Did dose escalated radiotherapy in stage III non-small cell lung cancer improve overall survival?

Lung cancer has been a leading cause for both male and female cancer patients worldwide (1,2). Unfortunately many of them would be diagnosed as advanced stage patients without the chance to be treated by surgery. Radiotherapy can be their alternative choice (3,4). In addition, radiotherapy has an important role in the palliation of metastatic non-small cell lung cancer (NSCLC) (5). In the 1980s, Perez launched a randomized controlled study (RTOG 7301) of various irradiation doses and fractionation schedules in the treatment of inoperable non-small-cell lung cancer. In this study, 60 Gy was firstly consolidated as an optimal dosage for radiotherapy which yielded higher tumor response, better survival and less intra thoracic recurrence than other less than 60 Gy groups (6). Since then, 60 Gy radiotherapy has been commonly accepted in treatment of advanced stage NSCLC patients. In the following clinical trial (7), concurrent radiochemotherapy has been confirmed to be beneficial for NSCLC patients. Some researchers believe that increased dosage may lead to better local control rate and longer overall survival (OS). However both acute and late toxicity results from high dosage may occur, which may hinder treatment plan and be life threatening sometimes. Therefore, several studies have been launched to explore its efficacy and its safety in clinical practice