Although the early toxicity findings of RTOG 0126 seem to favor IMRT over 3D-CRT, formal discussant of this trial, Juanita Crook, MD, FRCPC, of the British Columbia Cancer Agency, Kelowna, British Columbia, Canada, put the study’s findings in perspective. “Whether or not this is a significant finding depends on the importance of dose escalation,” she stated.

Dr. Crook added that although dose escalation is clearly desirable, IMRT may not be the most effective means of achieving this. Current trials are comparing the efficacy of IMRT to other means of dose escalation, such as brachytherapy boost using either LDR or HDR implants.

In addition, Dr. Crook addressed two other caveats about these preliminary toxicity findings. First, RTOG 0126 is not a randomized comparison, but rather, a planned stratification. “We often seem to embrace technology without level 1 evidence and then have to pursue the evidence after widespread adoption,” she declared. Second, the study was conducted largely in the era before image-guided radiation therapy. ■

Disclosure: Dr. Crook reported no potential conflicts of interest.