Intensity-modulated radiotherapy (IMRT) - KCE

Intensity-modulated radiotherapy (IMRT) - KCE

20 Intensity-modulated radiotherapy KCE reports 62

Key points

• Weak to moderate quality of evidence exists demonstrating a reduction

in toxicity after IMRT compared with 2D radiotherapy or 3DCRT for

head and neck cancer, prostate cancer and breast cancer. Current

reports do no allow for a good comparison of relapse or survival data

between IMRT and conventional techniques.

• As IMRT for head and neck cancer is more difficult to plan and deliver,

and still an area of investigation, it has been suggested restrict to this

treatment to centres with the necessary expertise.

IMRT or (3D) conformal radiation therapy (3DCRT) can be used to

deliver high doses for prostate cancer. The challenge is to precisely

target the prostate with or without the pelvic nodes each session.

Frequent image-based adjustments help to achieve this.

• Use of IMRT may reduce skin complications in breast cancer

radiotherapy, primarily in heavy breasted women. Long term studies

are required to assess the risk of induction of a secondary tumour in the

contralateral breast after IMRT before introduction into common


• The induction of fatal secondary malignancies is considered the greatest

risk associated with treatment radiation. Total body irradiation is

higher using IMRT and, in theory, may overall double the incidence of

fatal secondary malignancies compared with standard external

radiotherapy techniques. Especially younger patients are at risk.

• Large variations exist in total body irradiation between various IMRT

techniques. Also use of daily radiation-based imaging for treatment setup

verification adds to the overall exposure. Manufacturers and users of

IMRT hardware and software should be aware of this. Further product

improvement should be stimulated in an effort to reduce the risk for

secondary malignancies.

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