Hi all --

I am not sure that this issue (IMRT vs. XRT vs.?) can be resolved on this forum -- it awaits more data based on carefully designed clinical studies. When I asked our RO about "outcomes of IMRT, tomoTherapy IMRT and conventional XRT" he said that "every CCC is doing comparison studies on outcomes and side-effects" so hopefully more information will be forthcoming.

Minnie -- You should not feel bad that you did not receive IMRT -- time (and these studies) may prove that yours was ultimately the better approach!

However I do think everyone should at least ask (at the initial consult) if they will be receiving IMRT, and if not, the reasons why not. If there are good reasons for a certain treatment modality, the radiation oncologist will not be reluctant to share that with the patient. There may be excellent clinical reasons or it may be because the RO does not have the experience (or equipment). These are two very different scenarios which could affect the success of treatment.

It is also important to obtain -- whenever possible -- second opinions on diagnosis and treatment in cancer cases, and in fact many insurance plans require this (mine does, for example). We consulted at Hopkins and Sloan-Kettering and both centers agreed on Barry's DX and also, general treatment plan (chemoradiation, IMRT or in case of Hopkins, tomo-IMRT). This of course made us feel much better about the chosen course of action.

If one of the top CCCs want to use what we are calling "conventional XRT" (rather than available IMRT) they will explain why. At Hopkins (where Dr. Gillison is) both our ROs told us that (at that time Barry started treatment) they were almost exclusively using IMRT and in a majority of cases, tomo-IMRT, for HNC. The head of the department had done an in-house comparison study on outcome and side-effects before making this switch and told us he was confident that the clinical outcomes were as good or better and the QOL issue superior with the newer modalities. (I do not know if this has been published). Conventional XRT was being used in certain clinical trials for which it was the protocol, and for patients with disease that has widely metasticized -- into the lungs for example. Or in the case of palliative care. During Barry's treatment period, there were supposedly (per radiation physicist and techs) no patients who were receiving conventional XRT except one man in a clinical trial. But obviously who is getting what changes as the patient mix changes. This month our RO said they suddenly had a lot of very serious advanced cases referred to them, and I would not be surprised if many of these were getting the conformal beam radiation.

Now, when conventional XRT is used, it is -- as Brian notes -- very carefully planned and blocked out so that as much as possible the non-target organs and areas are spared maximum radiation dose. So it really comes back to who is doing the radiation planning. A radiation plan for conventional XRT done by an expert whose major clinical focus is head and neck cancers would probably have fewer serious side effects that an IMRT plan done by someone who treats relatively few HNC patients annually. This is why the OCF web site and virtually every other cancer web site and publication emphasize the importance of getting to the most experienced institutions when faced with such a serious disease. And to get informed up front and to ask the hrad questions. It is, after all, the most important thing in your life...it IS your life!

Gail