Nasopharyngeal carcinoma (NPC) patients with parapharyngeal space (PPS) involvement are routinely given boost irradiation in Hong Kong. The current technique that employs a single field has many limitations in terms of dose distribution. This study is aimed to compare the dose distribution between the newly designed 3-dimensional conformal radiotherapy (3DCRT) and conventional techniques for the boost treatment of PPS so as to determine the more optimal treatment.
Fifteen NPC patients with unilateral PPS involvement were recruited. Their CT images were loaded into the FOCUS planning system for treatment planning. The planning target volume (PTV) and seven organs at risk (OARs) including the spinal cord, brain stem, optic chiasm, mandible, temporal lobe, temporo-mandibular (TM) joint and lens were outlined for dose assessment. The conventional and 3DCRT plans were then generated for each patient and the dose distributions were compared using dose parameters derived from the dose volume histograms (DVHs).
The 3DCRT technique provides better target coverage and significantly better dose to the planning target volume than the conventional technique. The 3DCRT treatment plans gives better sparing of the ipsilateral TM joints, mandible and lens, but it is less effective to spare spinal cord, brain stem, optic chiasm and temporal lobe. Nevertheless, the total doses to these OARs remain within the clinically defined thresholds and are clinically acceptable.