IRELAND Lung Cancer 10 Suppl. 10994) Sll-S13 Dose intensity in lung cancer treatment J. Cox, D. Ball, C. Belani, N. Choi, R. Gralla, J. Halle, R. Komaki, T. Le Chevalier, T. Ohnoshi, E. Quoix, P. Ruffik, E. Shaw, R. Souhami, A. Turrisi 1. Non-small cell carcinoma 1.1. Consensus The treatment approaches discussed were predicated upon patients with locally advanced, non-metastatic (Stage II and III) tumors for which survival, rather than just palliation, is the endpoint to be studied. The reasons for failure for both radiation therapy and chemotherapy are: (1) inherent cellular resistance; (2) acquired resistance; and/or (3) proliferation (possibly accelerated) during treat- ment. Until novel treatments appear, dose intensification with chemotherapy, radiation therapy, and the two modalities combined, is a key strategic element in clinical investigations. Radiation therapy has a dose response between 40 and 70 Gy. In patients treated with curative intent, total doses of 60 Gy and above should be administered to all gross tumors with fractions I 2.5 Gy (all doses expressed in this report are uncorrected for tissue inhomogeneities). If larger fractions are used (usually with palliative intent), total doses must be lower. A ‘shrinking field’ technique is appropriate with total doses of approximately 50 Gy to the primary tumor and regional lymph nodes and higher total doses to sites of gross tumors. Techniques should be used that avoid posterior spinal cord blocks which diminish the doses in the central mediastinum. Reactions from radiation therapy alone or with chemotherapy in tissues surrounding tumors prevent assessment of response, rendering complete response (CR) or partial response (PR) of very little meaning; in fact CR and PR may be misleading unless corroborated with bronchoscopy and biopsy. Chemotherapy has no regimen that can be considered established or ‘standard’. Response rates are higher in patients with locally advanced, rather than metastatic tumors. Platinum-based regimens are considered most appropriate to study in search of dose-response. There are no consistent data to establish that doses above those used with most conventional combination regimens are associated with higher response. The investigation of new drugs should include the study of 0169-5002/94/$07.00 0 1994 Elsevier Science Ireland Ltd. Ail rights reserved. SSDI 0169-5002(93)00259-C