Evaluating the Impact of Invasive Intubation on Treatment Accuracy in Head and Neck Cancer Patients Undergoing...

To assess how nasogastric and tracheostomy tubes affect the precision of image-guided radiation therapy (IGRT) in head and neck cancer (HNC) patients.

A retrospective analysis was conducted on 79 patients treated with IGRT using the Varian EDGE linear accelerator at our institution from October 2021 to September 2023. Patients were divided into 3 groups based on the presence of invasive tubes: Group A with nasogastric tubes (n=29), Group B with tracheostomy tubes (n=20), and Group C without tubes (n=30). A total of 2580 displacement correction datasets were analyzed.

Tracheostomy tubes significantly increased displacement errors in the X and Y-axes compared with patients without tubes (P =0.027 and P =0.028, respectively). Nasogastric tubes increased errors in the Yaw-axis compared with patients without tubes (P =0.034) and Pitch-axis errors compared with patients with tracheostomy tubes (P =0.008). The choice of immobilization mask also affected displacement accuracy; for instance, patients with tracheostomy tubes using the head and neck mask had lower X-axis displacement errors than those using the head-neck-shoulder mask (P <0.001).

Our findings indicate that Head and neck masks are preferable for patients with tracheostomy tubes, whereas head-neck-shoulder masks are better suited for those with nasogastric tubes. Customized asymmetric planning target volume margins for each tube-mask combination may further improve treatment accuracy and target coverage.