BlueCross BlueShield of Tennessee Medical Policy Manual

Intensity-Modulated Radiotherapy (IMRT) of the Breast and Lung


Intensity-modulated radiotherapy (IMRT) allows adequate dosing to the tumor while minimizing the radiation dose to surrounding normal tissues and critical structures, especially the heart in left-sided breast cancer. IMRT, which uses CT images and magnetic resonance imaging (MRI), offers better conformality than 3-dimensional conformal radiation therapy (3D-CRT), as it is able to modulate the intensity of the overlapping radiation beams projected on the target. The radiation oncologist delineates the target on each slice of a CT scan and specifies the target’s prescribed radiation dose, adjacent normal tissue volumes to avoid, and acceptable dose limits within the normal tissues. Based on these parameters and a digitally reconstructed radiographic image of the tumor and surrounding tissues and organs at risk, computer software optimizes the location, shape and intensities of the beams to achieve the treatment plan’s goals. Increased conformality may permit escalated tumor doses without increasing normal tissue toxicity and thus may improve local tumor control with decreased exposure to surrounding normal tissues, potentially reducing acute and late radiation toxicities. Better dose homogeneity within the target may also improve local tumor control by avoiding underdosing within the tumor and may decrease toxicity by avoiding overdosing.

BCBST uses MCG Care Guidelines for all other uses of IMRT - Intensity Modulated Radiation Therapy (IMRT) ACG: A-0455)





Studies on IMRT for partial-breast irradiation are limited and have not demonstrated improvements in health outcomes. No studies have reported on health outcomes after IMRT for chest wall irradiation in post-mastectomy cases. 


BlueCross BlueShield Association. Evidence Positioning System. (8:2020). Intensity-modulated radiotherapy of the breast and lung. (8.01.46). Retrieved December 10, 2020 from (30 articles and/or guidelines reviewed)

Livi, L., Meattini, I., Marrazzo, L., Simontacchi, G., Pallotta, S., Saieva, C., et al. (2015). Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. European Journal of Cancer, 51 (4), 451-463. Abstract retrieved June 27, 2016 from PubMed database.

National Comprehensive Cancer Network. (2020, August). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Small cell lung cancer. V1.2021. Retrieved December 10, 2020 from the National Comprehensive Cancer Network.

National Comprehensive Cancer Network. (2020, November). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Non-small cell lung cancer.V1.2021. Retrieved December 10, 2020 from the National Comprehensive Cancer Network.

National Comprehensive Cancer Network. (2020, September). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Breast cancer.V6.2020. Retrieved December 10, 2020 from the National Comprehensive Cancer Network.

Winifred S. Hayes, Inc. Medical Technology Directory. (2018, October; last search updated January 2020). Accelerated partial breast irradiation for breast cancer using conformal and intensity-modulated radiation therapy.  Retrieved February 19, 2020 from (50 articles and/or guidelines reviewed)




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