[3D-CRT and intensity modulated radiation therapy (IMRT)].

Three-dimensional conformal radiation therapy (3D-CRT) conforms a high dose region closer to the target volume than does 2D radiation therapy. IMRT is the advanced form of 3D-CRT. With IMRT technique, using multiple intensity modulated beams, one can deliver a high dose of radiation to the target and a low dose to the surrounding normal structures. IMRT planning provides improved tumor target coverage when compared to 3D-CRT treatment planning. There is significant sparing of critical structures and other normal tissues. IMRT also produces dose distributions capable of delivering different dose prescriptions to multiple targets, providing a new opportunity for differential dose painting to increase the dose selectively to specific image-defined regions. Preliminary findings indicate that IMRT is a new clinically feasible tool in radiation oncology. The initial results of clinical studies demonstrate reduced xerostomia in head and neck cancer and also effectively reduced acute and late occurring toxicities, improving the QOL of patients treated for prostate cancer. According to these studies, IMRT will allow dose escalation, leading to better tumor control without normal tissue damage. On the other hand, there are some problems for IMRT in Japan: There are few medical physicists, which results in radiation technologists playing most clinical technological roles, including some dosimetrical and physical activities. Social recognition and economical and legal support for medical physicists should be established in providing better patient care services.