A review of radiation dose escalation trials for non-small cell lung cancer within the Radiation Therapy Oncology Group

Chemotherapy and radiation therapy (RT) is the therapy of choice for patients with locally advanced, inoperable non-small cell lung cancer (with an expected 4-year survival rate of 21% for radiation doses to 60 Gy given with concurrent chemotherapy in patients with good performance status and minimal weight loss, as established by Radiation Therapy Oncology Group (RTOG) 9410. While a minimal tumor dose of 60 Gy has been considered "standard" for the past 30 years, this dose is insufficient to control local disease. For patients receiving RT alone or radiation following induction chemotherapy, data from RTOG 9311 established that doses of 83.8 Gy using 3-dimensional conformal RT techniques were tolerable, with excess mortality observed at 90.3 Gy. When concurrent chemotherapy and 3-dimensional conformal RT are used, the maximum tolerated dose of radiation is reduced, and current indications suggest that the maximum tolerated dose in this setting is in the range of 70 to 74 Gy.