Arc IMRT for head and neck cancer

Radiotherapy plays an integral role in the treatment of early and locally advanced stage head and neck cancers (HNC). Due to the anatomical location of these tumours and the close proximity to critical structures, the challenge at this tumour site is achieving local control while sparing the organs at risk (OAR), including the spinal cord, brainstem, optic structures, parotid glands, etc.

Advances in radiotherapy in the last two decades have led to progressively more sophisticated methods for delivering treatment. A major improvement in radiation delivery techniques came with the introduction of intensity modulated radiotherapy (IMRT). This technique, introduced in the late 1990s, uses multileaf collimators (MLC) to vary the shape and intensity (dose) of radiation across each single beam. The combination of several fixed beams (5-9 most frequently) allows a high dose to be conformed to the target volume, but with improved sparing of the OARs and therefore a reduction in the toxicity from the treatment. In the UK, a randomised control trial or 3D-RT vs IMRT in head and neck cancer (PARSPORT) showed a significant reduction in xerostomia (dry mouth) in patients treated
with IMRT.

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