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New surgical methods have enabled resection of previously in‐operable tumours in the region of the parotid gland and ear. This has translated to deeper target volumes being treated with adjuvant radiotherapy. Due to the limitations of existing conformal techniques, alternative planning approaches are required to cover the target volume with appropriate sparing of adjacent critical structures. Although intensity modulated radiation therapy ( IMRT ) may be able to achieve these goals compared with the existing conformal method, a new orbital sparing radiation therapy ( OSR aT) technique was evaluated as an alternative conformal planning process. The study objective was to evaluate the dosimetry of three planning methods: pre‐existing conformal,  IMRT  and  OSR aT techniques.    Methods  Ten patients were planned retrospectively using the existing three‐dimensional conformal radiotherapy (3 DCRT ),  IMRT  and  OSR aT techniques. Dosimetry was analysed using the homogeneity index ( HI ), conformity index ( CI ), the volume of planning target volumes ( PTV ) under and over treated by the 95% isodose and dose to critical structures.    Results   OSR aT achieved superior 95% coverage of the high‐dose  PTV  while delivering  HI  similar to  IMRT  for intermediate and high‐dose  PTV s. The  CI  for the high‐dose  PTV  was comparable between the three techniques, however  IMRT  was statistically better for the low‐ and intermediate dose  PTV s. All three techniques showed adequate orbital sparing, however  OSR aT and  IMRT  achieved this with less under dosing of the  PTV s.    Conclusion  For the treatment of patients with advanced skin cancer of the parotid and ear, both  IMRT  and the  OSR aT techniques are viable options.

Conformal orbit sparing radiation therapy: a treatment option for advanced skin cancer of the parotid and ear region