Stereotactic ablative radiotherapy with or without immunotherapy for early-stage or isolated lung parenchymal recurrent node-negative non-small-cell lung cancer: an open-label, randomised, phase 2 trial

Personalized Radiation Therapy—Spurning the “One Size Fits All” Approach

“…The use of simultaneous integrated boosting (SIB) to gross disease is also highly encouraged; with 10-fraction HART, delivering a SIB to 80 Gy is safe and effective (especially with modern treatment planning technology and daily volumetric image guidance). 6 Even in the most contemporary era, using histologic findings to make SABR dose/fractionation decisions is clearly underutilized. The Stanford trial did so only for lung metastases, but ever since the study completed enrollment, there have been numerous and mounting retrospective data corroborating that squamous cell carcinomas (SCCs) experience poorer LC and other time-to-event outcomes compared with adenocarcinomas.…”

“…In addition, for large tumors (undoubtedly underrepresented in RTOG 0813), the HART scheme of 70 Gy in 10 fractions (BED of 119 Gy 10 ) may represent a more appropriate BED. The use of simultaneous integrated boosting (SIB) to gross disease is also highly encouraged; with 10-fraction HART, delivering a SIB to 80 Gy is safe and effective (especially with modern treatment planning technology and daily volumetric image guidance) …”

“…The recent publication of the randomized I-SABR trial has many implications for personalization of lung SABR. Therein, although all patients were treated with BED escalation (BED of 112-119 Gy 10 , SIB in most patients with BED of 144-150 Gy 10 ), immunotherapy seemed to exert an additional local effect because the risk of local failure was reduced from 13% (SABR alone) to 0% (I-SABR).…”

Lost in the shadow of giants: The neglected treatment modalities in oncologic trials

“…The study had identified local therapy trials to more frequently use OS as their primary end point, which is harder to achieve than a surrogate end point like progression‐free survival (PFS). Although not all may agree, PFS may be a suitable end point for these investigations 19 ; it may also be beneficial for trials investigating altered sequence of systemic therapies where an equivalent OS is possible. Choosing OS as the end point for local therapy trials may result in more trials failing to achieve their primary end point and never be reported due to the known bias against reporting negative trials in the literature 17,20–23 .…”

“…-3357 be a suitable end point for these investigations 19 ; it may also be beneficial for trials investigating altered sequence of systemic therapies where an equivalent OS is possible. Choosing OS as the end point for local therapy trials may result in more trials failing to achieve their primary end point and never be reported due to the known bias against reporting negative trials in the literature.…”