Radiation oncology update.

Recent technological developments in radiation oncology, enabled by high-speed computers, are allowing better target localization, faster throughput and more confined treatment delivery. Although available in only certain locations and beneficial for only selected cases, Intensity Modulated Radiation Therapy (IMRT) and Stereotactic Radiosurgery (SRS) represent exciting and revolutionary techniques of providing more concise doses of radiation to specifically targeted volumes while minimizing radiation to surrounding non-target tissues. IMRT and SRS, therefore, theoretically can improve control rates while lowering toxicity of radiation treatment. While the technology is less expensive and less logistically challenging than machines for neutron and proton delivery, increased time for treatment planning and quality assurance, financial feasibility and cost-effectiveness remain significant issues and have therefore limited more widespread application. Research continues on the use of chemotherapy and biologic modifiers to alter cell sensitivity to radiation, decrease side effects, and improve the therapeutic ratio. Potential applications are expanding for use of brachytherapy to prevent restenosis and in the treatment of brain, breast, and prostate neoplasms, but are presently limited by lack of mature studies and reimbursement issues. Due to the high costs of radiotherapy technology acquisition and equipment maintenance, increasing staff salaries and tenuous reimbursement environment, care should be taken to avoid unnecessary duplication of services in the community