Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Intensity-modulated radiation therapy in the treatment of head and neck cancer

Nature Clinical Practice Oncology volume 2, pages 34–39 (2005)Cite this article

Abstract

Intensity-modulated radiation therapy (IMRT) is a new technical improvement of radiotherapy, in which computer-controlled treatment machines produce multiple beams of radiotherapy whose intensity is optimized to deliver a high dose of radiation to specified volumes, while reducing the dose to adjacent non-target organs. The potential benefits include the ability to deliver higher doses to the target with an improved safety than has previously been possible, and to reduce side effects and complications. Using IMRT to treat some head and neck cancers is especially attractive due to the close vicinity of the targets and many critical, dose-limiting and non-involved structures, and because of the lack of breathing-related motion. The main clinical uncertainties in the use of IMRT for head and neck cancer relate to uncertainties in the extent of radiation to the target areas. In addition, large volumes of adjacent, non-target tissue receive moderate to low radiation doses, raising concerns of increased risk of radiation-related carcinogenesis in young patients. Initial promising clinical data have emerged from IMRT treatment of several head and neck tumor sites.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Wu Q et al. (2002) IMRT optimization based on the generalized equivalent uniform dose (EUD). Int J Radiat Oncol Biol Phys 52: 224–235

    Article  Google Scholar 

  2. Chao KSC et al. (2000) Intensity-modulated radiation therapy in head and neck cancer: The Mallincrodt experience. Int J Cancer 90: 92–103

    Article  CAS  Google Scholar 

  3. Eisbruch A et al. (1998) Comprehensive radiation of head and neck cancer using conformal multisegmental fields: assessment of target coverage and noninvolved tissue sparing. Int J Radiat Oncol Biol Phys 41: 559–5684

    Article  CAS  Google Scholar 

  4. Mohan R et al. (2000) Radiobiological considerations in the design of fractionation strategies for intensity modulated radiation therapy of the head and neck. Int J Radiat Oncol Biol Phys 46: 619–630

    Article  CAS  Google Scholar 

  5. Fu KK et al. (2000) RTOG phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003. Int J Rad Oncol Biol Phys 48: 7–16

    Article  CAS  Google Scholar 

  6. Butler EB et al. (1999) SMART (simultaneous modulated accelerated radiation therapy) boost: a new accelerated fractionation schedule for the treatment of head and neck cancer with intensity modulated radiotherapy. Int J Rad Oncol Biol Phys 45: 21–32

    Article  CAS  Google Scholar 

  7. Lee N et al. (2002) Intensity modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Rad Oncol Biol Phys 53: 12–21

    Article  Google Scholar 

  8. Wu Q et al. (2000) The potential for sparing of parotids and escalation of biologically equivalent dose with intensity modulated radiation treatments of head and neck cancers: A treatment design study. Int J Radiat Oncol Biol Phys 46: 195–2059

    Article  CAS  Google Scholar 

  9. Wu Q et al. (2003) Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced head and neck squamous cell carcinomas. I. Dosimetric results. Int J Rad Oncol Biol Phys 56: 573–585

    Article  Google Scholar 

  10. Lauve A et al. (2004) Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced head and neck cancer: II-clinical results. Int J Rad Oncol Biol Phys 60: 374–387

    Article  Google Scholar 

  11. Pignon JP et al. (2000) Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 355: 949–955

    Article  CAS  Google Scholar 

  12. Vineberg KA et al. (2002) Is uniform target dose possible in IMRT plans for head and neck cancer? Int J Radiat Oncol Biol Phys 52: 1159–1172

    Article  CAS  Google Scholar 

  13. Ling CC et al. (2000) Toward multidimensional radiotherapy: Biological imaging and biological conformality. Int J Radiat Oncol Biol Phys 47: 551–560

    Article  CAS  Google Scholar 

  14. Hockel M et al. (1996) Hypoxia and radiation response in human tumors. Semin Radiat Oncol 6: 3–9

    Article  CAS  Google Scholar 

  15. Som PM (1997) The present controversy over the imaging method of choice for evaluating the soft tissues of the neck. AJNR Am J Neuroradiol 18: 1869–1872

    CAS  PubMed  Google Scholar 

  16. Pieterman RM et al. (2000) Preoperative staging of non-small-cell lung cancer with positron-emission tomography. New Engl J Med 343: 254–261

    Article  CAS  Google Scholar 

  17. Schechter NR et al. (2001) Can positron emission tomography improve the quality of care for head and neck cancer patients? Int J Rad Oncol Biol Phys 51: 4–9

    Article  CAS  Google Scholar 

  18. Logue JP et al. (1998) Clinical variability of target volume description in conformal radiotherapy planning. Int J Radiat Oncol Biol Phys 41: 929–931

    Article  CAS  Google Scholar 

  19. Nowak P et al. (1997) Treatment portals for elective radiotherapy of the neck: an inventory in the Netherlands. Radiother Oncol 43: 81–86

    Article  CAS  Google Scholar 

  20. Eisbruch A et al. (2002) IMRT for head and neck cancer: Emphasis on the selection and delineation of the targets. Semin Radiat Oncol 12: 238–249

    Article  Google Scholar 

  21. Gregoire V et al. (2000) Selection and delineation of lymph node target volumes in head and neck conformal radiotherapy. Proposal for standardizing terminology and procedure based on the surgical experience. Radiother Oncol 56: 135–150

    Article  CAS  Google Scholar 

  22. Madu CN et al. (2001) Definition of supraclavicular and infraclavicular nodes: implicatuions for three-dimensional CT-based conformal radiation therapy. Radiology 221: 333–339

    Article  CAS  Google Scholar 

  23. Gregoire V et al. (Eds; 2004). Clinical Target volumes in conformal and intensity modulated radiation therapy. Berlin: Springer-Verlag

    Book  Google Scholar 

  24. Chao KS et al. (2003) Patterns of failure in patients receiving definitive and postoperative IMRT for head and neck cancer. Int J Radiat Oncol Biol Phys 56: 312–321

    Article  Google Scholar 

  25. Lee N et al. (2003) Intensity-modulated radiation therapy for head and neck cancer: the UCSF experience focusing on target volume delineation. Int J Radiat Oncol Biol Phys 57: 49–6029

    Article  Google Scholar 

  26. Eisbruch A et al. (2004) Recurrences near the base of skull following IMRT of head and neck cancer: Implications for target delineation in the high neck and for parotid gland sparing. Int J Radiat Oncol Biol Phys 59: 28–42

    Article  Google Scholar 

  27. Eisbruch A et al. Xerostomia and its predictors following parotid-sparing radiation of head and neck cancer. Int J Radiat Onc Biol Phys 50: 695–704

  28. Chao KSC et al. (2001) A prospective study of salivary function sparing in patients with head and neck cancers receiving intensity-modulated or three-dimensional radiation therapy: Initial results. Int J Radiat Oncol Biol Phys 49: 907–916

    Article  CAS  Google Scholar 

  29. Sultanem K et al. (2000) Three-dimensional intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: the University of California-San Francisco experience. Int J Radiat Oncol Biol Phys 48: 711–722

    Article  CAS  Google Scholar 

  30. Lin A et al. (2003) Quality of life following parotid-sparing IMRT of head and neck cancer: A prospective longitudinal study. Int J Radiat Oncol Biol Phys 57: 61–70

    Article  Google Scholar 

  31. Parliament MB et al. (2004) Preservation of oral health-related quality of life and salivary flow rates after inverse-planned intensity-modulated radiotherapy (IMRT) for head and neck cancer. Int J Radiat Oncol Biol Phys 58: 663–673

    Article  Google Scholar 

  32. Eisbruch A et al. Dysphagia and aspiration following chemo radiation of head and neck cancer: which anatomical structures are affected, and can they be spared by IMRT? Int J Radiat Oncol Biol Phys (in press)

  33. Huang E et al. (2002) Intensity-modulated radiation therapy for pediatric medulloblastoma: early report on the reduction of ototoxicity. Int J Rad Oncol Biol Phys 52: 599–605

    Article  Google Scholar 

  34. Claus F et al. (2001) An implementation strategy for IMRT of ethmoid sinus cancer with bilateral sparing of the optic pathways. Int J Rad Oncol Biol Phys 51: 318–331

    Article  CAS  Google Scholar 

  35. Claus F et al. (2002) Short-term profile for 32 sinonasal cancer patients treated with IMRT: can we avoid dry eye syndrome? Radiothr Oncol 64: 205–208

    Article  Google Scholar 

  36. Fukunaga-Johnson N et al. (1998) The use of 3D conformal radiotherapy to spare the cochlea in patients with medulloblastoma. Int J Rad Oncol Biol Phys 41: 77–82

    Article  CAS  Google Scholar 

  37. Martel MK et al. (1997) Dose-volume complication analysis for visual pathway structures of patients with advanced paranasal sinus tumors. Int J Radiat Oncol Biol Phys 38: 273–284

    Article  CAS  Google Scholar 

  38. Glatstein E (2003) The return of the snake oilmen. Int J Radiat Oncol Biol Phys 55: 561–562

    Article  Google Scholar 

  39. Lindsay KA et al. (2001) Radiation carcinogenesis modeling for risk of treatment-related second tumors following radiotherapy. Br J Radiol 74: 529–536

    Article  CAS  Google Scholar 

  40. Fowler JF et al. (2004) Loss of biological effect in prolonged fraction delivery. Int J Radiat Oncol Biol Phys 59: 242–249

    Article  Google Scholar 

  41. Mock U et al. (2004) Treatment planning comparison of conventional, 3D conformal, and intensity-modulated photon (IMRT) and proton therapy for paranasal sinus carcinoma. Int J Radiat Oncol Biol Phys 58: 147–154

    Article  Google Scholar 

Download references

Acknowledgements

Supported by NIH grant CA59827.

Author information

Authors and Affiliations

  1. Associate Professor and Director of Clinical Research at the Department of Radiation Oncology at the University of Michigan, Ann Arbor, MI, USA

    Avraham Eisbruch

Authors
  1. Avraham Eisbruch
    View author publications

    You can also search for this author in PubMed Google Scholar

Ethics declarations

Competing interests

The author declares no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Eisbruch, A. Intensity-modulated radiation therapy in the treatment of head and neck cancer. Nat Rev Clin Oncol 2, 34–39 (2005). https://doi.org/10.1038/ncponc0058

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncponc0058

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing