Advances in Radiotherapy

Abstract

Radiotherapy is the primary treatment modality for nonmetastatic nasopharyngeal carcinoma. With advances in intensity-modulated radiotherapy (IMRT) in the past few decades, the overall clinical outcome has dramatically improved. A recent population-based study in Hong Kong revealed excellent treatment outcomes with 5-year local control, regional control, distant control, and overall survival being 89%, 93%, 84%, and 76%, respectively. Success in IMRT requires not only well-defined contouring protocol, but also efficient planning optimization and highly accurate treatment delivery. While quality assurance plays a crucial role in ensuring consistency of treatment delivery, artificial intelligence such as autosegmentation and knowledge-based treatment planning is a rapidly evolving field that could also help to speed up and facilitate treatment optimization. Due to tumor shrinkage and weight loss, adaptive replanning may be required during the course of radiotherapy to correct for interfractional errors. Though IMRT is the current standard-of-care, other means of dose escalation/better means of organ sparing—proton therapy in particular—have also been studied. With significant improvements in imaging-based precision radiation therapy, concerted effort is much needed to develop genomic signatures to guide personalized radiotherapy.