Evidence or Excess-based? Intensity Modulated Radiation Therapy Utilization among Elderly Patients in the United States

Abstract

Intensity modulated radiation therapy (IMRT) is a radiation therapy (RT) modality that improves dose conformality compared with conventional external beam RT and is now used in the treatment of approximately 40% of patients. 1 Although there is a well-documented improved side effect profile in using IMRT to treat both prostate and head and neck cancers,2,3 the benefits of routine IMRT in other disease sites are less established. Moreover, there are some disadvantages to ubiquitous IMRT utilization, including a relatively high price,4 the potential for near misses, and a large volume of low-dose normal tissue exposure with emerging implications such of beam path toxicity and second malignancies.5,6 The Medicare Physician and Other Supplier Public Use File (POSPUF) was first created in 2014 by the Centers for Medicare and Medicaid Services (CMS) and contains data on services rendered by physicians to Medicare beneficiaries in the United States. In this study, we used the POSPUF to analyze the variability in IMRT use among radiation oncology providers.