Ugur Akbas, Med. Phys. ∗, ∗∗, Canan Koksal, Med. Phys. ∗, Nazmiye Donmez Kesen, Med. Phys. ∗, Kubra Ozkaya, M.D. †, Hatice Bilge, Med. Phys. ∗, Musa Altun, M.D. †
∗Division of Medical Physics, Istanbul University Oncology Institute, Istanbul, Turkey † Division of Radiation Oncology, Istanbul University Medical Faculty, Istanbul, Turkey

The aim of the study was to investigate the effect of the Hybrid technique which was created by combining of intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) for the treatment of nasopharyngeal cancer (NPC) patients. 7 to 9 field IMRT, triple arc VMAT, and Hybrid plans were generated for 10 advanced stage NPC patients. The homogeneity index (HI) and the conformity index (CI) of planning target volumes (PTVs) were calculated for each technique to evaluate the plan quality. The techniques were compared in terms of plan quality, sparing of organs at risk (OARs), monitor units (MUs), and delivery time. Hybrid technique significantly improved the target dose homogeneity and the conformity for PT V70 and PT V60 compared to IMRT and VMAT. Hybrid plans significantly reduced the maximum dose of the brainstem sparing compared to the VMAT plans and also improved the sparing of spinal cord compared to IMRT and VMAT. The MUs and the delivery time of Hybrid plans were found to be between values for IMRT and VMAT plans. Hybrid technique can be useful when IMRT and VMAT techniques are not adequate alone in the treatment of NPC patients.