I was told with IMRT that Amifostine is usually only considered when there are large (bulky) lymph nodes adjacent to the salivary glands so that it is difficult to avoid high doses to the salivary glands.

I was also told that several RT systems including Tomotherapy can usually treat these areas effectively without the need for Amifostine.

It was also mentioned that questions persist in regards to long term effects related to the modest level of protection Amifostine seems to also provide to the tumor(cancer).