Evaluation of the effects of dental filling material artifacts on IMRT treatment planning in patient with nasopharyngeal cancer

Background: Presence of artifacts, caused by dental filling high-Z materials (DFM), on intensity-modulated radiation therapy (IMRT) treatment plan CT images may lead to uncertainty in head and neck calculated dose distributions. Hence, the purpose of this study was to investigate the effects of DFM on the IMRT calculated dose distribution and consequent radiobiological derived outcomes for nasopharyngeal cancer patients. Materials and Methods: IMRT optimization of two groups (15 patients in each) of nasopharyngeal cancer (NPC) patients with (group I) and without (group II) dental amalgam was performed by using the Prowess Panther treatment planning system (TPS). For all the patients, target prescribed dose was 70 Gy to planning target volume. We used 3 sets of treatment plans including; nine fields arrangement (F9E) and two plans of seven fields (namely: F7 and F7E) at different angles. The dose volume histograms (DVHs), monitor units (MUs), Homogeneity index (HI), conformity index (CI), Tumor control probability (TCP) and normal tissue complication probability (NTCP) of main organs at risk (OARs) were analyzed. Results: According to the results, the TCP of PTV70 due to presence of dental filling material was significantly decreased (p=0.031). On the other hand received dose by mandible, left cochlea, both eyes and right optic nerve were considerably different between patients with and without artifacts (p<0.05), whereas mandible showed the maximum differences (up to 315.65 cGy) compared to the other studied OARs. Conclusion: Results Presence of dental artifact in patients with nasopharyngeal carcinoma leads to uncertainty in calculated dose of IMRT treatment plans, especially for mandible as an OAR.