title: Treatment planning and delivery of intensity-modulated radiation therapy for primary nasopharynx cancer.
abstract: OBJECTIVE
  To implement intensity-modulated radiation therapy (IMRT) for primary nasopharynx cancer and to compare this technique with conventional treatment methods.
  
  
  METHODS
  Between May 1998 and June 2000, 23 patients with primary nasopharynx cancer were treated with IMRT delivered with dynamic multileaf collimation. Treatments were designed using an inverse planning algorithm, which accepts dose and dose-volume constraints for targets and normal structures. The IMRT plan was compared with a traditional plan consisting of phased lateral fields and a three-dimensional (3D) plan consisting of a combination of lateral fields and a 3D conformal plan.
  
  
  RESULTS
  Mean planning target volume (PTV) dose increased from 67.9 Gy with the traditional plan, to 74.6 Gy and 77.3 Gy with the 3D and IMRT plans, respectively. PTV coverage improved in the parapharyngeal region, the skull base, and the medial aspects of the nodal volumes using IMRT and doses to all normal structures decreased compared to the other treatment approaches. Average maximum cord dose decreased from 49 Gy with the traditional plan, to 44 Gy with the 3D plan and 34.5 Gy with IMRT. With the IMRT plan, the volume of mandible and temporal lobes receiving more than 60 Gy decreased by 10-15% compared to the traditional and 3D plans. The mean parotid gland dose decreased with IMRT, although it was not low enough to preserve salivary function.
  
  
  CONCLUSIONS
  Lower normal tissue doses and improved target coverage, primarily in the retropharynx, skull base, and nodal regions, were achieved using IMRT. IMRT could potentially improve locoregional control and toxicity at current dose levels or facilitate dose escalation to further enhance locoregional control.
authors.affiliation: Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, Box 84, 1275 York Avenue, New York, NY 10021, USA. huntm@mskcc.org
authors.forename: M A
authors.initials: MA
authors.lastname: Hunt
authors.forename: M J
authors.initials: MJ
authors.lastname: Zelefsky
authors.forename: S
authors.initials: S
authors.lastname: Wolden
authors.forename: C S
authors.initials: CS
authors.lastname: Chui
authors.forename: T
authors.initials: T
authors.lastname: LoSasso
authors.forename: K
authors.initials: K
authors.lastname: Rosenzweig
authors.forename: L
authors.initials: L
authors.lastname: Chong
authors.forename: S V
authors.initials: SV
authors.lastname: Spirou
authors.forename: L
authors.initials: L
authors.lastname: Fromme
authors.forename: M
authors.initials: M
authors.lastname: Lumley
authors.forename: H A
authors.initials: HA
authors.lastname: Amols
authors.forename: C C
authors.initials: CC
authors.lastname: Ling
authors.forename: S A
authors.initials: SA
authors.lastname: Leibel
mesh_terms: D000465:Algorithms; D006801:Humans; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011786:Quality Control; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed