Does more aggressive therapy improve outcomes in the treatment of unresectable stage III non-small cell lung cancer?

Concurrent chemotherapy combined with radiation therapy currently offers the best treatment strategy in stage IIIA/IIIB non-small cell lung cancer. However, inadequate radiation dose may be a contributing factor in the resultant lack of adequate control of local disease. Hypothetically, radiation doses that are higher than "standard" (eg, 60 Gy) might increase patient morbidity without improving cure rates, and data from a University of North Carolina phase I/II trial suggested that at least 74 Gy can be given safely to patients receiving cytotoxic chemotherapy, with a trend toward improved survival. Also, clinical data indicate that the cytoprotective agent amifostine (Ethyol; MedImmune Inc, Gaithersburg, MD) can be used to reduce esophagitis (and possibly pneumonitis) in patients treated with conventional radiation doses. Finally, a phase III clinical trial is proposed to: (1) test the hypothesis that higher radiation doses lead to a survival advantage in non-small cell lung cancer patients; and (2) discern the value of amifostine as a cytoprotective agent in the high-radiation dose range.