Intrafraction motions of the larynx during radiotherapy.
OBJECTIVE
To quantify the intrafraction motions of the larynx during radiotherapy of laryngeal cancer. Depending on the magnitude, duration, and incidence, these motions may have clinical consequences for the choice of margins around the clinical target volume.


METHODS
The intrafraction motions were analyzed for 10 patients, treated in 33 or 35 fractions. The intrafraction motions of the larynx were visualized using an a-Si flat panel imager. Images were obtained every 200 ms, resulting in a movie of images for each beam. In addition to visual analysis of all movies, the tip of the epiglottis was delineated and used as a landmark, the coordinates of which were followed in time.


RESULTS
Movies were obtained during 79% of the total number of radiotherapy fractions. The total duration of swallowing was on average 0.45% (range 0.0-1.5) of the total irradiation time. Deviations of motions other than swallowing ranged between 0.3 and 11.5 mm. Some of these motions were more sudden, and others were probably related to breathing, because the frequency of these motions was 8-20/min.


CONCLUSIONS
The incidence and total duration of swallowing is low. Therefore, it is not necessary to apply an internal margin to take into account these displacements. Other motions, however, occur more often. In 95% of the irradiation time, the tip of the epiglottis moves within a range of 7.1 mm. A margin should be applied to the clinical target volume to take into account these motions.
van Asselen
Bram
B
Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands. b.vanasselen@radth.med.uu.nl
Raaijmakers
Cornelis P J
CP
Lagendijk
Jan J W
JJ
Terhaard
Chris H J
CH
D003679:Deglutition; D019583:Dose Fractionation, Radiation; D004825:Epiglottis; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy*; D007830:Larynx; D009068:Movement