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PLoS One. 2013 Sep 25;8(9):e75304. doi: 10.1371/journal.pone.0075304. eCollection 2013.

Which T category of nasopharyngeal carcinoma may benefit most from volumetric modulated arc therapy compared with step and shoot intensity modulated radiation therapy.

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State Key Laboratory of Oncology in Southern China, Department of Radiation Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.



To compare volumetric modulated arc therapy (VMAT) with conventional step and shoot intensity modulated radiation therapy (s-IMRT) in nasopharyngeal carcinoma (NPC) patients, and identify which T category patient gains the maximum benefit from VMAT.


Fifty-two patients that randomly selected from 205 patients received VMAT at a single center were retrospectively replanned with s-IMRT. For a fair comparison, the planning target volume (PTV) coverage of the 2 plans was normalized to the same level. A standard planning constraint set was used; the constraints for the organs at risk (OARs) were individually adapted. The calculated doses to the PTV and OARs were compared for s-IMRT and VMAT plans generated using the Monaco treatment planning system.


VMAT and s-IMRT plans had similar PTV coverage and OAR sparing within all T categories. However, in stratified analysis, VMAT plans lead to better or similar sparing of the OARs in early T category patients; and lead to poorer sparing of the OARs in advanced T category patients (P<0.05). VMAT shows significant advantages for low dose burden (P<0.05) compared with s-IMRT. The delivery time per fraction for VMAT (424±64 s) was shorter than s-IMRT (778 ± 126 s, p<0.01).


VMAT provides similar dose coverage of the PTVs and similar/better normal tissue sparing in early T category NPC, and poorer OARs sparing in advanced T category NPC. And VMAT shows significant advantages for low dose burden and delivery time.

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