Well I didn't want to weigh in here, since this is a VERY knowledgeable group of posters. IMRT is becoming the standard, and yes it can be pinpoint or diffused making it very adaptable to a variety of situations. I talked with Dr. Gillison at Johns Hopkins this AM about a variety of things, mostly
HPV, but also radiation. She assured me that while they use a great deal of IMRT there, they don not use it exclusively, and still use the older modalities in many cases, though she said patients are coming in asking for IMRT. Ditto a conversation with Dr. Ang at MDACC who holds the Fletcher chair in radiation and is the president of the American Academy of Radiation Oncologists. At MDACC, an early adopter of IMRT for H&N, it is still not used exclusively, and there are "many" patients which he says are still better candidates for a different radiation modality. The book has not been written yet, and I would like to remind all the passionate here that IMRT does not have any really long term peer reviewed published data in H&N, though clearly less radiation has fewer QOL issues. That doesn't mean that when we look at a 6 or 10 year study it is going to prove less effective, since radiation is radiation. But what it might show ( according to Ang) is that for the doctors and institutions using it, that there is a steep learning curve on mapping it to gain not only the ability to reduce side effects and overall radiation dosage, but more importantly, appropriate and effective treatment patterns, when programmed by someone getting up to speed on the technology. In my own case it was not available, but even if it were, Dr. Ang tells me that it is unlikely with a less than well-defined area of malignancy that I had, that he would have chosen it for me. It goes without saying that even with all of our personal experiences and opinions, we do not know the intimate details of each patient's situation or their doctor's reasons for choosing one modality over another. All this may be LESS about the technology, and MORE about the individuals using it.
