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analysis at 11 months median follow-up and including 213 patients in the 60 Gy arm
and 204 having received 74 Gy, the high-dose arm had a worse OS (20.7 months vs.
21.7 months, p = 0.02) and was closed. However, dose escalation can also be achieved
by increasing biological intensification, rather than by adding fractions and thus
increasing the overall treatment time. Most ongoing clinical trials on radiation dose
intensification thus use individualised, accelerated iso-toxic radiotherapy (INDAR),
based on organ at risk (OAR) constraints as their backbone. Obviously, much more
knowledge needs to be obtained on the complex interactions between systemic
treatments and radiotherapy and their effects on malignant tissues and OARs. RTOG
0617 nevertheless illustrates that with current standard radiotherapy doses and
Annals of Oncology
fractionation, when delivered in well selected patients and when the whole treatment
chain is of high quality, much better long-term survival can be achieved than in
historical series. In view of the preliminary data of RTOG 0617 and ongoing dose
intensification trials, radiation dose intensification is certainly not obsolete. For
standard practice, current protocols and guidelines should not be changed but
emphasis on quality assessment and if needed adjustment of the entire diagnostic,
treatment and supportive care process should be the main goal.
Disclosure: The author has declared no conflicts of interest.
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