A111
Clinical Challenges in the Implementation of a Tomotherapy service for Head and Neck Cancer patients in a Regional UK Radiotherapy Centre
Sanjoy Chatterjee1, Charles Kelly1, Susan Dixon1, Werner Dobrowski1, Vivien H W Loo1, Anthony Branson1, Gregory Smyth2, Judith Mott2
1Northern Centre for Cancer Care, Newcastle, UK, 2Regional Medical Physics Department, Newcastle, UK
Background
The Northern Centre for Cancer Care, Newcastle provides an Image Guided Intensity Modulated Radiotherapy service for a subset of head and neck cancer patients, using a recently commissioned Tomotherapy Hi Art machine. This presentation describes the clinical issues encountered in setting up this specialised service.
Method
Class solutions for head and neck radical radiotherapy were developed prior to clinical implementation and will be discussed. Planning, treatment and image guidance experiences for the first 10 new cases will also be reviewed. Primary sites for these patients included tumours of the oropharynx, supraglottis, hypopharynx, unknown primary, choroidal melanoma, as well as re-irradiation of the paranasal sinuses and parapharyngeal space from recurrent squamous cell carcinomas.
Results
DVH data for CTVs, PTVs and relevant OARs will be presented. The initial treatment experience also highlighted: 1) The need for effective streamlining of all aspects of the service to ensure compliance with cancer waiting time targets. 2) The necessity of patient toxicity audit to guide refinement of planning dose constraints. 3) The benefits of daily image guidance. 4) The effect of field width, pitch and modulation factor on planning; emphasising on how field width can affect doses to proximal OARs. 5) The continued requirement for accurate tumour delineation in IMRT. 5) Clinical workload issues. 6) The effect of changes in patient shape during treatment.
Conclusion
Tomotherapy treatment plans achieve excellent conformity to the PTV, while adequately sparing OARs. Clinical audit throughout treatment has the potential to change practice and prevent unexpected clinical problems. Implementation of a clinical Tomotherapy service requires a multidisciplinary team approach and relies heavily on good team working and effective communication. Experience with helical IMRT treatment planning should be built up in advance of clinical release and adequate time allocated in clinical pathways for the additional outlining, planning and quality assurance.
