Hi Bill,
about your IMRT questions. IMRT was introduced around 1995, originally for the treatment of prostate cancer. It has the advantage of sparing healthy tissue as much as possible (such as the salivary glands). It will give the same dose as conventional XRT but the dose distribution will be conformed to the actual shape of the tumor. Often it is programmed to irradiate other areas of interest as well, such as lymph nodes, or in the case of a tonsil cancer, both tonsils. I can safely say that all of the comprehensive cancer centers in the US offer it.

Only Proton Beam Therapy (PBT) can spare more tissue, but it is often used in conjunction with IMRT.

XRT is commonly called the "shotgun" approach. Typically it can cause more quality of life issues in the aftermath, such as permanent loss of salivary function.

You must be a candidate for IMRT. If your tumor is poorly differentiated they may only be able to treat you with XRT. IMRT works best for a well defined tumor in one location. I opted for IMRT because I was medically qualified and my concerns for quality of life issues. I also sought treatment at one of the pioneering comprehensive cancer centers in the IMRT field and had one of the top docs in the US for a radiation oncologist.

Many local and regional radiation oncology clinics are updating their equipment to allow IMRT. IMHO experience is vital for any emerging technology. Be aware also that in some instances of more aggressive cancer, it may not respond well to radiation as has happened to some unfortunate individuals here. I believe that this is less common and usually occurs almost immediately post Tx, in a few cases before Tx is even completed.

The FDA has "standardized" (or rather "cleared to market") the Linear Accelerators (and MLC) for treatment but the treatment plan itself is "prescriptive" and will differ for each patient. As I recall it, the programming fees for my treatment alone were around $20,000.00.

In my case the doc told me she felt I had an 80% chance of a "total response" to treatment (even though my statistical odds were around 38% 5 year survival). The actual data is still being accumulated and I haven't seen it posted anywhere yet. Possibly the clinical trial they are offering you is one of those collection points.

What I have been reading lately is that the chemo cocktail followed by twice a day radiation in the end phase of treatment is the most efficacious treatment plan currently for radiation & chemo treatment protocol. I would recommend talking it over with your medical team and obtain a clear picture of the risks and benefits of the proposed treatment protocol. Incidentally the NCCN recommends clinical trials whenever possible.

There are some of us here that had very good results with IMRT. I have about 50% or better of my salivary function back and sometimes even forget to bring a water bottle with me. At 16 months post Tx there are no signs of recurrence.

Another advantage of IMRT is, because it is so specifically targeted, it can be repeated (although not in the same exact location) if necessary.