The return of the snake oil salesmen: the sequel.

I. ReferencesII. Copyright To the Editor: Prostate intensity modulated radiation therapy (IMRT) now reigns supreme, with >95% market penetration inUnited States (1) . The widespread adoption of prostate IMRT has occurred despite the “expensive” IMRT being only marginallybetter than conformal radiation therapy 1, 2. In prostate cancer, the dosimetric advantages of IMRT are at risk of beingsquandered by dose escalation, for which there has been no overall survival benefit despite long follow-up (3) .Glatstein deplored the “veritable stampede” for IMRT, and his clarion call for well-designed clinical trials to evaluate IMRT in2003 seems to have gone unheeded (4) . Intensity modulated radiation therapy is so embedded now that even in the publiclyfunded health care of the United Kingdom, institutions cannot afford “not to do” IMRT for prostate cancer.Furthermore, the clinical adoption of new technology continues unabated, free of the shackles of evidence-based medicine.Proton therapy has been implemented before accumulation of robust clinical evidence. Recent studies showing increasedtoxicity with proton therapy should make radiation oncologists pause for mature randomized data before embracing protontherapy 1, 2.Back to Article Outline