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Dosimetric comparison between three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) in the treatment of different stages of nasopharyngeal carcinoma

  • Mohamed S. Ibrahim (a1), Ehab M. Attalla (a2), Mostafa El Naggar (a3) and Wael M. Elshemey (a4)

This work aims to compare the dosimetric performance of three-dimensional conformal radiotherapy (3D-CRT), a relatively available technique in developing countries, to intensity-modulated radiotherapy (IMRT) in the treatment of different stages of nasopharyngeal carcinoma (NPC).

Materials and Methods

According to the diagnostic stages, 40 NPC patients were divided into two equal groups. Three planning techniques such as 3D-CRT, seven-field IMRT (7F-IMRT) and nine-field IMRT (9F-IMRT) were compared. Dose prescriptions of 70 and 66 Gy were delivered in 35 fractions to gross planning target volume (PTV1) and bilateral retropharyngeal carcinoma (PTV2), respectively.


Stage I dose data for almost all of the three investigated planning techniques obey the international recommendations. The dose delivered to PTV1 and PTV2 for 3D-CRT and 7F-IMRT are statistically similar, whereas 9F-IMRT is significantly better than 3D-CRT. For organs at risk (OARs), the delivered dose is significantly better for 9F-IMRT compared with the other two techniques, whereas 7F-IMRT is significantly better than 3D-CRT.


3D-CRT is an acceptable alternative treatment technique for stage I NPC patients in developing countries suffering from the lack of advanced radiotherapy treatment techniques. 3D-CRT and 7F-IMRT have comparable performance in PTVs, while 9F-IMRT is superior in PTVs and OARs.

Corresponding author
Author for correspondence: Wael M. Elshemey, Biophysics Department, Faculty of Science, Cairo University, Giza 12613, Egypt. Tel: +201001560029. E-mail:
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1. Kutcher, G J, Fuks, Z, Brenner, H et al. Three-dimensional photon treatment planning for carcinoma of the nasopharynx. Int J Radiat Oncol Biol Phys 1991; 21: 169182.
2. LoSasso, T, Chui, C S, Kutcher, G J, Leibel, S A, Fuks, Z, Ling, C C. The use of a multi-leaf collimator for conformal radiotherapy of carcinomas of the prostate and nasopharynx. Int J Radiat Oncol Biol Phys 1993; 25: 161170.
3. Curado, M P, Edwards, B, Shin, H R et al Cancer incidence in five continents. Volume IX (IARC Scientific Publications No 160). Lyon: International Agency for Research on Cancer 2007.
4. Abdel-Wahab, M, Bourque, J-M, Pynda, Y et al. Status of radiotherapy resources in Africa: an International Atomic Energy Agency analysis. The Lancet Oncol 2013; 14 (4): e168e175.
5. Xia, P, Fu, K K, Wong, G W, Akazawa, C, Verhey, L J. Comparison of treatment plans involving intensity modulated radiotherapy for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2000; 48: 329337.
6. Goyal, S, Cohler, A, Camporeale, J, Narra, V, Yue, N J. Intensity-modulated radiation therapy for orbital lymphoma. Radiat Med 2008; 26: 573581.
7. Tejpal, G, JaiPrakash, A, Susovan, B, Ghosh-Laskar, S, Murthy, V, Budrukkar, A. IMRT and IGRT in head and neck cancer: have we delivered what we promised? Ind J Surg Oncol 2010; 1: 166185.
8. Bhatnagar, A K, Brandner, E, Sonnik, D et al. Intensity modulated radiation therapy (IMRT) reduces the dose to the contralateral breast when compared to conventional tangential fields for primary breast irradiation. Breast Cancer Res Treat 2006; 96: 4146
9. Zelefsky, M J, Fuks, Z, Hunt, M et al. High-dose intensity modulated radiation therapy for prostate cancer: early toxicity and biochemical outcome in 772 patients. Int J Radiat Oncol Biol Phys 2002; 53: 11111116
10. Heron, D E, Gerszten, K, Selvaraj, R N et al. Conventional 3D conformal versus intensity-modulated radiotherapy for the adjuvant treatment of gynecologic malignancies: a comparative dosimetric study of dose-volume histograms. Gynecol Oncol 2003; 91: 3945 8258(03)00461-X.
11. Lin, A, Kim, H M, Terrell, J E, Dawson, L A, Ship, J A, Eisbruch, A. Quality of life after parotid-sparing IMRT for head-and-neck cancer: a prospective longitudinal study. Int J Radiat Oncol Biol Phys 2003; 57: 6170.
12. Scott-Brown, M, Miah, A, Harrington, K, Nutting, C. Evidence-based review: quality of life following head and neck intensity-modulated radiotherapy. Radiother Oncol 2010; 97: 249257.
13. Tribius, S, Bergelt, C. Intensity-modulated radiotherapy versus conventional and 3D conformal radiotherapy in patients with head and neck cancer: is there a worthwhile quality of life gain. Cancer Treat Rev 2011; 37: 511519.
14. Guckenberger, M, Pohl, F, Baier, K, Meyer, J, Vordermark, D, Flentje, M. Adverse effect of a distended rectum in intensity-modulated radiotherapy (IMRT) treatment planning of prostate cancer. Radiother Oncol 2006; 79: 5964.
15. van Elmpt, W, Nijsten, S, Mijnheer, B, Dekker, A, Lambin, P. The next step in patient-specific QA: 3D dose verification of conformal and intensity-modulated RT based on EPID dosimetry and Monte Carlo dose calculations. Radiother Oncol 2008; 86: 8692.
16. Sultanem, K, Shu, H K, Xia, P et al. Three-dimensional intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: The University of California-San Francisco experience. Int J Radiat Oncol Biol Phys 2000; 48: 711722.
17. Lee, N Y, Zhang, Q, Pfister, D G et al. Addition of bevacizumab to standard chemoradiation for locoregionally advanced nasopharyngeal carcinoma (RTOG 0615): a phase 2 multi-institutional trial. The Lancet Oncol 2012; 13 (2): 172180.
18. Lee, N Y. RTOG 0615 protocol: a phase II study of concurrent chemoradiotherapy using three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiation therapy (IMRT)+Bevacizumab (BV) for locally or regionally advanced nasopharyngeal cancer. RTOG Foundation 2014.
19. Hunt, M A, Jackson, A, Narayana, A, Lee, N. Geometric factors influencing dosimetric sparing of the parotid glands using IMRT. Int J Radiat Oncol Biol Phys 2006; 66: 296304.
20. Mock, U, Georg, D, Bogner, J, Auberger, T, Pötter, R. Treatment planning comparison of conventional, 3D conformal, and intensity-modulated photon (IMRT) and proton therapy for paranasal sinus carcinoma. Int J Radiat Oncol Biol Phys 2004; 58: 147154.
21. Wagner, D, Christiansen, H, Wolff, H, Vorwerk, H. Radiotherapy of malignant gliomas: comparison of volumetric single arc technique (RapidArc), dynamic intensity-modulated technique and 3D conformal technique. Radiother Oncol 2009; 93: 593596.
22. Xing, L, Curran, B, Hill, R et al. Dosimetric verification of a commercial inverse treatment planning system. Phys Med Biol 1999; 44: 463478.
23. Low, D A, Harms, W B, Mutic, S, Purdy, J A. A technique for the quantitative evaluation of dose distributions. Med Phys 1998; 25: 656661.
24. Metwaly, M, Awaad, A M, El-Sayed, el-SM, Sallam, A S. Forward-planning intensity-modulated radiotherapy technique for prostate cancer. J Appl Clin Med Phys 2007; 8: 114128.
25. Metwaly, M, Awaad, A M, El-Sayed, el-SM, Sallam, A S. Comparison of intensity-modulated radiotherapy and forward-planning dynamic arc therapy techniques for prostate cancer. J Appl Clin Med Phys 2008; 9: 3756.
26. Cheung, K Y. Intensity modulated radiotherapy: advantages, limitations and future developments. Biomed Imaging Interv J 2006; 2 (1): e19.
27. Yong, J H E, McGowan, T, Redmond-Misner, R et al. Estimating the costs of intensity-modulated and 3-dimensional conformal radiotherapy in Ontario. Can Cancer Res J 2016; 23: 228238.
28. De Bunt, L V, Der Heide, U A, Ketelaars, M, de Kort, G A P, Jürgenliemk-Schulz, M. Conventional, conformal, and intensity-modulated radiation therapy treatment planning of external beam radiotherapy for cervical cancer: the impact of tumor regression. Int J Radiat Oncol Biol Phys 2006; 64: 189196.
29. Xu, D, Li, G, Li, H, Jia, F. Comparison of IMRT versus 3D-CRT in the treatment of esophagus cancer: a systematic review and meta-analysis. Med (Baltimore) J 2017; 96 (31): e7685.
30. Braam, P M, Terhaard, C H J, Roesink, J M, Raaijmakers, C P J. Intensity-modulated radiotherapy significantly reduces xerostomia compared with conventional radiotherapy. Int J Radiat Oncol Biol Phys 2006; 66: 975980.
31. Herrassi, M Y, Bentayeb, F, Malisan, M R. Comparative study of four advanced 3D-conformal radiation therapy treatment planning techniques for head and neck cancer. J Med Phys 2013; 38: 98105.
32. Kam, M K M, Chau, R M C, Suen, J, Chio, P H K, Teo, P M L. Intensity-modulated radiotherapy in nasopharyngeal carcinoma: dosimetric advantage over conventional plans and feasibility of dose escalation. Int J Radiat Oncol Biol Phys 2003; 56: 145157.
33. Stieler, F, Wolff, D, Schmid, H, Welzel, G, Wenz, F, Lohr, F. A comparison of several modulated radiotherapy techniques for head and neck cancer and dosimetric validation of VMAT. Radiother Oncol 2011; 101: 388393.
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Journal of Radiotherapy in Practice
  • ISSN: 1460-3969
  • EISSN: 1467-1131
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