Intensity-modulated radiation therapy use in the U.S, 2004

BACKGROUND. intensity-modulated radiation therapy (IMRT) is a novel approach to the planning and delivery of radiation therapy. The prevalence of IMRT use among radiation oncologists in the U.S. appears to be increasing, despite limited data evaluating its risks and benefits. METHODS. A random sample of radiation oncologists in the U.S., including a cohort of 441 physicians who were surveyed in 2002, was surveyed regarding IMRT use. IMRT users were questioned regarding their frequency of use, clinical applications, and reasons for adopting IMRT. IMRT nonusers were asked their reasons for not using IMRT, whether they planned to use it in the future, and reasons for wanting to adopt IMRT. Differences in responses between 2002 and 2004 were compared. RESULTS. The survey was conducted between July 1, 2004 and August 31, 2004. Of 368 evaluable participants, 239 physicians (64.9%) responded. The proportion of respondents who used IMRT was 73.2% (175 physicians), compared with 32.0% in 2002. The adoption rate of IMRT among nonusers from 2002 to 2004 was 62.7% (95% confidence interval, 51.9-73.5%). Many IMRT users (81.0%) had used IMRT to deliver higher than conventional doses of radiation, predominantly in patients with genitourinary and head and neck tumors. Major reasons cited for IMRT adoption were permitting normal tissue sparing (88.0%), dose escalation (85.1%), and economic competition (62.4%). Ninety-one percent of nonusers planned to adopt IMRT in the future. CONCLUSIONS. IMRT use among radiation oncologists in the U.S. has increased significantly since 2002. Standardized guidelines and careful, prospective analyses evaluating its risks and benefits are needed.