Dr Lee on the Role of IMRT in Locally Advanced NSCLC Management

“Our [radiation therapy] technique has evolved, and I would consider [IMRT] standard of care because we can spare more normal tissue and reduce [adverse] effects based on a better conformal radiation therapy plan.”

Percy Lee, MD, vice chair of Clinical Research in the Department of Radiation Oncology, medical director of Orange County & Coastal Region Radiation Oncology, and a professor in the Department of Radiation Oncology at City of Hope, discussed the evolution of radiation therapy techniques for patients with locally advanced non–small cell lung cancer (NSCLC).

Lee began by explaining that current technological advancements emphasize the importance of optimizing treatment delivery through improved dose conformity and crucial organ sparing in patients with NSCLC. He considers intensity modulated radiation therapy (IMRT) to be the standard of care in modern radiation oncology practice. The primary benefit of IMRT stems from the ability to create an improved conformal radiation therapy plan, which allows radiation oncologists to spare more normal tissue and consequently reduce adverse effects associated with treatment, according to Lee. By reducing the radiation delivered to critical healthy organs—such as the esophagus, heart, and lungs—IMRT ensures that patients can better tolerate the treatment, he said. This enhanced tolerance is vital, as it allows for the subsequent addition of systemic therapy, including both chemotherapy and immunotherapy, into the overall treatment regimen, he explained.

Although IMRT remains the standard for most patients, intensity modulated proton therapy (IMPT) offers potential advantages in selected patient populations, Lee noted. Proton therapy is capable of further reducing radiation doses to healthy tissue, including the lung, heart, and esophagus, he stated. Lee emphasized that the value of proton therapy is significant in specific-use cases. These include situations where there is a large tumor bulk and the team is attempting to deliver definitive therapy, or in instances where a second course of radiation is necessary in the same area, he reported. IMPT may be particularly beneficial for patients with poor pulmonary reserve, central tumors, or those with a history of prior thoracic radiation therapy, he concluded.