• Analysis of radiation dosing regimens in Phase III RTOG-0617 trial
• 74 Gy led to a 56% higher risk of death than 60 Gy along with greater risk of progression and local recurrence

This is but the first chapter in what is likely to be a gradual unveiling of findings from this major trial evaluating the role of high-dose radiation therapy (RT) at 74 Gy compared to standard dose (60 Gy) both combined with chemotherapy (carboplatin/paclitaxel) for patients with locally advanced NSCLC. This study also attempted to address the role of concurrent cetuximab, but those data are not yet mature and this report focused solely on RT. The findings presented at ASCO are not only important but also somewhat surprising and disturbing because the higher-dose RT arm was clearly inferior in terms of survival (HR 1.56), progression-free survival (HR = 1.3) and local control (HR = 1.37). A potential explanation, at least in part, for these somewhat unprecedented outcomes is underlying radiation toxicity — particularly occult cardiopulmonary complications — and it will be interesting to see how cetuximab changes the equation, if at all, as the data evolve. Regardless, the key take-away from this study is that standard-dose RT should be administered with concurrent chemotherapy.