Intensity modulated radiotherapy (lMRT) the white, black and grey: a clinical perspective

The radiotherapy community has in the past few decades witnessed dramatic shift in the treatment modalities from conventional 2-D radiotherapy to the now widely practiced 3-DCRT, IMRT and evolving IGRT. IMRT has generated so much interest because of its unique dosimetric modulation to concentrate doses to the targets of interests while also being able to relatively spare neighboring normal tissue. However IMRT is not the all in one solution for radiotherapeutic management of solid malignancies. The current enthusiasm in IMRT most be tempered with an understanding of the complexities of IMRT planning, treatment delivery, quality assurance, monitoring and clinical limitations. The widespread implementation of this technological innovation may have been a bit premature considering that clinical information regarding the same is still being generated. This article tries to give an overview of the potential advantages/disadvantages of IMRT in the clinical set up and the few controversies (Grey Zone) that are still being resolved. There is evidence to indicate that indiscriminately used IMRT may even harm the patient or have an inferior therapeutic index to 3DCRT. This and other pertinent issues will be covered by the authors in this short review of IMRT in clinical practice.