A Practical Guide to Intensity-Modulated Radiation Therapy

According to a Collaborative Working Group sponsored by the National Cancer Institute, "Intensity modulated radiotherapy (IMRT)...represents one of the most important technical advances in radiation therapy since the advent of the medical linear accelerators". In the last ten years, the clinicians and scientists at Memorial Sloan-Kettering Cancer Center have been fortunate to be involved in the development and implementation of this advanced form of radiotherapy. Indeed, it was in part serendipity that several key components of the IMRT process became available at MSKCC that permitted us to implement IMRT treatment with the use of dynamic multileaf collimation (DMLC) in 1995. Since then, we have amassed a body of technical and clinical experience in the use of this modality. This book is an attempt to provide an account of our perspective, methodology, and experience in the physical and medical aspects of IMRT. For the medical physicists, there are detailed discussions on the inverse method, the commissioning and acceptance testing of DMLC, dose calculation and independent monitor unit (MU) check. For the radiation oncologists and clinical physicists, the relevant material includes treatment planning, quality assurance protocols, disease-specific treatment procedures, and emerging clinical outcome data. In addition, advanced topics relevant to IMRT are addressed such as the estimation of tumor control and normal tissue complication probabilities, the quantification and minimization of treatment uncertainties, the use of respiration-controlled techniques, and the emerging importance of biological imaging. Given the enthusiasm for the potential benefits of this modality, we hope this book will be useful for our colleagues in the radiation oncology community interested in applying IMRT.