Evaluating the Impact of Invasive Intubation on Treatment Accuracy in Head and Neck Cancer Patients Undergoing Image-Guided Radiation Therapy.

Abstract

PurposeTo assess how nasogastric and tracheostomy tubes affect the precision of image-guided radiation therapy (IGRT) in head and neck cancer (HNC) patients.Methods and materialsA retrospective analysis was conducted on 79 patients treated with IGRT using the Varian EDGE linear accelerator at our institution from October 2021 to September 2023. Patients were divided into 3 groups based on the presence of invasive tubes: Group A with nasogastric tubes (n=29), Group B with tracheostomy tubes (n=20), and Group C without tubes (n=30). A total of 2580 displacement correction datasets were analyzed.ResultsTracheostomy tubes significantly increased displacement errors in the X and Y-axes compared with patients without tubes (P =0.027 and P =0.028, respectively). Nasogastric tubes increased errors in the Yaw-axis compared with patients without tubes (P =0.034) and Pitch-axis errors compared with patients with tracheostomy tubes (P =0.008). The choice of immobilization mask also affected displacement accuracy; for instance, patients with tracheostomy tubes using the head and neck mask had lower X-axis displacement errors than those using the head-neck-shoulder mask (P ConclusionsOur findings indicate that Head and neck masks are preferable for patients with tracheostomy tubes, whereas head-neck-shoulder masks are better suited for those with nasogastric tubes. Customized asymmetric planning target volume margins for each tube-mask combination may further improve treatment accuracy and target coverage.