At a press conference held during the ASTRO Annual Meeting, ASTRO President-Elect Brian D.
Kavanagh, MD, MPH, FASTRO, interim Chair of Radiation Oncology at the University of Colorado, Anschutz Medical Campus, Denver, said, “This study provides an important lesson for the field. We are lucky to have a lot of good technology. We need to find out the best use of these technologies.”

He continued, “The study points out a need for careful attention to the dose of radiation to surrounding tissue. I do think this is a great illustration of how sophisticated technology can be implemented across the country in a broad range of practice environments.”

Convincing Data

Also commenting on this paper, Mark A. Hallman, MD, PhD, Assistant Professor of Radiation Oncology at Fox Chase Cancer Center, Philadelphia, said, “These data are convincing. Although we have dosimetric and retrospective studies in favor of [intensity-modulated radiotherapy], clinical data from this prospective trial (RTOG 0617) are very informative and highly supportive of [intensity-modulated radiotherapy] in this patient subset.”

A barrier to greater uptake of intensity-modulated radiotherapy has been lack of reimbursement. One argument was the uncertainty of the effects of the low-dose bath. “An important finding of this trial is that the low-dose bath did not increase pneumonitis and, in fact, [intensity-modulated radiotherapy] reduced the incidence of grade 3 or higher pneumonitis despite increased low-dose volumes,” Dr. Hallman said.

“The fact that the patients who received [intensity-modulated radiotherapy] in this trial had worse prognostic factors, including larger tumor volumes, supports an even more widespread role for [intensity-modulated radiotherapy] in treating large lung tumors,” Dr. Hallman continued.

“I hope these data will help convince physicians to utilize and insurance companies to reimburse for [intensity-modulated radiotherapy]. The reduced risk of pneumonitis would likely balance a significant portion of the increased cost…. This may result in lowering the overall long-term costs of care, including treatment and hospitalization required for management of severe pneumonitis,” he stated.   ■

Disclosure: Dr. Kavanagh reported no potential conflicts of interest. Dr. Hallman is on the scientific advisory board for New Century Health.