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

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) certainly a surprise, with lots of valuable lessons. I was originally thinking that this trial would be a slam dunk showing the superiority of 74 Gy. When the first interim analysis was available, the data s...

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 benefit than what we could expect by changing non-targeted chemotherapy regimens as @Dr. First Last suggests. It matters what clinic door a patient walks into, probably for multiple reasons including ...

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 obvious that the dose must be increased since local control is 50% with 60 Gy (or lower if you believe the old Le Chevalier biopsy data) and the problems seen in 0617 were related to inexperience of cen...

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 was not radiotherapy, but what chemotherapy. RTOG 9410 took a long time from abstract to paper, and the simple question, sequential or concurrent was confounded by the odd arm of BID plus a different...

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 would be the issue of the immunological status of the patients.

So, Jeff, do you think is is feasible or worthwhile to see if there are any surrogate indicators, eg total lymphocyte counts, that could b...

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 magnitude of difference also seen when the total dose is 60Gy? An analysis of cetuximab use suggested it was associated with pneumonitis as well...is that variable controlled in the post hoc analyses? On...