title: Nasal cavity reirradiation: a challenging case for comparison between proton therapy and volumetric modulated arc therapy.
abstract: BACKGROUND
  The aim of this case report is to report on a dosimetric comparison between volumetric modulated arc therapy (RapidArc technique and active scanning proton therapy (single-field (SFO) and multifield (MFO) techniques) in a case of nasal cavity cancer recurrence.
  
  
  METHODS
  A 72-year-old man, who received adjuvant radiotherapy for a carcinoma of the nasal cavity, experienced an unresectable local recurrence in the previous surgical bed. Hence, the patient was evaluated for reirradiation by comparing different modalities, with a total prescribed dose of 50 Gy in standard fractionation. RA plan was revealed to be equivalent to the MFO plan in terms of target dose coverage and conformity index. SFO plan was not able to respect a maximum dose of 9 Gy to nervous structures, in contrast to RA and MFO plans.
  
  
  CONCLUSIONS
  In this challenging scenario, although a clear preference would be given to the MFO proton plan, the RA plan was revealed to be adequate for the clinical goal of target coverage and sparing of organs at risk.
authors.affiliation: Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar (Verona) - Italy.
authors.forename: Ruggero
authors.initials: R
authors.lastname: Ruggieri
authors.affiliation: Proton Therapy Unit, Department of Oncology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Dionisi
authors.affiliation: Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar (Verona) - Italy.|Radiation Oncology School, Palermo - Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Mazzola
authors.affiliation: Proton Therapy Unit, Department of Oncology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fellin
authors.affiliation: Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar (Verona) - Italy.
authors.forename: Alba
authors.initials: A
authors.lastname: Fiorentino
authors.affiliation: Proton Therapy Unit, Department of Oncology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento - Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Schwarz
authors.affiliation: Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar (Verona) - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ricchetti
authors.affiliation: Proton Therapy Unit, Department of Oncology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento - Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Amichetti
authors.affiliation: Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar (Verona) - Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Alongi
mesh_terms: D000368:Aged; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009296:Nasal Cavity / Q000473:pathology*; D009364:Neoplasm Recurrence, Local; D009669:Nose Neoplasms / Q000175:diagnosis / Q000532:radiotherapy*; D061766:Proton Therapy / Q000379:methods; D011874:Radiometry; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D000069475:Re-Irradiation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome