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Intensity-Modulated Radiotherapy Recommended for Locally Advanced Lung Cancer

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Patients receiving IMRT and three-dimensional conformal radiotherapy appear to have similar rates of developing secondary cancer

By Elana Gotkine HealthDay Reporter

TUESDAY, July 9, 2024 (HealthDay News) — Intensity-modulated radiotherapy (IMRT) is recommended for locally advanced non-small cell lung cancer (NSCLC) and appears to have good long-term outcomes, according to a study published online June 27 in JAMA Oncology.

Stephen G. Chun, M.D., from The University of Texas MD Anderson Cancer Center in Houston, and colleagues compared long-term prospective outcomes of patients receiving IMRT and three-dimensional conformal radiotherapy (3D-CRT) with concurrent carboplatin/paclitaxel in a phase 3 randomized trial involving 483 patients with locally advanced NSCLC. Of the patients, 228 and 255 received IMRT and 3D-CRT, respectively. The percentage of an organ volume (V) receiving a specified dose of radiation in units of Gy was reported as V(radiation dose).

The researchers found that compared with 3D-CRT, IMRT was significantly associated with a twofold reduction in grade 3 or higher pneumonitis adverse events (3.5 versus 8.2 percent). Heart V20, V40, and V60 were associated with worse overall survival in a univariate analysis. Significantly reduced heart V40 was seen with IMRT versus 3D-CRT (16.5 versus 20.5 percent). Significantly better overall survival was seen with heart V40 (<20 percent) versus V40 (≥20 percent; median, 2.5 versus 1.7 years). Heart V40 (≥20 percent) was associated with worse overall survival in a multivariable analysis, while no association was seen for lung V5 and age. Similar rates of developing secondary cancers were seen for patients receiving IMRT and 3D-CRT.

“With a substantial number of patients reaching long-term survivorship for locally advanced lung cancer, cardiac exposure can no longer be an afterthought,” Chun said in a statement.

Several authors disclosed ties to the biopharmaceutical and publishing industries.

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