Strategy to select nasopharyngeal cancer patients for adaptive radiotherapy

It is recommended to re-evaluate the RT plan during the period between fractions 15 and 20 of treatment. Patients treated for NCP could be selected for ART based on the following clinical criteria at diagnosis: N3 or higher classification, presence of a bulky lymph node larger than 15 millimeters, initial BMI exceeding 28 kg/m², mean planned dose to the ipsilateral parotid glands greater than 31 Gy, cumulative volume of the parotid glands greater than 56 cc, high-dose CTV of the primary tumor greater than 93 cc, and receiving RT with no prior induction chemotherapy. Validation of these pre-treatment clinical predictors in a large, prospective dataset is essential before clinical usage.