Nelie (and others):

The critical issue with IMRT and any targeted radiation is the radiation planning. I had a long talk with our RO at a recent HNC Conference at Hopkins, and he emphasized this. His point was that how the planning is done can have a drastic impact on the extent of side-effects, irregardless of equipment. He referred to the paper given at ASTRO a couple years ago where the same "test" HNC case was given to a large number of radiation oncologists, planning for IMRT treatment, and the plans differed widely.

IMRT can deliver more dosage to the target area but can also more precisely avoid non-target organs and tissues -- but that is where the planning comes into play. Not only the experience of the oncologist but also, his or her bias towards sparing, say, the parotid glands. Some doctors may well prefer to radiate a larger field, especially if there is an unknown primary, feeling that hitting all potential cancerous areas is the most important goal. But it gives the doctor more ability to avoid non-target areas.

Most of the folks I know who got IMRT have not had any strictures but they are not unknown -- Barry was checked for that both with his swallowing evaluation and with endoscope but one of the cautions his therapist gave him up front was to call her if he felt things were getting stuck in his throat -- this could be due to swelling (edema) or to a stricture. Actually, he did think this might be a problem a couple months ago but this has gradually resolved, and an exam last Friday showed no strictures.

His ENT pretty much said what James did -- usually these can be solved with relatively minor surgery -- she's the doctor who had radiation for HNC herself and knows where it's at!

Gail