Prone treatment position as a novel option for head and neck cancer patients with unmanageable secretions

Background: Supine orientation is the standard treatment position for radiation therapy for head and neck cancer. Some patients, however, cannot tolerate this due to pooling of secretions and airway concerns, and theoretically, treatment would be better tolerated in a prone position. Here, we described the first prone treatment setup and delivery for a patient with head and neck cancer. Methods: A 68-year-old male patient with inoperable locally advanced, T4aN0M0, squamous cell carcinoma of the maxillary sinus was simulated, planned, and treated in prone position due to sinus congestion. Results: Prone position was well tolerated by the patient, who then did not require daily anaesthesia for airway secretion management. The prone dosimetry demonstrated good target coverage and normal tissue sparing. His treatment setup was found to be reproducible throughout the course of therapy. Conclusions: We successfully demonstrated the feasibility of prone treatment position for patients with head and neck cancer who are unable to tolerate supine position due to unmanageable secretions. Consideration should be given to prone treatment when designing both radiation therapy protocols and individual treatment plans.