Upright patient positioning for pelvic radiotherapy treatments

Radiotherapy is typically delivered in supine position. However, upright positioning may affect organ volume, positioning, and movement, compared to supine/prone positioning which might have beneficial impacts. In this study, we report patient positioning data in an upright positioning system designed by Leo Cancer Care®. Sixteen patients with pelvic tumors were included in this study. They had 3 setups in an upright position: an initial setup with acquisition of reference optical images, and 2 repositioning setups. The intra-fraction motion was assessed during two 20-minute chair rotation sessions. The patient comfort in supine and upright position was assessed with a 5-point Likert scale questionnaire. Eight women and 8 men treated on regular linacs between October 2021 and June 2022 were included. Their median age and weight were 62.5 years (35 to 81 years) and 75.1 kg (41 to 107 kg). The inter-fraction shift means were -0.5 mm (SD = 2.5), -0.4 mm (SD = 1.3) and -0.9 mm (SD = 2.7) in left-right (LR), antero-posterior (AP), and cranio-caudal (CC) directions, respectively. The intrafraction shifts after 20 min were 0.0 mm (SD = 1.5), 0.2 mm (SD = 1.1) and 0.0 mm (SD = 0.3) in LR, CC, and AP directions, respectively. Average global comfort was 4.1 (3 to 5) for the upright position and 3.9 (2 to 5) for the supine position. In conclusion, the first study on pelvic cancer patients positioned in upright position on a chair is promising, and it opens a potential new direction for the treatment of cancer patients. Evaluation of thoracic and head and neck tumors is ongoing, and imaging with vertical CT is expected to start soon.