During most of the last century, verification of patient position on the radiotherapy treatment table was considered adequate if exposed on a photographic film by a megavoltage beam. It was a general standard to expose such a film once a week, to be approved by a radiation oncologist. The latter approved it after comparison to a kilovoltage simulation film exposed at the time of initial setup of the patient before the treatment regimen started. A common rule was to allow a ± 70 years of age) and younger head and neck cancer groups both tolerated definitive chemo-IGRT, without difference in grade 3–4 toxicity, treatment breaks, and with less weight loss in the elderly group (2). Another study resulted in disease-specific survival of 75% at 4 years and acceptable toxicity (3). Elderly patients with multiple comorbidities and locally advanced rectal cancer tolerated preoperative chemo-IGRT when compared to younger patients (4). These preliminary studies suggest that IGRT may become the treatment of choice for elderly cancer patients. Another subset of patients who may benefit from IGRT is patients with human immunodeficiency virus (HIV) infection and anal cancer. They may have an increased sensitivity to radiation because of thiol deficiency (5). Grade 3–4 skin, hematologic and gastrointestinal toxicity were frequent among HIV positive patients undergoing standard chemoradiotherapy and may result in death (6, 7). Chemo-IGRT may therefore provide HIV patients the opportunity to be treated with less toxicity (8, 9). Finally, IGRT may allow for radiation dose escalation in cancers with high-risk for loco-regional recurrences. A recent randomized study reported a 2-year survival of 57 and 44% and local failure of 30 and 38% for locally advanced NSCLC treated to 60 and 74 Gy, respectively. The poor survival in the 74 Gy group may be associated with cardiac toxicity (10). A 3-year survival of 45% and local failure of 15% was reported for patients with locally advanced NSCLC treated to 70–75 Gy with chemo-IGRT, with minimal toxicity (11). Dose escalation was also feasible in patients with locally advanced esophageal cancer because of lung and cardiac sparing (12). These preliminary results are intriguing but need to be corroborated in future prospective studies.