Is heterogeneity in stage 3 non-small cell lung cancer obscuring the potential benefits of dose-escalated concurrent chemo-radiotherapy in clinical trials?

摘要: The current standard of care for the management inoperable stage 3 non-small cell lung cancer (NSCLC) is concurrent chemoradiotherapy (cCRT) using radiotherapy dose-fractionation and chemotherapy regimens that were established decades ago. In an attempt to improve chances long-term control from cCRT, dose-escalation dose was assessed in RTOG 0617 randomised study comparing 60 Gy 30 fractions with a high-dose arm receiving 74 37 fractions. Following publication this trial thoracic oncology community surprised learn there worse survival dose-escalated now must remain lower dose. article we review paper subsequent analyses studies explore why use cCRT NSCLC has not shown benefits expected. overarching theme opinion piece how heterogeneity between cases terms patient, tumour, clinical factors may obscure potential by causing imbalances arms such as 0617. We also examine recent advances staging, management, technological delivery these be employed optimise trials future ensure any can detected.