As you all know I talk with doctors daily about treatments and what is coming down the pike. I will also be at the upcoming Astro Meeting in Colorado. There is little question that IMRT is a leap ahead. I have posted on it here twice in detail, and if you want the total answer you need to search for those postings, because I don't have time to do this in full again right now. RO's now need to know anatomy as well as a surgeon, they didn't in the past. Mapping the radiation isn't as simple as lead blocking was. There is going to be a period where they get up to speed on the technology. The machine doesn't do everything - the RO still has to tell it what to do. This reminds me of a friend who now thinks he's a graphic designer because he can use the stock tools in Photoshop to put in drop shadows in his images etc.... just because you have a powerful tool doesn't mean that you can use it properly. I call him a monkey with a shotgun. He's got a powerful design tool but with no basis for knowing how to use the tool properly he may be only partially effective in doing so. His advertisements still look like crap and he hasn't mastered the subtleties of the program.

I want to know that my RO has done a ton of cases with IMRT. He is the artist that is going to paint the area with radiation and determine what vital structures are going to be missed, what amount of radiation a particular pathway or areas is going to get and for how long, from what angle, etc. Given this tool he could just as easily UNDER paint areas that, even though near vital structures and things that effect QOL like the parotids, he may actually need to nuke them more to get rid of something that is hiding there in an occult fashion. (Eliminating some of the positive QOL issues in the process but getting all the disease.) It isn't black and white, and the way all of you talk about it, it would appear that you think so. This is a thousand shades of gray. The use of IMRT properly is a judgment call as much art as technology, and there are no absolutes or Cliff's Notes for this. Our OCF Board member Dr. Kian Ang, the head radiation doctor at MDACC used IMRT selectively on patients for over a year before he felt that he mastered all the nuances, and was actually SEEING the results he expected before he began to use it widely in the hospital. This is a guy that holds the Fletcher chair in radiation at the best of the best institution. That has to tell you something.

When I see that the 2, 5, and 7 year data in survival from IMRT is as good as we all hope that it is going to be, while sparing the QOL structures, I'll be the first to jump up and down. You can read all the studies that are out there. Is it for everyone right now? I hope after reading this you don't think so. Is it a better technology? You betcha. That doesn't mean the results of that study you are reading are going to apply to your doctor, your institution, or in particular -YOU. A doctor of lesser skills or judgment in an institution of lesser end results, using the same technology on a patient isn't going to get the same result as the best of the best using it. It isn't just about the technology...