[Skip to Navigation]
Sign In
Comment & Response
January 13, 2022

Hypofractionated Radiotherapy for Locally Advanced Non–Small Cell Lung Cancer—Does Size Matter?—Reply

Author Affiliations
  • 1Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
JAMA Oncol. 2022;8(3):481. doi:10.1001/jamaoncol.2021.7160

In Reply We thank Ohri and Werner-Wasik for their thoughtful comments and questions on our randomized clinical trial.1 Stepwise Cox regression analysis with logarithmic transformation of disease volumes and grouped diseases revealed the same significant variables as in our previous analysis. We did not identify any significant interaction between radiotherapy schedule and gross tumor volume, planning target volume, T stage, or N stage to explain the lack of association between disease volume and overall survival in our patient population.1 The discrepancy between our data and the findings of previous works may represent a differing disease burden compared with the Radiation Therapy Oncology Group (RTOG) 93-11 trial (which had a large proportion of patients with node-negative2 and stage I disease3) and lower performance status and ineligibility for the concurrent chemoradiation treatment of the ACRIN 6668/RTOG 0235 trial.4 In view of the association of esophageal biologically effective dose with worsened overall survival, a possibility is that, for patients with node-positive disease ineligible for concurrent chemotherapy, hypofractionated radiation to the mediastinum may be best limited to a more conservative total dose, while treatment intensification is reserved for the primary tumor. If so, ongoing trials of stereotactic body radiotherapy boost only to primary tumor in patients with stage III disease may help guide further treatment strategies for this frail patient population.

Add or change institution