conventional radiotherapy in achieving local tumour control and survival in locally advanced NSCLC. This indirectly suggests the importance of cell repopulation as a cause of failure in the conventional radiotherapy of NSCLC. The reduction in the risk of metastasis confirms that improved local tumour control, even in lung cancer, can reduce the incidence of distant metastasis. This trial shows that local tumour control in NSCLC can lead to an improvement in long term survival. While the CHART regimen demonstrated superior outcome compared to conventional radiation alone, treating three times a day is logistically challenging, which prevents its wide implementation. Furthermore, the Radiation Therapy Oncology Group RTOG 0617 [2.3] investigated dose escalation, where 76 Gy was compared with 60 Gy once a day with concurrent and adjuvant chemotherapy. The preliminary data were presented at the 2011 ASTRO meeting and demonstrated worse outcomes with the dose escalation arm: 12 month overall survival of 74% versus 81% (p = 0.02) and median survival of 20.7 months versus 21.7 months, respectively [2.4]. A total of 610 patients were randomly assigned to two concurrent regimens and one sequential chemotherapy and thoracic radiotherapy regimen in a three arm phase III trial [2.5]. The sequential arm included cisplatin at 100 mg/m2 on days 1 and 29 and vinblastine at 5 mg/m2 per week for five weeks with 63 Gy of thoracic radiotherapy delivered as a once daily fraction beginning on day 50. Arm 2 used the same chemotherapy regimen as arm 1, with 63 Gy of thoracic radiotherapy delivered as a once daily fraction beginning on day 1. Arm 3 used cisplatin at 50 mg/m2 on days 1, 8, 29 and 36, with oral etoposide at 50 mg twice daily for ten weeks on days 1, 2, 5 and 6, with 69.6 Gy delivered as 1.2 Gy twice daily fractions beginning on day 1. The primary end point was overall survival. Median survival times were 14.6, 17.0 and 15.6 months for arms 1–3, respectively. Five year survival was statistically significantly higher for patients treated with the concurrent regimen with once daily thoracic radiotherapy compared with the sequential treatment. With a median follow-up time of 11 years, the rates of acute grades 3–5 non-haematological toxic effects were higher with concurrent than with sequential therapy, but late toxic effects were similar. 32 Concurrent delivery of cisplatin based chemotherapy with thoracic radiotherapy confers a long term survival benefit compared with the sequential delivery of these therapies. Radiation doses of 60–66 Gy given daily are considered the standard radiation approach at this time. While there are no phase III data supporting dose escalation, it is hoped that ongoing clinical trials investigating novel agents with new radiation techniques and doses will improve outcomes. 2.4. STOMACH CANCER Post-operative chemoradiotherapy following surgical resection of adenocarcinoma of the stomach is curative in less than 40% of cases [2.6]. This clinical trial investigated the effect of surgery plus post-operative (adjuvant) chemoradiotherapy on the survival of patients with resectable adenocarcinoma of the stomach or gastro-oesophageal junction. A total of 556 patients with resected adenocarcinoma of the stomach or gastro-oesophageal junction were randomly assigned to surgery plus post-operative chemoradiotherapy or surgery alone. The adjuvant treatment consisted of 425 mg/m2 of fluorouracil per day, plus 20 mg/m2 of leucovorin per day for five days, followed by 45 Gy of radiation at 1.8 Gy per day, given five days per week for five weeks, with modified doses of 5-FU and leucovorin on the first four and the last three days of radiotherapy. One month after the completion of radiotherapy, two five day cycles of fluorouracil (425 mg/m2 per day) plus leucovorin (20 mg/m2 per day) were given one month apart. The median overall survival in the surgery only group was 27 months, as compared with 36 months in the chemoradiotherapy group; the hazard ratio for death was 1.35 (95% CI 1.09 to 1.66; p = 0.005). The hazard ratio for relapse was 1.52 (95% CI 1.23 to 1.86; p3 rectal bleeding, 3 patients (0.5%) in the ADT only group, 2 (0.3%) in the ADT and radiotherapy