Correspondence

Time to escalate quality that simultaneous integrated boost Key Laboratory of Carcinogenesis and Translational
radiotherapy has a greater effect on Research (Ministry of Education/Beijing),
assurance in small-cell the oesophagus than on the lungs.
Department of Radiation Oncology, Peking
University Cancer Hospital & Institute, Beijing
lung cancer As of the follow-up period, 100142, China (JY, AS); Key Laboratory of

radiotherapy trials there were no cases of grades 3–5 Carcinogenesis and Translational Research (Ministry
of Education/Beijing), Department I of Thoracic
pulmonary fibrosis or oesophageal Oncology, Peking University Cancer Hospital and
Authors’ reply stricture, which we would continue to Institute, Beijing, China (JZ)
We thank Gerard M Walls and follow up. The discrepancy between 1 Yu J, Jiang L, Zhao L, et al. High-dose
colleagues for their interest in the high- this study and the CONVERT trial hyperfractionated simultaneous integrated
boost radiotherapy versus standard-dose
dose hyperfractionated simultaneous might be due to variations in the radiotherapy for limited-stage small-cell lung
integrated boost radiotherapy dose constraints for organs at risk.4 cancer in China: a multicentre, open-label, If you would like to respond to
randomised, phase 3 trial. Lancet Respir Med
study.1 Indeed, the 45 Gy twice-daily Regarding late toxicity of CONVERT 2024; 12: 799–809.
an article published in
The Lancet Respiratory Medicine,
thoracic radiotherapy group in our trial, four patients in the once-daily 2 Higgins K, Hu C, Ross HJ, et al. Concurrent please submit your
trial showed longer survival compared group developed grade 3 oesophageal chemoradiation ± atezolizumab (atezo) in correspondence online at:
limited-stage small cell lung cancer (LS-SCLC):
with previous studies, and some stricture or fistulation, compared results of NRG Oncology/Alliance LU005.
https://www.editorialmanager.
com/THELANCETRM
recently reported studies have similarly with no patients in the twice-daily Int J Radiat Oncol Biol Phys 2024;
120 (suppl): S2.
suggested longer survival (median group.5 The oesophageal maximum
3 Senan S, Spigel DR, Cho BC, et al. LBA81
overall survival 35·4–44·8 months) dose of the four patients range from durvalumab (D) as consolidation therapy in
for the twice-daily radiotherapy in the 56·1 Gy to 69·9 Gy in the CONVERT limited-stage SCLC (LS-SCLC): outcomes by
prior concurrent chemoradiotherapy (cCRT)
treatment of limited-stage small-cell trial, 5 which is higher than dose regimen and prophylactic cranial irradiation
lung cancer.2,3 In the era of advanced constraints for oesophageal in our (PCI) use in the ADRIATIC trial. Ann Oncol 2024;
35 (suppl 2): 1–72.
radiotherapy techniques, further trial (required to be less than 59·4 Gy,
4 Faivre-Finn C, Snee M, Ashcroft L, et al.
exploration is needed to determine preferably be less than 56·7 Gy).1 Concurrent once-daily versus twice-daily
whether hyperfractionated twice-daily In our trial, approximately 20% chemoradiotherapy in patients with limited-
stage small-cell lung cancer (CONVERT):
radiotherapy is more effective for of patients were never-smokers, an open-label, phase 3, randomised,
limited-stage small-cell lung cancer. which is similar with another phase superiority trial. Lancet Oncol 2017;
18: 1116–25.
Based on the spatial location III small-cell lung cancer trial in
5 Walls GM, Mistry H, Barlesi F, et al. Long-term
between tumour and organs at risk, China.6 A previous study reported the outcomes after concurrent once- or twice-
the process of dose minimisation, proportion of never-smokers with daily chemoradiation in limited-stage small
cell lung cancer: a brief report from the
and the setting of radiation field small-cell lung cancer in east Asian CONVERT trial. Int J Radiat Oncol Biol Phys
via volumetric-modulated arc patients seems to be higher than that 2024; 119: 1386–90.
radiotherapy, result in diversity in White patients.7 6 Wang J, Zhou C, Yao W, et al. Adebrelimab or
placebo plus carboplatin and etoposide as
of parameters for organs at risk. We agree that it is urgent to first-line treatment for extensive-stage small-
Due to the radiation dose drop of conduct trials of accelerated radiation cell lung cancer (CAPSTONE-1): a multicentre,
randomised, double-blind, placebo-controlled,
the planning target volume, the therapy with dose escalation, using phase 3 trial. Lancet Oncol 2022; 23: 739–47.
numerical effect of the planning modern technology and detailed 7 Zhou F, Zhou C. Lung cancer in never
target volume on organs at risk is quality assurance. We look forward smokers—the East Asian experience.
Transl Lung Cancer Res 2018; 7: 450–63.
greater than that of gross tumour to subgroup analysis of data in the 8 Cheng Y, Spigel DR, Cho BC, et al. Durvalumab
volume. Among the organs at risk, high-dose twice daily radiotherapy after chemoradiotherapy in limited-stage
small-cell lung cancer. N Engl J Med 2024;
simultaneous integrated boost combined with immunotherapy in 391: 1313–27.
radiotherapy would show a greater ADRIATIC trial (NCT03703297).8
effect on the oesophagus than on We declare no competing interests.
the lungs. When the dose of the
planning target volume is consistent,
Jiayi Yu, Jun Zhao, *Anhui Shi
anhuidoctor@163.com
the assessment of organ risk reveals

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