Initial Experience of CT-Based Online Adaptive Radiotherapy for Nasopharyngeal Carcinoma With a Novel Integrated Platform: A Case Report

Intensity-modulated radiation therapy (IMRT) improves tumor control and reduces long-term radiation-induced complications of patients with nasopharyngeal carcinoma (NPC), contingent upon accurate contouring and precise delivery of treatment plans. Online adaptive radiotherapy (ART) involves real-time treatment plan modification based on the variations in targets and organs at risk (OARs) to uphold treatment planning accuracy. This study describes the first reported case of fan beam computed tomography (FBCT)-guided online ART for NPC using a novel integrated platform. Online ART was performed at the 25th fraction in this case, as tumors and the patient's anatomy were observed to regress inter-fractionally, necessitating adjustments to the contours based on the anatomy of the day. Online ART plan optimized target volume coverage while reducing doses to OARs. Notably, online ART significantly improved radiotherapy efficiency. This patient achieved a clinical complete response 12 weeks post-treatment, with Epstein-Barr virus DNA levels reduced to 0 copies/ml. Currently, the patient is alive without evidence of high-grade toxicity or local recurrence at approximately 10 months post-treatment. This case confirms the feasibility and dosimetric benefit of online ART for NPC using a novel integrated platform. Further research is needed to confirm its clinical benefits.