Intensity-Modulated Radiation Therapy for Head and Neck Carcinoma

Abstract

After completing this course, the reader will be able to:1. Outline innovations related to targeted radiation therapy.2. Describe trials proving an advantage using IMRT.3. Assess treatment planning modalities and how IMRT fields are designed.4. Evaluate when there is a toxicity advantage for IMRT.5. Discern when conventional radiotherapy should be used instead of IMRT.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACT Intensity-modulated radiation therapy (IMRT) for head and neck tumors refers to a new approach that aims at increasing the radiation dose gradient between the target tissues and the surrounding normal tissues at risk, thus offering the prospect of increasing the locoregional control probability while decreasing the complication rate. As a prerequisite, IMRT requires a proper selection and delineation of target volumes. For the latter, recent data indicate the potential of functional imaging to complement anatomic imaging modalities. Nonrandomized clinical series in paranasal sinuses and pharyngolaryngeal carcinoma have shown that IMRT was able to achieve a very high rate of locoregional control with less morbidity, such as dry-eye syndrome, xerostomia, and swallowing dysfunction. The promising results of IMRT are likely to be achieved when many treatment conditions are met, for example, optimal selection and delineation of the target volumes and organs at risk, appropriate physical quality control of the irradiation, and accurate patient setup with the use of onboard imaging. Because of the complexity of the various tasks, it is thus likely that these conditions will only be

IMRT and IGRT in head and neck cancer: Have we delivered what we promised?

“…1c) that has completely revolutionized contemporary radiotherapy practice. 6 The IMRT Collaborative Working Group 7 of the National Cancer Institute defines IMRT as an advanced form of high-precision radiotherapy that uses non-uniform radiation beam intensities that have been determined using various computer-based optimization techniques to achieve the desired dosedistribution (Fig. 2).…”

Commentary: IMRT for Head and Neck Cancer: Many Chapters Left to Write

“…In many centers, it has become the de facto standard for treating aggressive disease. With the introduction of IMRT, which offers its own benefits, as outlined by Grégoire et al [2], however, has come a dramatic reduction in the use of altered fractionation. IMRT is time-consuming to plan and deliver and thus makes the possibility of delivering altered fractionated radiation plus IMRT a logistical nightmare.…”

“…The question remains whether or not it represents a major improvement in the treatment of head and neck cancer. Grégoire et al [2] have nicely reviewed the salient data that currently exist for the theoretical and actual benefits of IMRT in this issue of The Oncologist. However, many questions remain unanswered.…”

Dosimetric impact of the 160 MLC on head and neck IMRT treatments

“…The highly conformal doses achieved with IMRT plan results in greater tissue sparing and toxicity with similar or better locoregional control when compared with three‐dimensional conformal treatments 1 , 2 …”