{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T22:39:30Z","timestamp":1780958370304,"version":"3.54.1"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T00:00:00Z","timestamp":1632700800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Although intensity-modulated radiotherapy (IMRT), volumetric-modulated arc therapy (VMAT) and tomotherapy (TOMO) are broadly applied for nasopharyngeal carcinoma (NPC), the best technique remains unclear. Therefore, this study was conducted to address this issue.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The priority-classified plan optimization model was applied to IMRT, VMAT and TOMO plans in forty NPC patients according to the latest international guidelines. And the dosimetric parameters of planning target volumes (PTVs) and organs at risk (OARs) were compared among these three techniques. The Friedman M test in SPSS software was applied to assess significant differences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median PGTVnx coverage of IMRT was the lowest (93.5%, P &amp;lt; 0.001) for all T categories. VMAT was comparable to TOMO in OARs clarified as priority I and II, and both satisfied the prescribed requirement. IMRT resulted in a relatively high dose for V25 and V30. Interestingly, subgroup analysis showed that the median PTV coverage of the three techniques was no less than 95% in the early T stage. The heterogeneity index (HI) of PGTVnx in VMAT was better than that in IMRT (P = 0.028). Compared to TOMO, VMAT showed a strong ability to protect eyesight and decrease low-dose radiation volumes. In the advanced T stage subgroup, TOMO numerically achieved the highest median PGTVnx coverage volume compared with VMAT and IMRT (93.61%, 91% and 90%, respectively). The best CI and HI of PCTV-1 were observed in TOMO. Furthermore, TOMO was better than VMAT for sparing the brain stem, spinal cord and temporal lobes (all P &amp;lt; 0.05). However, the median V5, V10, V15, V20 and V25 were significantly higher with TOMO than with VMAT (all P &amp;lt; 0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In the early T stage, VMAT provides a similar dose coverage and protection of OARs to IMRT, and there are no obvious advantages to choosing TOMO for NPC patients in the early T stage. TOMO may be recommended for patients in the advanced T stage due as it provides the largest dose coverage of PGTVnx and the best protection of the brain stem, spinal cord and temporal lobes. Additionally, more randomized clinical trials are needed for further clarification.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2021.646584","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T19:14:31Z","timestamp":1632770071000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Comparison of Dosimetric Benefits of Three Precise Radiotherapy Techniques in Nasopharyngeal Carcinoma Patients Using a Priority-Classified Plan Optimization Model"],"prefix":"10.3389","volume":"11","author":[{"given":"Qiaoli","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiyong","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruixue","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianrui","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiawen","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sijin","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoqiang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lixiu","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhui","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,9,27]]},"reference":[{"key":"B1","article-title":"Nasopharyngeal Carcinoma: Epidemiology, Histopathology and Aetiology","volume":"9","author":"Shanmugaratnam","year":"1980","journal-title":"Ann Acad Med Singapore"},{"key":"B2","first-page":"39","article-title":"Nasopharyngeal Carcinoma: Epidemiology and Dietary Factors","author":"Yu","year":"1991","journal-title":"IARC Sci Publ"},{"key":"B3","doi-asserted-by":"publisher","first-page":"394","DOI":"10.3322\/caac.21492","article-title":"Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"68","author":"Bray","year":"2018","journal-title":"CA Cancer J Clin"},{"key":"B4","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.radonc.2020.10.005","article-title":"Combining Tumor Response and Personalized Risk Assessment: Potential for Adaptation of Concurrent Chemotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma in the Intensity-Modulated Radiotherapy Era","volume":"155","author":"Luo","year":"2020","journal-title":"Radiother Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1177\/1758835920928214","article-title":"Induction Chemotherapy Followed by Radiotherapy Versus Concurrent Chemoradiotherapy in the Treatment of Different Risk Locoregionally Advanced Nasopharyngeal Carcinoma","volume":"12","author":"Liu","year":"2020","journal-title":"Ther Adv Med Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.13564","article-title":"Investigation of Long-Term Survival Outcomes and Failure Patterns of Patients With Nasopharyngeal Carcinoma Receiving Intensity-Modulated Radiotherapy: A Retrospective Analysis","volume":"7","author":"Zhao","year":"2016","journal-title":"Oncotarget"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0219611","article-title":"The Effectiveness of Intensity-Modulated Radiation Therapy Versus 2D-RT for the Treatment of Nasopharyngeal Carcinoma: A Systematic Review and Meta-Analysis","volume":"14","author":"Du","year":"2019","journal-title":"PloS One"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2015.08.005","article-title":"Intensity-Modulated Radiation Therapy Versus 2D-RT or 3D-CRT for the Treatment of Nasopharyngeal Carcinoma: A Systematic Review and Meta-Analysis","volume":"51","author":"Zhang","year":"2015","journal-title":"Oral Oncol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2020.104978","article-title":"Toxicity and Dosimetric Analysis of Nasopharyngeal Carcinoma Patients Undergoing Radiotherapy With IMRT or VMAT: A Regional Center\u2019s Experience","volume":"109","author":"He","year":"2020","journal-title":"Oral Oncol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"57","DOI":"10.5306\/wjco.v3.i4.57","article-title":"A Prospective Trial of Volumetric Intensity-Modulated Arc Therapy vs. Conventional Intensity Modulated Radiation Therapy in Advanced Head and Neck Cancer","volume":"3","author":"Fung-Kee-Fung","year":"2012","journal-title":"World J Clin Oncol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.radonc.2008.05.010","article-title":"Dosimetric Comparisons of Helical Tomotherapy and Step-and-Shoot Intensity-Modulated Radiotherapy in Nasopharyngeal Carcinoma","volume":"89","author":"Lee","year":"2008","journal-title":"Radiother Oncol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1007\/s00066-007-1698-x","article-title":"Simultaneous Integrated Boost (SIB) for Nasopharynx Cancer With Helical Tomotherapy. A Planning Study","volume":"183","author":"Fiorino","year":"2007","journal-title":"Strahlenther und Onkologie"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0075304","article-title":"Which T Category of Nasopharyngeal Carcinoma may Benefit Most From Volumetric Modulated Arc Therapy Compared With Step and Shoot Intensity Modulated Radiation Therapy","volume":"8","author":"Sun","year":"2013","journal-title":"PloS One"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2011.11.017","article-title":"Volumetric Modulated Arc Therapy for Nasopharyngeal Carcinoma: A Dosimetric Comparison With TomoTherapy and Step-and-Shoot IMRT","volume":"104","author":"Lu","year":"2012","journal-title":"Radiother Oncol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2019.06.2540","article-title":"International Guideline on Dose Prioritization and Acceptance Criteria in Radiation Therapy Planning for Nasopharyngeal Carcinoma","volume":"105","author":"Lee","year":"2019","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B16","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.radonc.2017.10.032","article-title":"International Guideline for the Delineation of the Clinical Target Volumes (CTV) for Nasopharyngeal Carcinoma","volume":"126","author":"Lee","year":"2018","journal-title":"Radiother Oncol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2000.93.supplement","article-title":"A Simple Scoring Ratio to Index the Conformity of Radiosurgical Treatment Plans. Technical Note","author":"Paddick","year":"2000","journal-title":"J Neurosurg"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1093\/jrr\/rrs111","article-title":"Volumetric Intensity-Modulated Arc Therapy vs. Conventional Intensity-Modulated Radiation Therapy in Nasopharyngeal Carcinoma: A Dosimetric Study","volume":"54","author":"White","year":"2013","journal-title":"J Radiat Res"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.7150\/jca.22843","article-title":"Prospective Matched Study on Comparison of Volumetric-Modulated Arc Therapy and Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma: Dosimetry, Delivery Efficiency and Outcomes","volume":"9","author":"Chen","year":"2018","journal-title":"J Cancer"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2011.02.002","article-title":"Volumetric-Modulated Arc Therapy in Head and Neck Radiotherapy: A Planning Comparison Using Simultaneous Integrated Boost for Nasopharynx and Oropharynx Carcinoma","volume":"23","author":"Johnston","year":"2011","journal-title":"Clin Oncol (Royal Coll Radiol (Great Britain))"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/2653497","article-title":"Dosimetric Comparisons of Volumetric Modulated Arc Therapy and Tomotherapy for Early T-Stage Nasopharyngeal Carcinoma","volume":"2018","author":"Li","year":"2018","journal-title":"BioMed Res Int"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2021.646584\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T19:14:35Z","timestamp":1632770075000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2021.646584\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,27]]},"references-count":21,"alternative-id":["10.3389\/fonc.2021.646584"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2021.646584","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,27]]},"article-number":"646584"}}