Evidence behind use of intensity-modulated radiotherapy: a systematic review of comparative clinical studies

Summary Since its introduction more than a decade ago, intensity-modulated radiotherapy (IMRT) has spread to most radiotherapy departments worldwide for a wide range of indications. The technique has been rapidly implemented, despite an incomplete understanding of its advantages and weaknesses, the...

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Bibliographic Details
Published in:The lancet oncology 2008-04, Vol.9 (4), p.367-375
Main Authors: Veldeman, Liv, Dr, Madani, Indira, MD, Hulstaert, Frank, MD, De Meerleer, Gert, MD, Mareel, Marc, Prof, De Neve, Wilfried, MD
Format: Article
Language:English
Subjects:
Dose-Response Relationship, Radiation
Evidence-Based Medicine
Female
Follow-Up Studies
Hematology, Oncology and Palliative Medicine
Humans
Male
Neoplasms - mortality
Neoplasms - pathology
Neoplasms - radiotherapy
Radiation Injuries - epidemiology
Radiation Injuries - prevention & control
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
Radiotherapy, Conformal - adverse effects
Radiotherapy, Conformal - methods
Radiotherapy, Intensity-Modulated - adverse effects
Radiotherapy, Intensity-Modulated - methods
Randomized Controlled Trials as Topic
Risk Assessment
Survival Analysis
Treatment Outcome
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Summary:Summary Since its introduction more than a decade ago, intensity-modulated radiotherapy (IMRT) has spread to most radiotherapy departments worldwide for a wide range of indications. The technique has been rapidly implemented, despite an incomplete understanding of its advantages and weaknesses, the challenges of IMRT planning, delivery, and quality assurance, and the substantially increased cost compared with non-IMRT. Many publications discuss the theoretical advantages of IMRT dose distributions. However, the key question is whether the use of IMRT can be exploited to obtain a clinically relevant advantage over non-modulated external-beam radiation techniques. To investigate which level of evidence supports the routine use of IMRT for various disease sites, we did a review of clinical studies that reported on overall survival, disease-specific survival, quality of life, treatment-induced toxicity, or surrogate endpoints. This review shows evidence of reduced toxicity for various tumour sites by use of IMRT. The findings regarding local control and overall survival are generally inconclusive.
ISSN:1470-2045
1474-5488
DOI:10.1016/S1470-2045(08)70098-6