Clinical use of intensity-modulated radiotherapy: part II.

Intensity-modulated radiotherapy (IMRT) is a novel conformal radiotherapy technique which is gaining increasingly widespread use. This second clinical article aims to summarize the published data pertaining to prostate cancer, pelvic irradiation, gynaecological and breast cancer. Prostate cancer patients represent the largest group treated to date. The main indication has been radiation dose escalation within acceptable normal tissue late toxicity. Phase II data are promising, but no randomized clinical trial data are available to support its use. Pelvic IMRT aims to deliver radical radiation doses to pelvic lymph nodes while sparing the bowel and bladder. Indications for breast IMRT data are reviewed, and current data presented. Further data from randomized trials are required to confirm the anticipated benefits of IMRT in patients.

[1]  S. Dische,et al.  Where exactly does failure occur after radiation in head and neck cancer? , 1995, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[2]  Daniel A Low,et al.  Patterns of failure in patients receiving definitive and postoperative IMRT for head-and-neck cancer. , 2003, International journal of radiation oncology, biology, physics.

[3]  E. B. Butler,et al.  The use of intensity modulated radiotherapy for the treatment of extensive and recurrent juvenile angiofibroma. , 2000, International journal of pediatric otorhinolaryngology.

[4]  D. Dearnaley,et al.  IMRT clinical implementation: Prostate and pelvic node irradiation using Helios and a 120‐leaf multileaf collimator , 2002, Journal of applied clinical medical physics.

[5]  E. B. Butler,et al.  Intensity-modulated radiation therapy (IMRT) for meningioma. , 2002, International journal of radiation oncology, biology, physics.

[6]  J. Tsai,et al.  Dosimetric comparison of stereotactic radiosurgery to intensity modulated radiotherapy. , 1998, Radiation oncology investigations.

[7]  C. Ling,et al.  Planning, delivery, and quality assurance of intensity-modulated radiotherapy using dynamic multileaf collimator: a strategy for large-scale implementation for the treatment of carcinoma of the prostate. , 1997, International journal of radiation oncology, biology, physics.

[8]  W. Dörr,et al.  Cancer induction by radiotherapy: dose dependence and spatial relationship to irradiated volume. , 2002, Journal of radiological protection : official journal of the Society for Radiological Protection.

[9]  J. Vermorken Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials , 2000, The Lancet.

[10]  D Low,et al.  Intensity-modulated radiation therapy (IMRT) reduces small bowel, rectum, and bladder doses in patients with cervical cancer receiving pelvic and para-aortic irradiation. , 2001, International journal of radiation oncology, biology, physics.

[11]  B. Rasmussen,et al.  Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial , 1999, The Lancet.

[12]  D P Dearnaley,et al.  Reduction of small and large bowel irradiation using an optimized intensity-modulated pelvic radiotherapy technique in patients with prostate cancer. , 2000, International journal of radiation oncology, biology, physics.

[13]  E. Hall,et al.  Radiation-induced second cancers: the impact of 3D-CRT and IMRT. , 2003, International journal of radiation oncology, biology, physics.

[14]  K. Harrington,et al.  In regard to Lee et al., IJROBP 2002;53:630-637. , 2003, International Journal of Radiation Oncology, Biology, Physics.

[15]  I. Hardan,et al.  The role of irradiation of the internal mammary lymph nodes in high-risk stage II to IIIA breast cancer patients after high-dose chemotherapy: a prospective sequential nonrandomized study. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[16]  A. Garden,et al.  Carcinoma of the nasopharynx treated by radiotherapy alone: determinants of local and regional control. , 1997, International journal of radiation oncology, biology, physics.

[17]  R Mohan,et al.  A comparison of three stereotactic radiotherapy techniques; ARCS vs. noncoplanar fixed fields vs. intensity modulation. , 1998, International journal of radiation oncology, biology, physics.

[18]  T. Bortfeld,et al.  Number and orientations of beams in intensity-modulated radiation treatments. , 1997, Medical physics.

[19]  E. B. Butler,et al.  Smart (simultaneous modulated accelerated radiation therapy) boost: a new accelerated fractionation schedule for the treatment of head and neck cancer with intensity modulated radiotherapy. , 1999, International journal of radiation oncology, biology, physics.

[20]  F. Vicini,et al.  Optimizing breast cancer treatment efficacy with intensity-modulated radiotherapy. , 2002, International journal of radiation oncology, biology, physics.

[21]  M. Carol,et al.  Initial clinical experience with the Peacock intensity modulation of a 3-D conformal radiation therapy system. , 1996, Stereotactic and functional neurosurgery.

[22]  K. Harrington,et al.  Intensity-modulated radiotherapy improves target coverage, spinal cord sparing and allows dose escalation in patients with locally advanced cancer of the larynx. , 2004, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[23]  Intensity-modulated radiotherapy reduces lung irradiation in patients with carcinoma of the oesophagus. , 2002, Frontiers of radiation therapy and oncology.

[24]  E. Strong,et al.  Patterns of failure in carcinoma of the nasopharynx: I. Failure at the primary site. , 1985, International journal of radiation oncology, biology, physics.

[25]  W. Woodward,et al.  Cardiovascular death and second non-breast cancer malignancy after postmastectomy radiation and doxorubicin-based chemotherapy. , 2003, International journal of radiation oncology, biology, physics.

[26]  D P Dearnaley,et al.  Improvements in target coverage and reduced spinal cord irradiation using intensity-modulated radiotherapy (IMRT) in patients with carcinoma of the thyroid gland. , 2001, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[27]  C. Perez,et al.  Cancer of the nasopharynx. Factors influencing prognosis , 1969, Cancer.

[28]  M Partridge,et al.  The delivery of intensity modulated radiotherapy to the breast using multiple static fields. , 2000, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[29]  S. Webb,et al.  Potential improvements in the therapeutic ratio of prostate cancer irradiation: dose escalation of pathologically identified tumour nodules using intensity modulated radiotherapy. , 2002, The British journal of radiology.

[30]  W. Schlegel,et al.  The Role of Stereotactically Guided Conformal Radiotherapy for Local Tumor Control of Esthesioneuroblastoma , 2002, Strahlentherapie und Onkologie.

[31]  C G Rowbottom,et al.  Beam-orientation optimization of intensity-modulated radiotherapy: clinical application to parotid gland tumours. , 2001, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[32]  C. Ling,et al.  Intensity-modulated radiotherapy versus conventional three-dimensional conformal radiotherapy for boost or salvage treatment of nasopharyngeal carcinoma. , 2002, International journal of radiation oncology, biology, physics.

[33]  E. B. Butler,et al.  Post-nerve-sparing prostatectomy, dose-escalated intensity-modulated radiotherapy: effect on erectile function. , 2002, International journal of radiation oncology, biology, physics.

[34]  J. Overgaard,et al.  Morbidity and mortality of ischaemic heart disease in high-risk breast-cancer patients after adjuvant postmastectomy systemic treatment with or without radiotherapy: analysis of DBCG 82b and 82c randomised trials , 1999, The Lancet.

[35]  D Verellen,et al.  Risk assessment of radiation-induced malignancies based on whole-body equivalent dose estimates for IMRT treatment in the head and neck region. , 1999, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[36]  R Mohan,et al.  Radiobiological considerations in the design of fractionation strategies for intensity-modulated radiation therapy of head and neck cancers. , 2000, International journal of radiation oncology, biology, physics.

[37]  S L Meeks,et al.  Potential clinical efficacy of intensity-modulated conformal therapy. , 1998, International journal of radiation oncology, biology, physics.

[38]  Linda Hong,et al.  IMRT of large fields: whole-abdomen irradiation. , 2001, International journal of radiation oncology, biology, physics.

[39]  M. Hiraoka,et al.  Clinical evaluation of dynamic arc conformal radiotherapy for paraaortic lymph node metastasis. , 2003, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[40]  Jan J W Lagendijk,et al.  The dose to the parotid glands with IMRT for oropharyngeal tumors: the effect of reduction of positioning margins. , 2002, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[41]  W. De Gersem,et al.  Conformal radiotherapy of Stage III non-small cell lung cancer: a class solution involving non-coplanar intensity-modulated beams. , 1998, International journal of radiation oncology, biology, physics.

[42]  W. De Gersem,et al.  An implementation strategy for IMRT of ethmoid sinus cancer with bilateral sparing of the optic pathways. , 2001, International journal of radiation oncology, biology, physics.

[43]  John Wong,et al.  Intensity modulation to improve dose uniformity with tangential breast radiotherapy: initial clinical experience. , 2000 .

[44]  M K Martel,et al.  Patterns of local-regional recurrence following parotid-sparing conformal and segmental intensity-modulated radiotherapy for head and neck cancer. , 2000, International journal of radiation oncology, biology, physics.

[45]  P. Xia,et al.  Three-dimensional intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: the University of California-San Francisco experience. , 2000, International journal of radiation oncology, biology, physics.

[46]  P M Evans,et al.  Practical implementation of compensators in breast radiotherapy. , 1998, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[47]  C C Ling,et al.  High dose radiation delivered by intensity modulated conformal radiotherapy improves the outcome of localized prostate cancer. , 2001, The Journal of urology.

[48]  R Mohan,et al.  Conformal radiation treatment of prostate cancer using inversely-planned intensity-modulated photon beams produced with dynamic multileaf collimation. , 1996, International journal of radiation oncology, biology, physics.

[49]  M. Martel,et al.  Parotid gland sparing in patients undergoing bilateral head and neck irradiation: techniques and early results. , 1996, International journal of radiation oncology, biology, physics.

[50]  M. Robinson,et al.  The role of intensity-modulated radiotherapy in the treatment of parotid tumors. , 2002, International journal of radiation oncology, biology, physics.

[51]  F. Claus,et al.  Postoperative radiotherapy for adenocarcinoma of the ethmoid sinuses: treatment results for 47 patients. , 2002, International journal of radiation oncology, biology, physics.

[52]  Michael J. Zelefsky,et al.  High-dose intensity modulated radiation therapy for prostate cancer: early toxicity and biochemical outcome in 772 patients. , 2002, International journal of radiation oncology, biology, physics.

[53]  J. Kuo,et al.  Intensity-modulated radiation therapy for the spine at the University of California, Irvine. , 2002, Medical dosimetry : official journal of the American Association of Medical Dosimetrists.

[54]  D. Leavitt,et al.  Intensity-modulated photon arc therapy for treatment of pleural mesothelioma. , 2002, Medical dosimetry : official journal of the American Association of Medical Dosimetrists.

[55]  E. B. Butler,et al.  The Potential Use of Intensity Modulated Radiotherapy (IMRT) in Women with Pectus Excavatum Desiring Breast‐Conserving Therapy , 2001, The breast journal.

[56]  A. Eisbruch,et al.  Parotid Sparing Study in Head and Neck Cancer Patients Receiving Bilateral Radiation Therapy: One-year Results , 1997, Journal of dental research.

[57]  K. Forster,et al.  Intensity-modulated radiotherapy following extrapleural pneumonectomy for the treatment of malignant mesothelioma: clinical implementation. , 2003, International journal of radiation oncology, biology, physics.

[58]  R Mohan,et al.  The potential for sparing of parotids and escalation of biologically effective dose with intensity-modulated radiation treatments of head and neck cancers: a treatment design study. , 2000, International journal of radiation oncology, biology, physics.

[59]  R K Ten Haken,et al.  Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. , 1999, International journal of radiation oncology, biology, physics.

[60]  C S Chui,et al.  Inverse planning algorithms for external beam radiation therapy. , 2001, Medical dosimetry : official journal of the American Association of Medical Dosimetrists.

[61]  C C Ling,et al.  Clinical experience with intensity modulated radiation therapy (IMRT) in prostate cancer. , 2000, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[62]  E. B. Butler,et al.  A comparison of intensity modulated conformal therapy with a conventional external beam stereotactic radiosurgery system for the treatment of single and multiple intracranial lesions. , 1996, International journal of radiation oncology, biology, physics.

[63]  Michael B Sharpe,et al.  Initial clinical experience with moderate deep-inspiration breath hold using an active breathing control device in the treatment of patients with left-sided breast cancer using external beam radiation therapy. , 2003, International journal of radiation oncology, biology, physics.

[64]  K. Chao,et al.  Lymphangiogram-assisted lymph node target delineation for patients with gynecologic malignancies. , 2002, International journal of radiation oncology, biology, physics.

[65]  Sasa Mutic,et al.  PET-guided IMRT for cervical carcinoma with positive para-aortic lymph nodes-a dose-escalation treatment planning study. , 2003, International journal of radiation oncology, biology, physics.

[66]  J. Roeske,et al.  Intensity-modulated whole pelvic radiation therapy in patients with gynecologic malignancies. , 2000, International journal of radiation oncology, biology, physics.

[67]  P. Grigsby,et al.  Applicator-guided intensity-modulated radiation therapy. , 2002, International journal of radiation oncology, biology, physics.

[68]  M. Martel,et al.  Dose-volume complication analysis for visual pathway structures of patients with advanced paranasal sinus tumors. , 1997, International journal of radiation oncology, biology, physics.

[69]  S Webb,et al.  Cardiac avoidance in breast radiotherapy: a comparison of simple shielding techniques with intensity-modulated radiotherapy. , 2001, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[70]  P M Evans,et al.  Dose-position and dose-volume histogram analysis of standard wedged and intensity modulated treatments in breast radiotherapy. , 2002, The British journal of radiology.

[71]  D A Low,et al.  Intensity‐modulated radiation therapy in head and neck cancers: The Mallinckrodt experience , 2000, International journal of cancer.

[72]  J. Roeske,et al.  Initial clinical experience with intensity-modulated whole-pelvis radiation therapy in women with gynecologic malignancies. , 2001, Gynecologic oncology.

[73]  K. Ang,et al.  CT-based delineation of lymph node levels and related CTVs in the node-negative neck: DAHANCA, EORTC, GORTEC, NCIC,RTOG consensus guidelines. , 2003, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[74]  A. Eisbruch,et al.  The influence of pre-radiation salivary flow rates and radiation dose on parotid salivary gland dysfunction in patients receiving radiotherapy for head and neck cancers. , 1998, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[75]  Ping Xia,et al.  Skin toxicity due to intensity-modulated radiotherapy for head-and-neck carcinoma. , 2002, International journal of radiation oncology, biology, physics.

[76]  P. Voet,et al.  An evaluation of two techniques for beam intensity modulation in patients irradiated for stage III non-small cell lung cancer. , 2001, Lung cancer.

[77]  Jürgen Debus,et al.  Clinical results of retreatment of vertebral bone metastases by stereotactic conformal radiotherapy and intensity-modulated radiotherapy. , 2002, International journal of radiation oncology, biology, physics.

[78]  S. Webb,et al.  A systematic study of techniques for elective cervical nodal irradiation with anterior or opposed anterior and posterior beams. , 2003, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[79]  Yi-Jen Chen,et al.  Intensity-modulated radiotherapy for previously irradiated, recurrent head-and-neck cancer. , 2002, Medical Dosimetry.

[80]  S. Webb,et al.  Potential role of intensity-modulated radiotherapy in the treatment of tumors of the maxillary sinus. , 2001, International journal of radiation oncology, biology, physics.

[81]  A. Renshaw,et al.  Changing prostate-specific antigen outcome after surgery or radiotherapy for localized prostate cancer during the prostate-specific antigen era. , 2002, International journal of radiation oncology, biology, physics.

[82]  B J Mijnheer,et al.  Beam intensity modulation to reduce the field sizes for conformal irradiation of lung tumors: a dosimetric study. , 1999, International journal of radiation oncology, biology, physics.

[83]  A L Boyer,et al.  Modulated beam conformal therapy for head and neck tumors. , 1997, International journal of radiation oncology, biology, physics.

[84]  L Verhey,et al.  Static field intensity modulation to treat a dominant intra-prostatic lesion to 90 Gy compared to seven field 3-dimensional radiotherapy. , 1999, International journal of radiation oncology, biology, physics.

[85]  K. Forster,et al.  Intensity-modulated radiation therapy: a novel approach to the management of malignant pleural mesothelioma. , 2003, International journal of radiation oncology, biology, physics.

[86]  T L Phillips,et al.  Toxicity following high-dose three-dimensional conformal and intensity-modulated radiation therapy for clinically localized prostate cancer. , 2001, Urology.

[87]  T. Bortfeld,et al.  The role of proton therapy in the treatment of large irradiation volumes: a comparative planning study of pancreatic and biliary tumors. , 2000, International journal of radiation oncology, biology, physics.

[88]  Joseph Y Ting,et al.  Treatment of pancreatic cancer tumors with intensity-modulated radiation therapy (IMRT) using the volume at risk approach (VARA): employing dose-volume histogram (DVH) and normal tissue complication probability (NTCP) to evaluate small bowel toxicity. , 2002, Medical dosimetry : official journal of the American Association of Medical Dosimetrists.

[89]  John C Roeske,et al.  Impact of intensity-modulated radiotherapy on acute hematologic toxicity in women with gynecologic malignancies. , 2002, International journal of radiation oncology, biology, physics.

[90]  L. Milas,et al.  Initial Experience Combining Cyclooxygenase-2 Inhibition with Chemoradiation for Locally Advanced Pancreatic Cancer , 2003, American journal of clinical oncology.

[91]  T LoSasso,et al.  Treatment planning and delivery of intensity-modulated radiation therapy for primary nasopharynx cancer. , 2001, International journal of radiation oncology, biology, physics.

[92]  A. Gustafsson,et al.  Partially wedged beams improve radiotherapy treatment of urinary bladder cancer. , 2001, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[93]  Lambert Zijp,et al.  Reduction of cardiac and lung complication probabilities after breast irradiation using conformal radiotherapy with or without intensity modulation. , 2002, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[94]  W. De Gersem,et al.  Postoperative radiotherapy of paranasal sinus tumours: a challenge for intensity modulated radiotherapy. , 1999, Acta oto-rhino-laryngologica Belgica.

[95]  G J Kutcher,et al.  Intensity-modulated tangential beam irradiation of the intact breast. , 1999, International journal of radiation oncology, biology, physics.

[96]  K. Herfarth,et al.  Intensity-Modulated Radiotherapy of Sacral Chordoma , 2002, Acta oncologica.

[97]  W. Grant,et al.  Intensity-Modulated Radiotherapy: First Results with this New Technology on Neoplasms of the Head and Neck , 1999, Ear, nose, & throat journal.

[98]  K. Zedeler,et al.  Evaluation of radiotherapy in high-risk breast cancer patients: report from the Danish Breast Cancer Cooperative Group (DBCG 82) Trial. , 1990, International journal of radiation oncology, biology, physics.

[99]  T. Kawata,et al.  Late retinal complications of radiation therapy for nasal and paranasal malignancies: relationship between irradiated-dose area and severity. , 1999, International journal of radiation oncology, biology, physics.

[100]  R. Cameron,et al.  Radical pleurectomy/decortication and intraoperative radiotherapy followed by conformal radiation with or without chemotherapy for malignant pleural mesothelioma. , 2001, The Journal of thoracic and cardiovascular surgery.

[101]  P. Levendag,et al.  High-dose, high-precision treatment options for boosting cancer of the nasopharynx. , 2002, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[102]  J. G. Li,et al.  Breast-conserving radiation therapy using combined electron and intensity-modulated radiotherapy technique. , 2000, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[103]  B. Rhein,et al.  Intensity modulated radiotherapy (IMRT) for recurrent, residual, or untreated skull-base meningiomas: preliminary clinical experience. , 2003, International journal of radiation oncology, biology, physics.

[104]  John C Roeske,et al.  Intensity-modulated whole pelvic radiotherapy in women with gynecologic malignancies. , 2002, International journal of radiation oncology, biology, physics.

[105]  W. De Gersem,et al.  Radiotherapy of prostate cancer with or without intensity modulated beams: a planning comparison. , 2000, International journal of radiation oncology, biology, physics.

[106]  N. Le,et al.  Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. , 1997, The New England journal of medicine.

[107]  W. De Gersem,et al.  Clinical delivery of intensity modulated conformal radiotherapy for relapsed or second-primary head and neck cancer using a multileaf collimator with dynamic control. , 1999, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[108]  P. Xia,et al.  Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. , 2001, International journal of radiation oncology, biology, physics.

[109]  M. Oldham,et al.  Comparison of intensity-modulated tomotherapy with stereotactically guided conformal radiotherapy for brain tumors. , 1999, International journal of radiation oncology, biology, physics.

[110]  P M Evans,et al.  Evaluation of compensation in breast radiotherapy: a planning study using multiple static fields. , 2000, International journal of radiation oncology, biology, physics.

[111]  J. Yarnold,et al.  Correlation of breast dose heterogeneity with breast size using 3D CT planning and dose-volume histograms , 1995 .

[112]  R. Dowsett,et al.  Treatment of Recurrent Malignant Gliomas With Stereotactic Intensity Modulated Radiation Therapy , 2002, American journal of clinical oncology.

[113]  A. Hounsell,et al.  Clinical implementation of dynamic multileaf collimation for compensated bladder treatments. , 2001, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[114]  K. Ang,et al.  Randomized phase I/II trial of two variants of accelerated fractionated radiotherapy regimens for advanced head and neck cancer: results of RTOG 88-09. , 1995, International journal of radiation oncology, biology, physics.

[115]  M. Urie,et al.  Intensity modulation for breast treatment using static multi-leaf collimators. , 2000, International journal of radiation oncology, biology, physics.

[116]  S. Marnitz,et al.  Intraindividual Comparison of Conventional Three-Dimensional Radiotherapy and Intensity Modulated Radiotherapy in the Therapy of Locally Advanced Non-Small Cell Lung Cancer , 2002, Strahlentherapie und Onkologie (Print).

[117]  S. Webb,et al.  Optimisation of radiotherapy for carcinoma of the parotid gland: a comparison of conventional, three-dimensional conformal, and intensity-modulated techniques. , 2001, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[118]  W. Grant,et al.  Intensity modulated conformal therapy for intracranial lesions. , 1998, Medical dosimetry : official journal of the American Association of Medical Dosimetrists.

[119]  B. Salter,et al.  Fractionated stereotactic intensity-modulated radiotherapy (FS-IMRT) for small acoustic neuromas. , 2002, Medical dosimetry : official journal of the American Association of Medical Dosimetrists.

[120]  Benedick A Fraass,et al.  Potential gains for irradiation of chest wall and regional nodes with intensity modulated radiotherapy. , 2003, International journal of radiation oncology, biology, physics.

[121]  M. Martel,et al.  Comprehensive irradiation of head and neck cancer using conformal multisegmental fields: assessment of target coverage and noninvolved tissue sparing. , 1998, International journal of radiation oncology, biology, physics.

[122]  C. Reddy,et al.  Short-course intensity-modulated radiotherapy (70 GY at 2.5 GY per fraction) for localized prostate cancer: preliminary results on late toxicity and quality of life. , 2001, International journal of radiation oncology, biology, physics.

[123]  W P Mayles,et al.  Design of compensators for breast radiotherapy using electronic portal imaging. , 1995, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.