2Department of Medical Physics, Cipto Mangunkusumo General Hospital Faculty of Medicine, Universitas Indonesia, Jakarta-Indonesia DOI : 10.5505/tjo.2023.3938 OBJECTIVE
This study aimed to evaluate the dosimetry changes and provide an overview of the time for radiation
METHODS
This prospective cohort study recruited nasopharyngeal cancer patients aged 18 or older. Radiation
planning adjustment was performed if at least one normal organ at-risk or target volume deviated from
the criteria.
RESULTS
A total of 11 patients were included as study subjects. After completing up to the 30th fraction of radiation,
8 of 11 patients lost more than 10% of their weight and required adjustments in their radiation
plan. The analysis of the relationship between the fractionation time and planning adjustment showed
the greatest increase in fractions 11 to 16, RR: 2.83 (1.74-4.61) and 4.76 (2.35-9.65), with a statistically
significant result (p=0.000). The widest neck separation demonstrated the highest sensitivity of plan adjustment
need (93.3%) and specificity (87.5%) at 1.21 cm with an area under the curve (AUC) of 0.951
and a 95% CI of 0.905-0.996 (p<0.001). The mastoid tip separation showed the highest plan adjustment
need sensitivity of 93.3% and specificity of 40.6% at 0.435 cm with an AUC of 0.741, 95% CI 0.631-0.852
(p<0.001). The Δ body weight percentage showed the plan adjustment needs a sensitivity of 91.1% and
specificity of 81.2% at 4.49 with an AUC of 0.911, 95% CI 0.844-0978 (p<0.001).
CONCLUSION
The radiation planning adjustment in patients with locally advanced nasopharyngeal cancer is suggested
at the 16th fraction, the 3rd week. It is recommended at the widest lymph node area separation of 1.21 cm
or a weight loss percentage of 4.49%.