Evidence behind use of intensity-modulated radiotherapy: a systematic review of comparative clinical studies

Lancet Oncol. 2008 Apr;9(4):367-75. doi: 10.1016/S1470-2045(08)70098-6.


Since its introduction more than a decade ago, intensity-modulated radiotherapy (IMRT) has spread to most radiotherapy departments worldwide for a wide range of indications. The technique has been rapidly implemented, despite an incomplete understanding of its advantages and weaknesses, the challenges of IMRT planning, delivery, and quality assurance, and the substantially increased cost compared with non-IMRT. Many publications discuss the theoretical advantages of IMRT dose distributions. However, the key question is whether the use of IMRT can be exploited to obtain a clinically relevant advantage over non-modulated external-beam radiation techniques. To investigate which level of evidence supports the routine use of IMRT for various disease sites, we did a review of clinical studies that reported on overall survival, disease-specific survival, quality of life, treatment-induced toxicity, or surrogate endpoints. This review shows evidence of reduced toxicity for various tumour sites by use of IMRT. The findings regarding local control and overall survival are generally inconclusive.

Publication types

  • Comparative Study
  • Review
  • Systematic Review

MeSH terms

  • Dose-Response Relationship, Radiation
  • Evidence-Based Medicine
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Neoplasms / mortality*
  • Neoplasms / pathology
  • Neoplasms / radiotherapy*
  • Radiation Injuries / epidemiology
  • Radiation Injuries / prevention & control*
  • Radiotherapy Dosage
  • Radiotherapy Planning, Computer-Assisted*
  • Radiotherapy, Conformal / adverse effects
  • Radiotherapy, Conformal / methods
  • Radiotherapy, Intensity-Modulated / adverse effects
  • Radiotherapy, Intensity-Modulated / methods*
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Survival Analysis
  • Treatment Outcome