Patient outcome and standard of care

Since the introduction of IMRT to mainstream clinical practice in 2000, the field of radiation oncology has been very rapidly evolving.  Around that time, hundreds of clinical trials were launched to assess the benefits and appropriateness of new treatment technologies. These studies typically take 5-10 years of patient follow up to complete, and then, new trials are initiated based on the result.  So, the standard of care in radiation oncology has been drastically revised several times in the last 20 years.

Additionally, there are hundreds of different types of cancer which each demand a different approach.  This multiplies the obstacles for physicians in small to medium sized departments who cannot afford to specialize in one part of the body.

Basics of radiation treatment

To treat a patient, a physician must manually draw out radiation targets on scans of the individual patient. 

Before the advent of IMRT, a physician would commonly draw a few circles using a wax pencil on one or two plain film x-rays.  Today, physicians are using complex software packages to draw hundreds of circles on 30-100 CT and MR scans for each patient.  This represents a massive increase in the work required.

Before the advent of IMRT, there were only a few clinical criteria which had to be evaluated before treatment.  Today, some disease sites have over 20 different clinical criteria which all impact the hundreds of drawn areas targeted for radiation.

These significant increases in work and knowledge required present huge obstacles to providing standard of care treatment.

The value of protocol compliance

Treatment based upon the newest and best scientific data (known as protocol compliance) has been found to be the most important factor in patient outcome.  Some studies report that over 25% of patients treated have noncompliant plans (Lester J Peters, et al., Critical impact of radiotherapy protocol compliance and quality in the treatment of advanced head and neck cancer: results from TROG 02.02 – PubMed (

They also find that the patients with non-compliant plans were at much higher risk for tumor recurrence and significantly shorter survival.  However, balancing a heavy patient load and finding the time to constantly relearn the newest protocols is challenging for many clinical physicians.