The International Commission on Radiation Units and Measurements (ICRU) report No. 83 provides the information necessary to standardize techniques and procedures and to harmonize the prescribing, ...recording, and reporting of intensity modulated radiation therapy. Applicable concepts and recommendations in previous ICRU reports concerning radiation therapy were adopted, and new concepts were elaborated. In particular, additional recommendations were given on the selection and delineation of the targets volumes and the organs at risk; concepts of dose prescription and dose-volume reporting have also been refined.
Le rapport n
o 83 de l’International Commission on Radiation Units and Measurements (ICRU) présente les concepts récents sur la prescription, le rapport et l’enregistrement de la dose en radiothérapie avec modulation d’intensité. Les recommandations proposées dans les rapports de l’ICRU précédents ont été revues et adaptées, et de nouveaux concepts ont été élaborés. Plus particulièrement, de nouvelles recommandations ont été proposées pour la sélection et la délimitation des volumes cibles et des organes à risque ; les notions de prescription et de rapport de la dose ont été revues pour intégrer l’aspect volumétrique.
•The upright positioning is associated with a reasonable first positioning and repositioning time when 1 RTT was involved, and a much shorter duration when 2 RTT were involved;•The inter-fraction ...repositioning was on average below 1 mm accuracy for patient setup in upright position for pelvic tumor site;•The intra-fraction motion was within 3 mm for more than 90 % of patients in a 20-minute time frame for patient setup in upright position for pelvic tumor site;•The patient’s subjective assessment of the upright positioning was at least as good, and for some items even better, than in supine position;
Radiotherapy is typically delivered in supine position. However, upright positioning may affect organ volume, positioning, and movement, compared to supine/prone positioning which might have beneficial impacts. In this study, we report patient positioning data in an upright positioning system designed by Leo Cancer Care®.
Sixteen patients with pelvic tumors were included in this study. They had 3 setups in an upright position: an initial setup with acquisition of reference optical images, and 2 repositioning setups. The intra-fraction motion was assessed during two 20-minute chair rotation sessions. The patient comfort in supine and upright position was assessed with a 5-point Likert scale questionnaire.
Eight women and 8 men treated on regular linacs between October 2021 and June 2022 were included. Their median age and weight were 62.5 years (35 to 81 years) and 75.1 kg (41 to 107 kg). The inter-fraction shift means were −0.5 mm (SD = 2.5), −0.4 mm (SD = 1.3) and −0.9 mm (SD = 2.7) in left–right (LR), antero-posterior (AP), and cranio-caudal (CC) directions, respectively. The intrafraction shifts after 20 min were 0.0 mm (SD = 1.5), 0.2 mm (SD = 1.1) and 0.0 mm (SD = 0.3) in LR, CC, and AP directions, respectively. Average global comfort was 4.1 (3 to 5) for the upright position and 3.9 (2 to 5) for the supine position.
In conclusion, the first study on pelvic cancer patients positioned in upright position on a chair is promising, and it opens a potential new direction for the treatment of cancer patients. Evaluation of thoracic and head and neck tumors is ongoing, and imaging with vertical CT is expected to start soon.
•This EHNS-ESMO-ESTRO Clinical Practice Guideline provides key recommendations for managing SCCHN.•It covers clinical and pathological diagnosis, staging and risk assessment, treatment and ...follow-up.•Opportunities for personalised medicine in SCCHN are also discussed.•All recommendations were compiled by a multidisciplinary group of experts from different institutions and countries.•Recommendations are based on available clinical evidence and the collective expert opinion of the authors.
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