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What is the standard RT dose in locally advanced NSCLC with concurrent chemotherapy?

Is it reasonable to dose escalate beyond 60 Gy if meeting all dosimetric criteria and with some room to spare? RTOG 0617 would suggest 60 Gy should be the standard dose for locally advanced NSCLC with concurrent chemotherapy but RTOG 1308 has both arms going to 70 Gy.
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What dose do you use for locally advanced NSCLC with concurrent chemotherapy?

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6 Answers
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Radiation Oncology · University of Pennsylvania Health System
Answered on

I have an opinion on this topic....several opinions actually! The paper is coming out soon. We included a tremendous amount of data. I hope you will read through it in your journal clubs. I agree with @Dr. First Last that the results of RTOG 0617 were a 'kick in the gut'. They were (and are) certain...

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Radiation Oncology · University of Pennsylvania Health System
Answered on

Re-reading the above commentary, I have updates to my prior comments. The manuscript on 'Experience matters...' has been published in preliminary form by the JNCI. It is worthy of thorough review and dialogue here. People may not like its message, but a 10% survival advantage is huge! It's a larger ...

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Radiation Oncology · Mayo Clinic
Answered on

This is either a difficult question, or very obvious (but with different conclusions) depending on who you ask. My medical oncologists are telling me that it's obvious that 60 Gy is the right dose given 0617, and no other dose is supportable at the moment. Some colleagues in Rad Onc say that it's ob...

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Radiation Oncology · Quillen VA Medical Center
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The complexity of RTOG 0617 confounds the simple question of dose. A decade earlier, we attempted to mount a "Carolina Consortium" trial of high dose versus low dose and met with barriers: 60 or 63 Gy; 1.8 v 2.0 per fraction, elective nodal irradiation or not, but arguably the most contentious issue...

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Radiation Oncology · University of Colorado School of Medicine
Answered on

This discussion has been excellent. Thanks to Jeff for leading this important trial and to Ken and Drew for thoughtful inputs.

I am obliged to ask Jeff if one of the trendiest potential explanations for the 0617 results is being explored in a secondary analysis or at least contemplated, and that wo...

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Radiation Oncology · Quillen VA Medical Center
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As the primary purpose of 0617 was to invetigate 74 Gy vs 60 Gy, and now the post hoc "secondary analyses" describe "a benefit" observed in reducing radiation pneumonitis from ~8% to ~ 4% when IMRT was used, is that observation for the entire study population? For those treated to 74 Gy? Is that mag...

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