intensity-modulated radiotherapy

Emotionally, a mess.

Um, but, uh, one thing I was grateful for in meeting Dr. McDonald when I didn't get approved for proton therapy, I ended up getting approved for what is called IMRT, um, form of radiation.

And it was-

Okay

When I started working at Chris O'Brien Lifehouse, which is where I still work.

As a staff specialist, we were doing a lot of hybrid IMRT treatments for our breast patients.

We then moved to full IMRT treatments and now VMAT has replaced that as our routine practice for breast radiation therapy.

And that's just one example.

I think some of the treatment paradigms in general oncology have also shifted considerably since I graduated as well.

The only one in São Paulo, uh, tomotherapy and one Cyber- CyberKnife.

Uh, about the techniques of treatment, uh, we use the same technique, uh, IMRT, VMAT, conformal therapy, um, uh, radiation, uh, hypersurgery if, um, frameless, uh, lung, uh, SBRT for lung cancer and liver.

Uh, it's very similar, uh, to US.

Okay.

Uh, but, uh, a couple years ago, uh, we have a partnership, uh, between, um, the, um, National Institute of Health from Brazil with, uh, Varian Technology, Varian Systems, and they, uh, bought about more than, uh, 100 machines, uh, with new technology.

For me, uh, especially, it's a challenging when you have a, a, a new technology, uh, but it's good because you always learning.

Uh, for example, in my case, I think the big challenge it was in 2001 when we, uh- We buy a new technology, IMRT.

In that time, uh, everyone have, uh, information about IMRT, and I remember for me it's a little bit different because we did a lot of, uh, conformal treatment planning, and IMRT is totally the opposite of, uh, conformal, uh, treatment planning.

Head and neck cancer surgery has advanced with less invasive surgeries and markedly improved reconstruction techniques.

Radiation precision has advanced with routine use of image-guided treatments, IMRT, and proton radiation for improved normal tissue sparing.

Even with respect to cisplatin delivery, identifying patients at high risk to develop chronic cisplatin toxicity has achieved much more sophisticated definition, along with global education of practitioners regarding recommendations for premedication, hydration, and patient monitoring to facilitate optimal safety and efficacy outcomes.

I think that's a really good point, that while we might look at a regimen on paper and say, "Well, this is still radiation and cisplatin," there are so many background changes that happen across months and years and even decades, as Steve pointed out, that really actually are making differences, but that will never perhaps be captured in a randomized trial.

And so trying to find workflows and then, uh, resource capability to be able to offer this, you know, pre-treatment and during treatment for head and neck cancer patients I think will be the, the, the main challenge really as well.

I think the ability to offer the treatment is really, um, already available nationwide with standard, um, IMRT or VMAT, uh, but it's really gonna be more so the, the nuclear medicine, I think, capability, um, to be able to offer this on a, on a wide scale for patients.

All right, I'm gonna bounce us to CPOST, which read out at ASCO last year.

Yeah, yeah.

Modern advanced cervical cancer treatment in Germany relies on highly developed diagnostic and therapeutic technologies.

From high-resolution MRI and PET/CT imaging used for precise staging to robotic surgery and image-guided radiotherapy techniques like IMRT, German hospitals apply tools that increase accuracy while reducing side effects.

These innovations are especially important in the treatment of advanced stage cervical cancer, where precision can directly impact survival and quality of life.

In top centers, advanced techniques are part of routine clinical practice, not experimental options.

Today's paper is by Nishant Chadha and colleagues from Memorial Sloan Kettering with Nancy Lee as the senior author, published in Oral Oncology in 2026.

It updates an earlier NCDB analysis from 2004 to 2012, now extending to 2021 into the IMRT era.

study design this is a retrospective ncdb cohort it included patients with non-metastatic adenoid cystic carcinoma of the major salivary glands who had definitive surgery from 5649 patients the final cohort was 2384 of these 1,776 or 74.5% had postoperative radiation and 608 or 25.5% had surgery alone.

Patients who died within six months were excluded to reduce the immortal time bias.

The radiation group had more PT3-T4 disease, 27.6% against 20.2%, and more positive margins, 45.9% against 28.3%.

The surgery alone group was older with a median age of 61 against 56.5 years.

IMRT use rose from 16.9% in 2004 to 64% in 2020.

Now let's look at the key results.

They're going to shrink it so that it is consistently every day you come in only getting the tumor.

And this is called IMRT, image modulated radiation therapy.

So in 2000, we get the PET CT scan.

The PET CT scan is amazing.