Which nasopharyngeal cancer patients need adaptive radiotherapy?

Abstract

Abstract Background Adaptive radiotherapy (ART) has potential benefits in patients with nasopharyngeal cancer (NPC). This retrospective study aimed to identify the factors favoring ART. Materials and methods Forty NPC patients were retrospectively included in this study. All patients received two-phase, volumetric modulated arc radiotherapy (VMAT) and underwent a second computed tomography (CT) for the phase II ART. We generated phantom, non-ART plans by a hybrid method for comparison with ART plans. A paired t-test was used to evaluate the dose differences between these two plans. A subgroup analysis through a paired t-test was used to evaluate the factors favoring ART. Results The second CT images were captured at the median 22 fractions. The median total dose of the planning target volume-one (PTV-1) was 72 Gy, and the phase II dose was 16 Gy. The volumes of the ipsilateral parotid gland (23.2 vs. 19.2 ml, p 60 kg, p 21.5, p 2.8 kg, p < 0.000), concurrent chemoradiotherapy (p < 0.000), and stages III–IV (p < 0.000) favored the use of ART. Conclusions ART could significantly reduce the mean dose to the ipsilateral parotid gland. ART has dosimetrical benefit for patients with a heavy initial weight, large BMI, obvious weight loss, concurrent chemoradiotherapy, and cancer in stages III–IV.

Keywords

• Nasopharyngeal cancer
• Radiotherapy
• Adaptive radiotherapy
• Intensity-modulated radiotherapy
• Volumetric modulated arc radiotherapy