Glenn and Gary --

What HNCs are not treatable by IMRT? I ran this question by two ROs and our radiation physicist and they said -- essentially none -- although RP added that since the planning is a major factor, IMRT poorly planned can be less effective than XRT well-planned. But that the side-effects from the latter can be "severe" (their words, not mine) and at Hopkins they are getting better results with IMRT (this is with concurrent chemo) re cancer control in any case. More dose to the target is what RP said. Our MO confirmed that since they have started using IMRT/concurrent chemo they are getting improved results even with Stage IV cancers, with fewer long-term side effects.

This is not to say that XRT will not be effective or that it does not have a place. But it does indicate that one should explore all (and ask hard questions) this before starting treatment.

Gail