ESTRO 2024 - Abstract Book

S128 ESTRO 2024 patient comfort, satisfaction, setup duration as well as reproducibility and immobilisation could be influenced by the upright position. Last, a seated and standing position could foster radiotherapy access due to a reduced equipment cost. In the literature, patients included in studies dealing with upright radiotherapy were either patients treated in an upright position for various tumour sites (e.g. cranial tumour, head and neck cancer, Hodgkin disease or lung cancer) or patients involved in research protocols aiming at testing an up-right positioning (e.g. breast and pelvic cancer patients). The majority of the upright positioners used in these studies allowed a seated position only; one device could setup a patient in a seated or standing position. Patient physical comfort and satisfaction were evaluated in two studies carried out at Leon Bérard Cancer Centre in France, one with pelvis cancer patients, and another with breast cancer patients. In these studies, patients were at least as comfortable and satisfied in the upright position as in supine position and sometimes even more comfortable. In the cohort of pelvis cancer patients, patients were more physically comfortable at the shoulder and back levels, and more satisfied with breathing, getting in and getting out the device in the perched position than in the supine position. Out of the 9 breast cancer patients, 7 would have preferred to be treated in an upright position (seated or perched position). A publication reported the comfort of 6 head and neck cancer patients treated in forward tilted seated position with a posterior thermoplastic mask. Patients were more comfortable at the level of their arms and their back, and more stable in seated position than in supine position, while neck comfort was better in supine position. Regarding setup duration, only our data on 16 pelvis cancer patients is available; the setup time of patient in upright position with two RTTs took an average of 5.0 min for the first patient’s positioning and 4.9 min for their repositioning. For these patients, and based on optical images, the inter-fraction shift means were inferior to 1mm in left-right (LR), antero-posterior (AP), and cranio-caudal (CC) directions, respectively. The intrafraction shifts after 20 min were inferior to 0.5mm. In the literature, reproducibility and stability accuracy were assessed, sometimes based on X-ray images, and up to 50 patients were included in these studies. Based on 4 studies that assessed reproducibility and accuracy for head and neck cancer patients, and 3 articles that evaluated reproducibility for thoracic region, the average inter-fraction motion was less than 3mm. According to 3 studies reporting the patient stability for head and neck area, stability was assessed in a time frame ranging from 5 to 30 min after the patient setup, and in average the intra fraction motion was less than 3mm. In conclusion, the feasibility of radiotherapy treatment was studied by several teams for different treatment locations and with various chairs mainly in seated position. The results for the patient comfort and satisfaction show that patients tend to be physically more comfortable and satisfied in upright position compared to supine position. The durations to setup a patient in this position were reasonable. Reproducibility and immobilisation accuracy are promising but require extended evaluation with other methods, in particular in terms of image registration. In general, the data remains limited and additional research and assessment is needed. Invited Speaker

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Upright: potential challenges

Lennart Volz

GSI Helmholtz Center for Heavy Ion Research GmbH, Biophysics, Darmstadt, Germany

Abstract:

Upright radiotherapy (RT), i.e., positioning and imaging the patient in an upright position, is seeing renewed interest. Upright RT promises advantages related to cost and footprint of treatment facilities, improved patient comfort particularly for those with troubles lying down, and even certain anatomical benefits as indicated in recent literature[1,2]. Yet, upright patient positioning is by no means a new idea, and has been investigated since the advent