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However, in T4 NPC, dosimetric inadequacy enforced by dose constraints on OARs may significantly impact tumor control.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a single\u2010institute cohort that patients diagnosed between July 2005 and December 2010 with T4 NPC treated with IMRT. All patients were re\u2010classification according to the 7th\u2010AJCC stage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, the average doses such as <jats:italic>D<\/jats:italic><jats:sub>max<\/jats:sub>, <jats:italic>D<\/jats:italic><jats:sub>1%<\/jats:sub>, <jats:italic>D<\/jats:italic><jats:sub>2%<\/jats:sub> and <jats:italic>D<\/jats:italic><jats:sub>1cc<\/jats:sub> for various Central nervous system (CNS) OARs including brainstem, optic nerve, chiasm, temporal lobes and spinal cord were found to exceed published guidelines as RTOG0225. However, no clinical toxicities were seen during the follow\u2010up period except for 13% patients with temporal lobe necrosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our retrospective review showed that its feasible to maximize gross tumor volume dose coverage while exceeding most CNS OAR constraint standards, with ideal local control and no obvious increase of craniocerebral toxicity.<\/jats:p><\/jats:sec>","DOI":"10.1002\/hed.27315","type":"journal-article","created":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T11:10:19Z","timestamp":1677669019000},"page":"1130-1140","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Prioritizing sufficient dose to gross tumor volume over normal tissue sparing in intensity\u2010modulated radiotherapy treatment of <scp>T4<\/scp> nasopharyngeal 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