Matthew Hatton, MBChB, MSc, FRCP, FRCR

Invited discussant Matthew Hatton, MBChB, MSc, FRCP, FRCR, a consultant and Honorary Professor in Clinical Oncology at Weston Park Cancer Center, Sheffield, UK, pointed out that the original analysis of RTOG 0617 was disappointing and failed to find evidence that intensity-modulated radiation therapy (IMRT) was better than three-dimensional conformal radiotherapy (3D-CRT). The secondary analysis Dr. Chun presented showed that IMRT had a toxicity advantage over 3D-CRT.

Prof. Hatton said: “IMRT should be used standardly. We turned the page on 3D-CRT for other cancers such as head and neck and prostate and gynecologic cancers 20 years ago based on flimsy evidence. It is time for us to turn the page on 3D-CRT to IMRT for non–small cell lung cancer.”

“We should be much less willing to follow the tendency to adopt [newer techniques]. This study shows us there is a real place for randomized trials to move us forward,” he added.

Insurance Implications

In a separate interview, Charles Simone, MD, Research Professor and Chief Medical Officer of New York Proton Center and a radiation oncologist at Memorial Sloan Kettering Cancer Center, New York, was equally enthusiastic about the results of RTOG 0617, especially because he hopes they will convince more insurance companies to cover IMRT.

Charles Simone, MD

“Although IMRT is costlier to deliver than 3D-CRT, it reduces toxicities over the short and longer term. Pneumonitis and major cardiac events can require hospitalization. So, IMRT can be cost-effective in both the acute and late settings,” Dr. Simone noted.

“Reducing heart and lung toxicities is a win for our field. In many places, IMRT has already become standard care. The field is moving toward IMRT, especially for more advanced lung tumors. This secondary analysis shows that IMRT clearly reduces the dose of radiation to the heart and lungs. Radiation to the heart is correlated with overall survival, and pneumonitis can be dose-limiting and life-threatening,” he explained. 

DISCLOSURE: Prof. Hatton has served on the speakers bureau of AstraZeneca and Takeda and on the advisor board of Janssen and Varian. Dr. Simone reported no conflicts of interest.