Paul, My husband was treated at a CCC (ranked #13 USNews) and we were rather dismayed with the radiation department there. Just learning about options at the time (and about cancer for that matter), we learned about IMRT and, of course, wanted that treatment for him. Their policy is to use IMRT for patients not having surgery but to use standard radiation for post-operative patients. He had surgery, and I had read the following study "Intensity-Modulated Radiation Therapy for Oropharyngeal Carcinoma: Impact of Tumor Volume" done by M.D. Anderson among others and published in May, 2004, and basically went in and begged the R.O. to give him IMRT. And he did. I later found out that another local cancer center (not a CCC)gives IMRT for post-surgery H&N patients as standard treatment. In talking with the R.O., the impression I got was - 1) this particular CCC didn't feel there was sufficient evidence of better results for post-op patients using IMRT, 2) a lot of their patient's insurance doesn't cover it (??ours considered it medically necessary), and 3) it took a more resources and time to do IMRT rather than standard treatment. But as I said, he did give him the IMRT treatment. In the study I mentioned above, it covered 74 patients (tonsil, base of tongue, and soft palate), 70% of whom were Stage IV (93% were either Stage III/IV). Patients (43) in the study who had both surgery and IMRT had a 92% 4-yr est of DFS rate, a 95% est of LRC rate, and a 94% est of DMFS rate. Only 4 of these patients had chemo. Those who had IMRT with no surgery had a 66% 4-yr est of DFS rate. The study also breaks things down between Gender, Subsite, T stage, Nodal Status, AJCC stage, Fraction Size. It also profiles the side effects and percentages of these for both Acute and Late Toxicity (skin, mucositis, xerostomia, trismus) From what I've read this is one of the few large studies done regarding the use of IMRT specifically. This study also documents the outcomes of eight other studies done using standard rad with variations of +- surgery +- chemo. The Disease Free Survival (DFS) rates are all much lower in these other studies than in the Anderson IMRT study.

I'm 7 months new to all this and I don't really know how you are supposed to view the results of one study - but personally, I liked the odds on this one. Our CCC apparently doesn't view this study's IMRT patient outcomes in the same light that we did.