Matching IMRT fields with static photon field in the treatment of head-and-neck cancer

Radiation treatment with intensity-modulated radiation therapy (IMRT) for head-and-neck cancer usually involves treating the superior aspects of the target volume with intensity-modulated (IM) fields, and the inferior portion of the target volume (the low neck nodes) with a static anterior-posterior field (commonly known as the low anterior neck, or LAN field). A match line between the IM and the LAN fields is created with possibly large dose inhomogeneities, which are clinically undesirable. We propose a practical method to properly match these fields with minimal dependence on patient setup errors. The method requires mono-isocentric setup of the IM and LAN fields with half-beam blocks as defined by the asymmetric jaws. The inferior jaws of the IM fields, which extend approximately 1 cm inferiorly past the isocenter, are changed manually before patient treatment, so that they match the superior jaw of the LAN field at the isocenter. The matching of these fields therefore does not depend on the particular treatment plan of IMRT and depends only on the matching of the asymmetric jaws. Measurements in solid water phantom were performed to verify the field-matching technique. Dose inhomogeneities of less than 5% were obtained in the match-line region. Feathering of the match line is done twice during the course of a treatment by changing the matching jaw positions superiorly at 3-mm increments each time, which further reduces the dose inhomogeneity. Compared to the method of including the lower neck nodes in the IMRT fields, the field-matching technique increases the delivery efficiency and significantly reduces the total treatment time.