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Neck Node Bolus Technique in the Treatment of Nasopharyngeal Carcinoma with Intensity-modulated Radiotherapy

  • Phua, Chee Ee (Clinical Oncology Unit, Faculty of Medicine, University of Malaya) ;
  • Ung, Ngie Min (Clinical Oncology Unit, Faculty of Medicine, University of Malaya) ;
  • Tan, Boon Seang (Department of Clinical Oncology and Radiotherapy) ;
  • Tan, Ai Lian (Department of Clinical Oncology and Radiotherapy) ;
  • Eng, Kae Yann (Department of Clinical Oncology and Radiotherapy) ;
  • Ng, Bong Seng (Department of Clinical Oncology and Radiotherapy)
  • Published : 2012.12.31

Abstract

Purpose: To study the effect of bolus versus no bolus in the coverage of the nodal tumour volume with intensity-modulated radiotherapy (IMRT) for the treatment of nasopharyngeal carcinoma (NPC). Methods and Materials: This retrospective study used data from 5 consecutive patients with NPC who were treated with bolus for large neck nodes using IMRT from November 2011-January 2012 in our institute. All these patients were treated radically with IMRT according to our institution's protocol. Re-planning with IMRT without bolus for these patients with exactly the same target volumes were done for comparison. Comparison of the plans was done by comparing the V70 of PTV70-N, V66.5 of PTV70-N, V65.1 of PTV70-N and the surface dose of the PTV70-N. Results: The mean size of the largest diameter of the enlarged lymph nodes for the 5 patients was 3.9 cm. The mean distance of the GTV-N to the skin surface was 0.6 cm. The mean V70 of PTV70-N for the 5 patients showed an absolute advantage of 10.8% (92.4% vs. 81.6%) for the plan with bolus while the V66.5 of PTV70-N had an advantage of 8.1% (97.0% vs. 88.9%). The mean V65.1 also had an advantage of 7.1% (97.6% vs. 90.5%). The mean surface dose for the PTV70-N was also much higher at 61.1 Gy for the plans with bolus compared to only 23.5 Gy for the plans without bolus. Conclusion: Neck node bolus technique should be strongly considered in the treatment of NPC with enlarged lymph nodes treated with IMRT. It yields a superior dosimetry compared t o non-bolus plans with acceptable skin toxicity.

Keywords

Nasopharyngeal carcinoma (NPC);bolus;intensity;modulated radiotherapy (IMRT)

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