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

Purpose of review: Intensity-modulated radiation therapy (IMRT) represents a potentially significant new advance in the radiotherapeutic treatment of head and neck cancer patients. The capacity of IMRT to produce highly conformal dose distributions affords the opportunity to decrease the spectrum of toxicities associated with head and neck radiation. This review updates recent advances regarding the use of this emerging technology. Recent findings: Mature clinical data demonstrating head and neck IMRT safety and efficacy remain relatively limited to date. Recent publications have sought to clarify target selection and delineation. Refinements in target design driven by clinical outcomes are beginning to emerge. Technical aspects of IMRT delivery such as the impact of daily set-up variation, planning methods, and optimal fractionation regimens are progressing. Summary: Stepwise refinement in the practice of IMRT for head and neck cancer patients is advancing worldwide. However, mature clinical data remains relatively limited and specific aspects regarding the practice of head and neck IMRT remain heterogeneous.