Dose Escalation Optimization in Patients With Locally Advanced Non–Small-Cell Lung Cancer: The Right Dose, in the Right Location, to the Right Patient, at the Right Time

Results from RTOG 0617, comparing conventionally fractionated 60 Gy vs 74 Gy with concurrent chemotherapy in patients with unresectable non–small-cell lung cancer (NSCLC), informed us that uniform dose escalation over the entire tumor volume in an unselected population to 74 Gy led to inferior survival compared with 60 Gy.¹ The exact cause of inferior survival in the higher-dose arm is unclear; however, local failure remains a considerable problem in radiation therapy (RT) for locally advanced NSCLC, with local failure rates of 31% to 39% at 2 years reported in RTOG 0617, consistent with other studies. Kong et al² attempt to address this problem with the phase 2 trial reported in this issue of JAMA Oncology.