One of the major criticisms of the recently published trials of postoperative radiation (PORT) for lung cancer such as LungART is the vast majority of enrollees received 3D-conformal treatment. Maybe the excess cardiopulmonary toxicity wouldn’t have happened with more modern techniques such as intensity modulated radiation (IMRT)? Here is a pooled analysis of outcomes across 377 patients receiving PORT at 27 rad onc clinics in Michigan where two-thirds of patients had IMRT. It turns out, heart and lung dosimetry did not significantly differ by technique. Nor did it notably differ from that reported in LungART: the average mean heart dose was 10 and 13 Gy, respectively, and average mean lung dose 11 and 13 Gy. Granted, those plans were likely not generated with the same knowledge of lung and heart toxicity we have recently gained. Nevertheless, techniques and technology may be able to only do so much when treating disease in the mediastinum. | Herr, Pract Radiat Oncol 2023
