Authors' objectives:

The report aims to: a) analyse the scientific evidence on intensity modulated radiotherapy (IMRT), in terms of effectiveness and security, in comparison with the treatments of conformed radiotherapy. b) Obtain information on the resources needed to carry out the technique, materials as humans and to carry out an approach to the standardization of the technique.

Authors' results and conclusions: In the systematic revision that forms part of, four articles have been included. Three studies analyzed the therapeutic results of IMRT relation to conformed radiotherapy on the treatment of localized prostate cancer, and one of oropharyngeal cancer. All are retrospective. Studies only two of the articles give results of effectiveness. In prostate cancer, Kupelian et al find a statistically significant difference amongst the two techniques in the results related with the quality of life in relation to sexual donain (measured with the questionnaire of quality of life EPIC), finding better results in those patients treated with IMRT and don't observe significant differences amongst the two techniques in the biochemical relapse-free survival. In the treatment of the oropharyngeal cancer, Chao et al the, find significant differences in the disease-free survival and in the global survival after two years of treatment, observing the best results in the group tried with IMRT. In the three articles that make reference to the locatized prostate cancer, there were not statistically significant differences amongst the two techniques as for the urinary or genitourinary acute or late toxicity. Kupelian et al and Zelefsky et al find statistically significant differences between technique the two for acute rectal toxicity but present favorable results for patients IMRT in relation to the late rectal toxicity grade 2. In the study that includes diagnosed patients of oropharyngeal cancer, there are no apparent differences as for acute toxicity amongst the two techniques, however they were statistically significant differences in favor of IMRT for late toxicity at the salivary gland level. In relation to the situation of IMRT in our country, it is necessary point out that before the cumplimentati n of the first questionnaire (May 2004) 1.028 patients had been treated by this IMRT. Most of the Spanish centers have of planning 3D, lineal accelerator and TC-simulated and carry out segmental-IMRT. All the centers that respond to the questionnaire carry out a specific control of quality of IMRT. In the consent meeting an approach to the standardization of the technique was achieved for prostate and head and neck cancer (to see table-summary in following pages).

Authors' recommendations: The scientific evidence on the effectiveness and security of IMRT in comparison with the conformed radiotherapy is scarce and of low quality, which limits establishment of rigorous conclusions. Prospective comparative studies are necessary to value the effectiveness and cost-effectiveness of IMRT in comparison with conformed radiotherapy. In our country certain variability is observed in some practical aspects of IMRT. The follow-up of the recommendations settled down in this document, achieved by consentment of the professionals, will help in the establishment of a standardized clinical practice -assuring the quality- and a better evaluation of the results of the clinical intervention.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.sergas.es/MostrarContidos_N3_T02.aspx?IdPaxina=60063&uri=http://www.sergas.es/gal/Servicios/docs/AvaliacionTecnoloxias/IA2005_01%20IMRT.pdf&hifr=750&seccion=0

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Scientific Advice Unit, avalia-t; The Galician Health Knowledge Agency (ACIS)

Contact Address: Conselleria de Sanidade, Xunta de Galicia, San Lazaro s/n 15781 Santiago de Compostela, Spain. Tel: 34 981 541831; Fax: 34 981 542854;

Contact Name: avalia-t@sergas.es

Contact Email: avalia-t@sergas.es

Copyright: Galician Agency for Health Technology Assessment (AVALIA-T)