Radiobiological considerations in the design of fractionation strategies for intensity-modulated radiation therapy of head and neck cancers

Disease-control rates following intensity-modulated radiation therapy for small primary oropharyngeal carcinoma

“…Several reports have suggested that the SIB plans are superior to planning the boost separately. 15,16 In general, however, plans generated in these reports have relied on the initial optimization parameters established in dosimetric exercises. Our experience suggests that a concomitant boost schedule delivered via a sequential set of plans can meet the established set of constraints as well as SIB, if sufficient time is invested in individual plan optimization.…”

Radiation Techniques in Neuro-Oncology

“…5 Because IMRT dose distributions are highly complex, it is not unusual to see unanticipated toxicities in low-dose areas, such as alopecia or mucositis, in the exit-beam regions. Finally, because of the potentially larger volume receiving low doses of radiation, it is conceivable that the long-term risk of second malignancies may be higher.…”

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

“…IMRT is time-consuming to plan and deliver and thus makes the possibility of delivering altered fractionated radiation plus IMRT a logistical nightmare. Thus, many investigators and institutions have made one of two choices, either to omit altered fractionation in favor of IMRT or to develop a new technique called simultaneous integrated boost (SIB) [14]. SIB, as the name indicates, delivers a higher dose per fraction to areas at higher risk, while at the same time delivering a lower dose per fraction to areas of subclinical risk.…”