The arms-up position
is the most common treatment position adopted for lung cancer patients treated
with radiation therapy. However, many elderly or frail patients have shoulder
problems and cannot tolerate such an overstretched position for an extended
period. Therefore, the arms-down position becomes the only alternative for this
group of patients during radiation therapy. Even though the arms-down position
is not ideal, it does provide a stable and comfortable patient immobilization
position for radiation treatments that require a longer delivery time, such as
stereotactic body radiation therapy (SBRT). In this study, we designed a
protocol to treat lung cancer patients with VMAT stereotactic body radiation
therapy (VMAT SBRT) and deep inspiration breath-hold (DIBH) in the arms-down
position. Our initial clinical experience with this protocol indicates that it
is reliable for patient immobilization and accurate in delivered dosimetry.
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