M, Thornton AF (1995) A precision cranial immobilization system for conformal stereotactic fractionated radiation therapy. Int J Radiat Oncol Biol Phys 35:1239–1245

25.

Salter BJ, Fuss M, Vollmer DG et al (2001) The talon removable head frame system for stereotactic radiosurgery/radiotherapy: measurement of the repositioning accuracy. Int J Radiat Oncol Biol Phys 51:555–562PubMedCrossRef

26.

Scorsetti M, Mancosu P, Navarria P et al (2011) Stereotactic body radiation therapy (SBRT) for adrenal metastases: a feasibility study of advanced techniques with modulated photons and protons. Strahlenther Onkol 187:238–244PubMedCrossRef

27.

Herk M van, Remeijer P, Rasch C, Lebesque JV (2000) The probability of correct target dosage: dose-population histograms for deriving treatment margins in radiotherapy. Int J Radiat Oncol Biol Phys 47:1121–1135PubMedCrossRef

28.

Santvoort J van, Wiggenraad R, Bos P (2008) Positioning accuracy in stereotactic radiotherapy using a mask system with added vacuum mouth piece and stereoscopic X-ray positioning. Int J Radiat Oncol Biol Phys 72:261–267PubMedCrossRef

29.

Wiehle R, Koth HJ, Nanko N et al (2009) On the accuracy of isocenter verification with kV imaging in stereotactic radiosurgery. Strahlenther Onkol 185:325–330PubMedCrossRef

30.

Willner J, Flentje M, Bratengeier K (1997) CT simulation in stereotactic brain radiotherapy-analysis of isocenter reproducibility with mask fixation. Radiother Oncol 45:83–88PubMedCrossRef

31.

Wong VY, Tung SY, Leung TW, Ho KH (2003) verification of isocentre relocatability using stereotactic mask fixation system. Clin Oncol (R Coll Radiol) 15:280–287

Title: Relocatable fixation systems in intracranial stereotactic radiotherapy
Accuracy of serial CT scans and patient acceptance in a randomized design
Authors: A. Theelen
J. Martens, BSc
G. Bosmans, PhD
R. Houben, MSc
J.J. Jager, MD PhD
I. Rutten, MD
P. Lambin, MD PhD
A.W. Minken, PhD
Dr. B.G. Baumert, MD PhD
Publication date: 01-01-2012
Publisher: Urban and Vogel
Published in: Strahlentherapie und Onkologie / Issue 1/2012
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-011-0018-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Relocatable fixation systems in intracranial stereotactic radiotherapy

Accuracy of serial CT scans and patient acceptance in a randomized design

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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