The best way to improve survival in the lung cancer patient population is through carefully designed phase III clinical trials. Unfortunately, many phase III trials in lung cancer, including those designated priority, have failed to answer their proposed question(s) because they closed early due to poor accrual. Although trials comparing one chemotherapeutic regimen to another usually accrue well, trials that combine different therapeutic modalities (i.e., surgery versus radiotherapy) often result in poor accrual; and yet these trials pose some of the most important clinical questions. Therefore, it is important that we identify trials a priori with a high probability of successful accrual as well as identify modifiable factors that can enhance accrual in these trials. When one reviews accrual information for locally advanced non-small cell lung cancer (NSCLC) (Table 1) initiated since 1993 by the CTCGs, only one of four trials (25%) that involved all three conventional modalities (trials investigating different sequences of chemotherapy, radiotherapy, and surgery) completed accrual. This contrasts with successful accrual of four of six (66%) trials that did not involve surgery but were primarily focused on definitive radiotherapy which met their targeted accrual. In patients with early-stage NSCLC, stage IV NSCLC (Table 2), or small cell lung cancer (Table 3), patient accrual was accomplished on a consistent basis. Only 1 of 18 trials failed to achieve its accrual end point and closed early. Enhancing accrual to individual trials can involve adding resources and/or funding to implement actions that may improve accrual (opening at multiple institutions), simpli- fying eligibility criteria or omitting extra tests, or closing a poorly accruing study to release resources for others. However, the intangible element in this equation remains the scientific relevancy that a clinical trial is investigating. This is particularly germane in locally advanced NSCLC where trials may be investigating the role of different modalities in the treatment paradigm. In some sense, comparing one drug against another may be relatively easier to accomplish, but the scientific importance and potential survival impact may be less compelling. The design of a clinical trial can have several aspects that may limit accrual. A challenge that constantly faces investigator is the scientific end point and the statistical