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Clinical Impact of the Bolus in Intensity-Modulated Radiotherapy and Volumetric-Modulated Arc Therapy for Stage I–II Nasal Natural Killer/T-Cell Lymphoma

Introduction: To estimate the clinical impact of bolus in intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) for stage I–II nasal natural killer/T-cell lymphoma (NNKTCL), including target quality, organs at risk (OARs) sparing, and tumor control probability (TCP). Methods: Two different treatment plans were designed in IMRT and VMAT for 10 stage I–II NNKTCL patients. The clinical plans added bolus perfectly contacting the nose skin, similar to common clinical planning design practices. The edited bolus plans resulted from dose recalculation with the edited bolus, which simulated the actual shape of a commercial flat bolus during treatment. All the plans were with no beam passing through the couch avoiding beam attenuation caused by the couch. Differences between both types of plans in target quality, OARs sparing, and TCP were evaluated. Results: Compared with clinical plans, the D98%, D2%, Dmean, and TCP of edited bolus plans with IMRT slightly decreased (p = 0.002, 0.015, 0.000, and 0.000), the homogeneity index increased 8.33% (p = 0.024), and the doses to a small number of OARs slightly changed. Similar results were obtained for VMAT. Conclusion: The bolus deformation in practical clinical treatment resulted clinically in tiny changes with respect to the target coverage, OARs sparing, and TCP in both IMRT and VMAT for stage I–II NNKTCL. This implied that the clinical impact of the boluscan be negligible when utilizing it to increase the dose to irregularly shaped tumors in the nasal area.