Assessment of the therapeutic accuracy of cone beam computed tomography-guided nasopharyngeal carcinoma radiotherapy

The aim of the present study was to determine the ability of cone beam computed tomography (CBCT) to improve the accuracy of nasopharyngeal carcinoma (NPC) radiotherapy by analyzing the setup and inter-fraction errors at different levels and directions of the target volumes. A total of 113 patients with NPC who were undergoing intensity-modulated radiotherapy were recruited for the present study. Each patient had at least three CBCT exams prior to the start of radiation therapy. Three anatomic bony landmarks, including the upper neck, lower neck and head, were used to represent the different levels of assessment. The positioning errors were registered in three planes throughout the course of radiotherapy: The right-left (RL), superior-inferior (SI) and anterior-posterior (AP) directions. The planning CT images were matched with the CBCT images to determine the naso-pharynx shifts. A receiver operating characteristic curve was plotted to establish the specificity and sensitivity of CBCT. The planning target volume margin (MPTV) for the head was 0.9 mm, 1.4 mm for the upper neck and 2.0 mm for the lower neck. MPTVs of 1.5, 0.6 and 2.2 mm in the RL, SI and AP directions, respectively, were detected. In addition, there was evidence of setup errors in the three planes (RL, SI and AP) with the greatest error observed in the AP direction. Furthermore, the setup uncertainties in the neck region were greater than those of the head. In conclusion, CBCT could greatly improve the accuracy of radiotherapy by minimizing the setup errors and MPTV.