{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T04:18:00Z","timestamp":1793765880130,"version":"4.6.1"},"reference-count":12,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>The optimal radiotherapy technique for unresectable locally advanced non\u2013small cell lung cancer (NSCLC) is controversial, so evaluating long-term prospective outcomes of intensity-modulated radiotherapy (IMRT) is important.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare long-term prospective outcomes of patients receiving IMRT and 3-dimensional conformal radiotherapy (3D-CRT) with concurrent carboplatin\/paclitaxel for locally advanced NSCLC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>A secondary analysis of a prospective phase 3 randomized clinical trial NRG Oncology\u2013RTOG 0617 assessed 483 patients receiving chemoradiotherapy (3D-CRT vs IMRT) for locally advanced NSCLC based on stratification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Long-term outcomes were analyzed, including overall survival (OS), progression-free survival (PFS), time to local failure, development of second cancers, and severe grade 3 or higher adverse events (AEs) per Common Terminology Criteria for Adverse Events, version 3. The percentage of an organ volume (V) receiving a specified amount of radiation in units of Gy is reported as V(radiation dose).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 483 patients (median [IQR] age, 64 [57-70] years; 194 [40.2%] female), 228 (47.2%) received IMRT, and 255 (52.8%) received 3D-CRT (median [IQR] follow-up, 5.2 [4.8-6.0] years). IMRT was associated with a 2-fold reduction in grade 3 or higher pneumonitis AEs compared with 3D-CRT (8 [3.5%] vs 21 [8.2%]; <jats:italic>P<\/jats:italic>\u2009=\u2009.03). On univariate analysis, heart V20, V40, and V60 were associated with worse OS (hazard ratios, 1.06 [95% CI, 1.04-1.09]; 1.09 [95% CI, 1.05-1.13]; 1.16 [95% CI, 1.09-1.24], respectively; all <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). IMRT significantly reduced heart V40 compared to 3D-CRT (16.5% vs 20.5%; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). Heart V40 (&amp;amp;lt;20%) had better OS than V40 (\u226520%) (median [IQR], 2.5 [2.1-3.1] years vs 1.7 [1.5-2.0] years; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). On multivariable analysis, heart V40 (\u226520%), was associated with worse OS (hazard ratio, 1.34 [95% CI, 1.06-1.70]; <jats:italic>P<\/jats:italic>\u2009=\u2009.01), whereas lung V5 and age had no association with OS. Patients receiving IMRT and 3D-CRT had similar rates of developing secondary cancers (15 [6.6%] vs 14 [5.5%]) with long-term follow-up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>These findings support the standard use of IMRT for locally advanced NSCLC. IMRT should aim to minimize lung V20 and heart V20 to V60, rather than constraining low-dose radiation bath. Lung V5 and age were not associated with survival and should not be considered a contraindication for chemoradiotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/classic.clinicaltrials.gov\/ct2\/show\/NCT00533949\">NCT00533949<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoncol.2024.1841","type":"journal-article","created":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T17:35:14Z","timestamp":1719509714000},"page":"1111","source":"Crossref","is-referenced-by-count":45,"title":["Long-Term Prospective Outcomes of Intensity Modulated Radiotherapy for Locally Advanced Lung Cancer"],"prefix":"10.1001","volume":"10","author":[{"given":"Stephen G.","family":"Chun","sequence":"first","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center, 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