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British Journal of Radiology (2003) 76, 673
© 2003 British Institute of Radiology
doi: 10.1259/bjr/14151356
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Editorial

Intensity-modulated radiotherapy (IMRT): the most important advance in radiotherapy since the linear accelerator?

C Nutting

Consultant and Senior Lecturer in Clinical Oncology, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK

Over the last 10 years there has been an explosion in the development and implementation of an advanced form of radiotherapy called IMRT (intensity-modulated radiotherapy). This represents a major shift in the practice of modern radiotherapy [1]. The goal of radiation therapy has always been to confine the radiation dose to tumour-bearing tissues, and avoid irradiation of normal tissue structures. This maximizes tumour control rates and reduces the risk of radiation-induced normal tissue damage. IMRT is the latest step towards achieving this goal. It is a form of conformal radiotherapy and from the clinicians perspective it represents a further development from three-dimensional conformal radiotherapy techniques.

IMRT differs from other forms of radiotherapy in a number of important areas including localization of targets and normal tissues, treatment planning, optimization, delivery and treatment verification. IMRT employs radiation beams with non-uniform intensity which when added together within a patient can produce a dose distribution with a concave shape. The clinical applications of this approach are numerous, but IMRT has the largest potential to benefit patients where the target volume surrounds or partially surrounds an organ at risk of radiation injury [2], for example tumours of the head and neck (specifically thyroid, advanced larynx and hypopharynx cancer) where the planning target volume (PTV) surrounds the spinal cord [3], or prostate cancer where the PTV (prostate gland and seminal vesicles) wrap around the rectum [4].

Clinical trials of IMRT are currently underway in the USA, Europe and in the UK to establish the benefits of these improved dose distributions in patients, and it is likely that these will re-define radiation therapy techniques for certain tumour types.

This issue of the Journal marks the start of a new series of review articles covering the topic of IMRT. The first review by Webb covers the history of development of IMRT, the physical basis of IMRT and inverse treatment planning [5]. Subsequent articles will concentrate on delivery techniques, quality assurance, implementation, clinical results and future directions. This series of articles serves as an introduction to the principles and practice of IMRT and is aimed at those radiotherapy centres currently considering implementation of this new technology.

References

  1. Eisbruch A. Intensity-modulated radiation therapy: a clinical perspective. Introduction. Semin Radiat Oncol 2002;12:197–8.[CrossRef][Medline]
  2. Nutting C, Dearnaley DP, Webb S. Intensity modulated radiation therapy: a clinical review. Br J Radiol 2000;73:459–69.[Abstract]
  3. Nutting CM, Convery DJ, Cosgrove VP, Rowbottom C, Vini L, Harmer C, et al. Improvements in target coverage and reduced spinal cord irradiation using intensity-modulated radiotherapy (IMRT) in patients with carcinoma of the thyroid gland. Radiother Oncol 2001;60:173–80.[CrossRef][Medline]
  4. Zelefsky MJ, Fuks Z, Hunt M, Yamada Y, Marion C, Ling CC, et al. High-dose intensity modulated radiation therapy for prostate cancer: early toxicity and biochemical outcome in 772 patients. Int J Radiat Oncol Biol Phys 2002;53:1111–6.[CrossRef][Medline]
  5. Webb S. The physical basis of IMRT and inverse planning. Br J Radiol 2003;76:678–89.[Abstract/Free Full Text]




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