A new study from The University of Texas MD Anderson Cancer Center advocates for the use of intensity-modulated radiotherapy (IMRT) over 3D-conformal radiotherapy (3D-CRT) in treating unresectable, locally advanced non-small cell lung cancer (NSCLC). Published in JAMA Oncology, the study reveals that IMRT leads to fewer severe side effects, such as pneumonitis, while delivering similar survival outcomes compared to 3D-CRT. This finding is based on a secondary analysis of long-term data from 483 patients enrolled in the Phase III NRG Oncology-RTOG 0617 trial.

The research highlights the technological advancements in IMRT, which unlike the older 3D-CRT that uses straight radiation beams, employs complex computational methods to modulate radiation beams, allowing for a more precise targeting of tumors and sparing of normal tissue. Despite concerns about the long-term effects of low-dose radiation exposure from IMRT, the study confirms that this does not lead to increased secondary cancers or toxicity over time. This makes IMRT a preferable choice in the management of NSCLC, noted for its precision over the rudimentary 3D-CRT, which has been in use for over 50 years.

Statistical analysis of the study data shows that patients treated with IMRT had slightly better, though not statistically significant, five-year overall and progression-free survival rates compared to those treated with 3D-CRT. Even patients with larger or unfavorably located tumors near the heart showed improved outcomes with IMRT. The study emphasizes the need to minimize cardiac exposure during radiation planning, linking lower heart exposure to better median survival rates.

Endorsed by lead author Stephen Chun, the study supports a shift towards prioritizing IMRT in lung cancer treatment, similar to its adoption in other cancers like prostate and brain tumors. This shift reflects a broader move towards maximizing treatment precision to improve patient outcomes while reducing side effects. The research was supported by the National Institutes of Health and other organizations, reinforcing its findings within the oncological community.

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