A prospective study of supine versus prone positioning and whole-body thermoplastic mask fixation for craniospinal radiotherapy in adult patients



      To evaluate neuroaxis irradiation for adults in the supine position using head body thermoplastic mask fixation, from the aspects of dose distribution, patient comfort and set-up accuracy.

      Methods and materials

      Nine of the 12 adult patients were positioned for craniospinal axis irradiation in both prone and supine positions. After mask fixation and planning CTs in both positions, a questionnaire relating to the comfort was completed. The doses to the target and to the organs at risk of the 3D conformal plans in the supine and prone positions were compared. Portal images of all 12 patients irradiated in the supine position were evaluated, the van Herk formulas being used to calculate the systemic and random errors.


      No significant difference was found between the prone and supine positions target coverage, the dose homogeneity and the dose to the organs at risk. The supine position was considered more comfortable by the patients (scores of 2.8 versus 4.29), with a vector random error of 3.27 mm, and a systematic error of 0.32 mm. The largest random set-up error was observed in the lateral direction: 4.83 mm.


      The more comfortable supine position is recommended for craniospinal irradiation in adult patients. Whole-body thermoplastic mask immobilization provides excellent repositioning accuracy.


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        • Skowrońska-Gardas A.
        • Chojnacka M.
        • Morawska-Kaczyńska M.
        • Perek D.
        • Perek-Polnik M.
        Patterns of failure in children with medulloblastoma treated with 3D conformal radiotherapy.
        Radiother Oncol. 2007; 84: 26-33
        • Wilkinson J.M.
        • Lewis J.
        • Lawrence G.P.
        • Lucraft H.H.
        • Murphy E.
        Craniospinal irradiation using a forward planned segmented field technique.
        Br J Radiol. 2007; 80: 209-215
        • Yom S.S.
        • Frija E.K.
        • Mahajan A.
        • et al.
        Field-in-field technique with intrafractionally modulated junction shifts for craniospinal irradiation.
        Int J Radiat Oncol Biol Phys. 2007; 69: 1193-1198
        • Christ G.
        • Denninger D.
        • Dohm O.S.
        • Weigel B.
        • Hönes A.
        • Paulsen F.
        Craniospinal radiotherapy in an advanced technique.
        Strahlenther Onkol. 2008; 184: 530-535
        • Pai Panandiker A.
        • Ning H.
        • Likhacheva A.
        • et al.
        Craniospinal irradiation with spinal IMRT to improve target homogeneity.
        Int J Radiat Oncol Biol Phys. 2007; 68: 1402-1409
        • Huang E.
        • Teh B.S.
        • Strother D.R.
        • et al.
        Intensity-modulated radiation therapy for pediatric medulloblastoma: early report on the reduction of ototoxicity.
        Int J Radiat Oncol Biol Phys. 2002; 52: 599-605
        • Parker W.
        • Filion E.
        • Roberge D.
        • Freeman C.R.
        Intensity-modulated radiotherapy for craniospinal irradiation: target volume considerations, dose constraints, and competing risks.
        Int J Radiat Oncol Biol Phys. 2007; 69: 251-257
        • Stoiber E.M.
        • Giske K.
        • Schubert K.
        • et al.
        Local Setup Reproducibility of the spinal column when using intensity-modulated radiation therapy for craniospinal irradiation with patient in supine position.
        Int J Radiat Oncol Biol Phys. 2011; 81: 1552-1559
        • Bauman G.
        • Yartsev S.
        • Coad T.
        • Fisher B.
        • Kron T.
        Helical tomotherapy for craniospinal radiation.
        Br J Radiol. 2005; 78: 548-555
        • Sharma D.S.
        • Gupta T.
        • Jalali R.
        • Master Z.
        • Phurailatpam R.D.
        • Sarin R.
        High-precision radiotherapy for craniospinal irradiation: evaluation of three-dimensional conformal radiotherapy, intensity-modulated radiation therapy and helical TomoTherapy.
        Br J Radiol. 2009; 82: 1000-1009
        • Cochran D.M.
        • Yock T.I.
        • Adams J.A.
        • Tarbell N.J.
        Radiation dose to the lens during craniospinal irradiation-an improvement in proton radiotherapy technique.
        Int J Radiat Oncol Biol Phys. 2008; 70: 1336-1342
        • Lee C.T.
        • Bilton S.D.
        • Famiglietti R.M.
        • et al.
        Treatment planning with protons for pediatric retinoblastoma, medulloblastoma, and pelvic sarcoma: how do protons compare with other conformal techniques?.
        Int J Radiat Oncol Biol Phys. 2005; 63: 362-372
        • Timmermann B.
        • Lomax A.J.
        • Nobile L.
        • et al.
        Novel technique of craniospinal axis proton therapy with the spot-scanning system: avoidance of patching multiple fields and optimized ventral dose distribution.
        Strahlenther Onkol. 2007; 183: 685-688
        • Wisser L.
        • Nguyen T.P.
        • Barwig P.
        • Stolz A.
        • Niewald M.
        • Schüller H.
        Craniospinal irradiation–patient positioning and verification with portal films.
        Strahlenther Onkol. 2003; 179: 50-53
        • Chang E.L.
        • Wong P.F.
        • Forster K.M.
        • Petru M.D.
        • Kowalski A.V.
        • Maor M.H.
        Verification techniques and dose distribution for computed tomographic planned supine craniospinal radiation therapy.
        Med Dosim. 2003; 28: 127-131
        • Hawkins R.B.
        A simple method of radiation treatment of craniospinal fields with patient supine.
        Int J Radiat Oncol Biol Phys. 2001; 49: 261-264
        • Michalski J.M.
        • Klein E.E.
        • Gerber R.
        Method to plan, administer, and verify supine craniospinal irradiation.
        J Appl Clin Med Phys. 2002; 3: 310-316
        • Munshi A.
        • Jalali R.
        A simple technique of supine craniospinal irradiation.
        Med Dosim. 2008; 33: 1-5
        • Parker W.A.
        • Freeman C.R.
        A simple technique for craniospinal radiotherapy in the supine position.
        Radiother Oncol. 2006; 78: 217-222
        • Safadi N.S.
        • Alawi T.A.
        • Alhadab A.A.
        • Saoudi A.S.
        • Khan A.K.
        • et al.
        Craniospinal irradiation in supine position in young children treated for medulloblastoma.
        Cancer/Radiothérapie. 2007; : P033
        • Rades D.
        • Holtzhauer R.
        • Baumann R.
        • Leuwer M.
        • Karstens J.H.
        Craniospinal axis irradiation in children. Treatment in supine position including field verification as a prerequisite for anesthesia without intubation.
        Strahlenther Onkol. 1999; 175: 409-412
        • Slampa P.
        • Pavelka Z.
        • Dusek L.
        • et al.
        Longterm treatment results of childhood medulloblastoma by craniospinal irradiation in supine position.
        Neoplasma. 2007; 54: 62-67
        • South M.
        • Chiu J.K.
        • Teh B.S.
        • Bloch C.
        • Schroeder T.M.
        • Paulino A.C.
        Supine craniospinal irradiation using intrafractional junction shifts and field-in-field dose shaping: early experience at Methodist Hospital.
        Int J Radiat Oncol Biol Phys. 2008; 71: 477-483
        • Thomadsen B.
        • Mehta M.
        • Howard S.
        • Das R.
        Craniospinal treatment with the patient supine.
        Med Dosim. 2003; 28: 35-38
        • Verellen D.
        • Van den Heuvel F.
        • De Neve W.
        • De Beukeleer M.
        • Storme G.
        Dynamic radiotherapy: interactive movement of patient couch for treatment of craniospinal axis.
        Int J Radiat Oncol Biol Phys. 1996; 35: 771-776
        • van Herk M.
        Errors and margins in radiotherapy.
        Semin Radit Oncol. 2004; 14: 52-64
        • Prabhakar R.
        • Haresh K.P.
        • Munshi A.
        • et al.
        A simple technique for cranio-spinal irradiation in pediatric patients.
        J Cancer Res Ther. 2009; 5: 113-115
        • Liu X.
        • Yu J.
        • Yu Y.
        • et al.
        Conventional craniospinal irradiation with patient supine and source-skin distance (SSD) 100 cm for spinal field.
        Med Dosim. 2010; (Epub ahead of print)
        • Fogliata A.
        • Bergström S.
        • Cafaro I.
        • et al.
        Cranio-spinal irradiation with volumetric modulated arc therapy: a multi-institutional treatment experience.
        Radiother Oncol. 2011; 99: 79-85
        • Kortmann R.D.
        • Kühl J.
        • Timmermann B.
        • et al.
        Postoperative neoadjuvant chemotherapy before radiotherapy as compared to immediate radiotherapy followed by maintenance chemotherapy in the treatment of medulloblastoma in childhood: results of the German prospective randomized trial HIT ‘91.
        Int J Radiat Oncol Biol Phys. 2000; 46: 269-279
        • Ahern V.
        • Koh E.S.
        • Gebski V.
        • Sathiyaseelan Y.
        Paediatric medulloblastoma: patterns of care and radiotherapy quality assurance in Australia.
        Australas Radiol. 2007; 51: 458-464