Is 60 Gy in 40 fractions BID an appropriate regimen to use for LS-SCLC now?

So as to answer the question and not to bury the lede: IMHO, yes.

Here's an XRT-style-vs-XRT-style trial showing a survival advantage. How rare is that in radiation oncology? There are probably less than 10 such trials in medical history (wild guess). I can't recall the last time that outright pure d...

The reported results are very interesting and potentially practice changing. The 45 Gy BID was developed in 1983, doubted since then but undefeated in large prospective trials, including the RTOG/CALGB trial presented at ASCO. Its 5-week arm with partial 1.8 BID for part was dropped. Four weeks BID ...

My initial concern when this study was initially presented was the presence of an OS benefit with what seemed like no signal of PFS benefit.

In the full publication, while the PFS benefit is not statistically significant, there is some separation of curves after the first 6 months, although the p-val...

We now have two randomised studies (CONVERT and CALGB study) showing that a higher dose (66-70 Gy QD conventional fractionation) is not superior to 45 Gy BID. Usually, the decision to give QD vs BID treatment comes down to patient convenience. If a patient does not want to come BID then I recommend ...

The paper was finally published. It is still very surprising to have the dose go up by 33%, yet toxicity doesn't change. We know that when we went from 45/25 qD to 45/30 BID, the acute esophagitis increased significantly. Now, we are going up to 60 Gy/40 BID, and no difference. In addition, neither ...

The THORA trial results are certainly intriguing, but worthy of yet additional investigation and corroboration. In addition to previous comments about the OS benefit seen without a concomitant LC, PFS, or MFS benefit, there are a couple of other criticisms that have been leveled against this study t...

Would not do until it becomes standard of care, WITH appropriately approved constraints and adequate follow-up data.

How does the updated paper influence you all with HD BID treatment? What about incorporating consolidation immuno, like ADRIATIC?

Grønberg et al., PMID 40258573