A Pediatric Nasal Esthesioneuroblastoma Treated by Helical Tomotherapy

Purpose: To compare 3-dimensional conformal radiotherapy (3DCRT) with intensity modulated radiotherapy (IMRT) in the irradiation of pediatric head and neck tumor. Case report: A 13-year old boy with the diagnosis of olfactory neuroblastoma (stage Kadish B), who had postoperative residual disease referred to our clinic for adjuvant radiotherapy (RT). A total of 60 Gy image guided (IG)-IMRT were applied in two phases (50Gy/30 fractions and 10 Gy/5 fractions). Before irradiation, RT planning was performed by in two different therapy techniques, namely 3DCRT and IMRT, and these techniques were compared regarding conformation number (CN) and homogeneity index (HI) for planning target volume (PTV), as well as maximum, minimum and mean doses for selected critical organs and PTV. Results: IMRT planning with helical tomotherapy had an apparent superiority compared to 3DCRT planning, as expected. The patient was maintaining remission after 26 months from RT and no side effect related to RT were detected. Conclusions: Today, irradiation of pediatric tumors with 3DCRT is the standard practice. However, IMRT may be required in case of tumors at close proximity to the critical organs in which high dose of irradiation is indicated.