[Intensity modulated radiotherapy for head and neck cancers: ethics and patients selection]

Area of Science:

• Radiation Oncology
• Medical Physics
• Bioethics

Background:

• Intensity modulated radiotherapy (IMRT) offers superior target coverage and organ-at-risk sparing for head and neck cancers, potentially reducing toxicity.
• IMRT demands more resources than conformational radiotherapy, necessitating patient selection during shortages, which raises ethical concerns.
• Understanding the decision-making process for choosing radiotherapy techniques during resource limitations is crucial for ethical practice.

Purpose of the Study:

• To analyze the criteria used for selecting patients for IMRT versus conformational radiotherapy during a period of physicist shortage.
• To evaluate these choices against established bioethical principles.
• To propose a framework for patient selection in crisis situations.

Main Methods:

• Retrospective collection of patient data and the rationale for radiotherapy technique selection over one month.
• Analysis of treatment choices (IMRT vs. conformational radiotherapy) based on clinical factors.
• Ethical evaluation using Beauchamp and Childress principles (beneficence, non-maleficence, justice, autonomy).

Main Results:

• Nineteen patients received IMRT, while eight received conformational radiotherapy.
• Conformational radiotherapy was used for palliative, post-surgery, laryngeal, and re-irradiation cases to reduce treatment delays.
• IMRT was preferred for complex target volumes and sites at high risk of xerostomia; ethical analysis revealed challenges with justice (selection) and patient autonomy.

Conclusions:

• A hierarchical selection strategy for IMRT in resource-limited settings is proposed.
• Key criteria include proximity of complex volumes to critical organs, high xerostomia risk, patient life expectancy, and postoperative constraints.
• This framework aims to guide ethical decision-making in radiotherapy patient selection during shortages.