Intensity-modulated radiation therapy in the treatment of children

Intensity-modulated radiation therapy (IMRT) is a relatively new method of conformal radiotherapy delivery that is rapidly being incorporated in clinical practice. Of all patients treated with conformal techniques, children are the most likely to benefit as normal, developing structures can be minimized in the radiation field. The advantages of IMRT, including increased conformality and possible dose escalation, are discussed in this review. Possible disadvantages of IMRT in children are also discussed, such as lack of dose homogeneity in the target volume, increased dose to nontarget tissues, reliability of treatment setup, increased anesthesia time in younger children, and prolonged treatment planning. The issue of increased risk of second malignancy in this very young population is important, as many of these children will be long-term survivors with current multimodality therapy.