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Computed tomography-based simulation for thoracic radiation therapy: technical advance or clinical evidence?

TO THE EDITOR: In a recent issue of the Journal, Chen et al 1 examined the benefit of computed tomography (CT) – based simulation for thoracic radiation therapy (TRT) among Medicare beneficiaries diagnosed with stage III non–small-cell lung cancer (NSCLC) between 2000 and 2005. By using the Surveillance, Epidemiology, and End Results–Medicare linked data, the authors concluded that CTbased simulation was associated with higher survival among patients with stage III NSCLC receiving TRT. 1 This high-quality study provides meaningful information and encourages continued innovation in the setting of TRT. However, more information regarding diseasefree progression would be useful to ensure that this benefit is attributable to TRT improvements through CT simulation. Because patients with CT were treated over a more recent time period than their counterparts treated with 2D techniques (74.5% treated between 2004 and 2005v 25.5%, respectively), a benefit in overall survival only could be attributed to confusing factors.