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Cutaneous squamous cell carcinoma with large nerve perineural ( LNPN ) infiltration of the base of skull is a radiotherapeutic challenge given the complex target volumes to nearby organs at risk ( OAR ). A comparative planning study was undertaken to evaluate dosimetric differences between volumetric modulated arc therapy ( VMAT ) versus intensity modulated radiation therapy ( IMRT ) in the treatment of  LNPN .    Methods  Five consecutive patients previously treated with  IMRT  for  LNPN  were selected.  VMAT  plans were generated for each case using the same planning target volumes ( PTV ), dose prescriptions and  OAR  constraints as  IMRT . Comparative parameters used to assess target volume coverage, conformity and homogeneity included V95 of the  PTV  (volume encompassed by the 95% isodose), conformity index ( CI ) and homogeneity index ( HI ). In addition,  OAR  maximum point doses, V20, V30, non‐target tissue ( NTT ) point max doses,  NTT  volume above reference dose, monitor units ( MU ) were compared.    Results   IMRT  and  VMAT  plans generated were comparable for  CI  ( P  = 0.12) and  HI  ( P  = 0.89).  VMAT  plans achieved better V95 ( P  = < 0.001) and reduced V20 and V30 by 652 cubic centimetres (cc) (28.5%) and 425.7 cc (29.1%), respectively.  VMAT  increased  MU  delivered by 18% without a corresponding increase in  NTT  dose.    Conclusion  Compared with  IMRT  plans for  LNPN ,  VMAT  achieved comparable  HI  and  CI .

journal of medical radiation sciences

Volumetric modulated arc therapy versus step‐and‐shoot intensity modulated radiation therapy in the treatment of large nerve perineural spread to the skull base: a comparative dosimetric planning study