Advances in the planning and delivery of radiotherapy: new expectations, new standards of care.

The practice of radiation therapy continues to build on rapid advancements in treatment planning and delivery technology, which brings real potential for improving treatment outcomes. Manufacturers have employed advanced computer and imaging technology to produce treatment planning/delivery systems capable of precise shaping of dose distributions, conformal target volume coverage for even the most complex shapes and conformal avoidance of specified sensitive normal structures. However, these new systems have led to a more complex, less intuitive planning and treatment delivery process that presents great challenges for quality assurance/treatment verification. Advances in planning and delivery technologies will continue to occur at record paces, pushing the field toward even higher expectations for radiotherapy accuracy, reliability and applicability and leading the field to new standards of care. However, this optimism must be tempered with the realizations that for this to happen, progress is urgently needed in 3 areas, (1) accuracy in specification of gross tumor volume and clinical target volume, (2) radiation oncology informatics and (3) quality assurance, if we are to keep pace with these rapid planning and delivery developments.