Intensity-modulated radiation therapy for gynecologic cancers: pitfalls, hazards, and cautions to be considered

Intensity Modulated Radiation Therapy (IMRT) is considered a major advance in radiaton therapy (RT) capability. Therefore, it has been rapidly accepted and implemented in the treatment of multiple cancers in which RT plays a major role. Early reports of IMRT in gynecologic cancers have been largely favorable, particularly in terms of decreased acute morbidity. However, IMRT has not been prospectively shown to be superior to conventional 3-dimensional RT techniques when judged against criteria established in advance. Furthermore, there are many reasons to consider the possibility that outcomes might be compromised by IMRT techniques used to treat gynecologic cancers. This article reviews the potential pitfalls and hazards of IMRT techniques on patient safety and treatment efficacy. In addition, the article describes multiple technical issues with IMRT implementation, arguing for caution in IMRT use.