Rebuttal from Prof. Kong and Dr. Rabatic

Bryan M. Rabatic, Feng-Ming (Spring) Kong


We have the fortune of an eloquent consideration to the alternatives of concurrent chemoradiation offered by our esteemed colleague for patients diagnosed with stage III non-small cell lung cancer (NSCLC). Dr. Rodrigues rightfully clarifies the significant challenges of a concurrent treatment regimen in this very heterogeneous patient population. Understandably from his viewpoint, there exists low success of cure in the face of such advanced cancer. We concur that treating patients with significant morbidity may potentially increase treatment-related toxicities, and possibly, death. While toxicity seen with the use of concurrent chemotherapy for stage III NSCLC cancer can be an argument for avoiding a concurrent treatment paradigm, we must recognize that we do not have data which demonstrates mortality is significantly higher in patients treated with concurrent chemoradiation, compared to those treated with sequential chemoradiation or radical radiation therapy alone. Additionally, the negative result of poorer survival in high dose arm of RTOG 0617 cannot support the “Con” for concurrent chemoradiation, as the standard arm of concurrent chemoradiation had outstanding survival (1).