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There does appear to be a local control advantage of 60 Gy > 74 Gy. I agree that this does not make logical sense on the face of it. There are alternative explanations aplenty:
1. Perhaps 74 Gy arms used more IMRT = tighter margins = more beams with greater tissue-air dose build up issues
2, More toxicity as alluded above. Perhaps due to high V5 lung.
3. Longer treatment planning process to meet dose constraints in 74 Gy arm and/or longer breaks due to toxicity breaks
In the end I agree that the final publication and not the abstract would be most enlightening.
QA is a thorny subject for trials of this size and magnitude. Ideally, it should be rigorous but keep in mind there is already stringent criteria just to enroll in RTOG, let alone perform IMRT in RTOG trials. Rapid review is best suited for Phase II single arm trials that are testing a novel concept (e.g. hippocampal sparing IMRT).
How you choose to interpret the data is up to you. However, unless you are a thoracic RO specialist you probably have no business escalating dose beyond 60 Gy under normal circumstances.
1. Perhaps 74 Gy arms used more IMRT = tighter margins = more beams with greater tissue-air dose build up issues
2, More toxicity as alluded above. Perhaps due to high V5 lung.
3. Longer treatment planning process to meet dose constraints in 74 Gy arm and/or longer breaks due to toxicity breaks
In the end I agree that the final publication and not the abstract would be most enlightening.
QA is a thorny subject for trials of this size and magnitude. Ideally, it should be rigorous but keep in mind there is already stringent criteria just to enroll in RTOG, let alone perform IMRT in RTOG trials. Rapid review is best suited for Phase II single arm trials that are testing a novel concept (e.g. hippocampal sparing IMRT).
How you choose to interpret the data is up to you. However, unless you are a thoracic RO specialist you probably have no business escalating dose beyond 60 Gy under normal circumstances.
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