Acknowledgement of the limitations of current therapy for the large number of patients with locally advanced lung cancer is part of the daily lexicon of general thoracic surgeons. While waiting for the much needed quantum leap in systemic therapy, we must be satisfied with small increments in survival that can sometimes be achieved by careful manipulation of existing therapeutic modalities. Granted, the staggering prevalence of the disease allows even small advances to be impressively magnified in number of lives altered; nevertheless, such epidemiologic consequences are of limited consolation to the individual surgeon who continues to witness far more failures than successes with these patients, usually due to systemic progression of disease. The trimodality strategy of concomitant chemotherapy and radiation therapy followed by resection is now generally accepted as the preferred approach to locally advanced lung cancer, particularly stage IIIa and selected stage IIIb. The current study from a highly regarded lung cancer program investigates the potential benefits of increasing the radiation component of this strategy to full dose, greater than 59 GY, as opposed to the generally accepted 45 GY. The lower dose has always been a compromise between radiation therapists, who have viewed it as suboptimal based upon well-established dose-response curves, and surgeons, who have feared difficult complications associated with the higher dose therapy, particularly adult respiratory distress syndrome and bronchial stump breakdown. The authors postulate that this modification, if tolerated, would result in better local control that would be reflected in improved survival data. In many ways, the results presented herein are indeed impressive. Perhaps because of the more focused radiation delivery offered by three-dimensional conformal protocols as well as excellent surgical and postoperative care, the authors were able to minimize the previously described adverse consequences of full dose preoperative radiation therapy. There were no operative deaths, no bronchial stump problems after muscle flap reinforcement was standardized, and other complications proved manageable. This favorable experience included 11 pneumonectomies, a procedure, especially on the right, that has reportedly had formidable mortality following induction therapy. Furthermore, the response to therapy (87.5% sterilization of pathologically confirmed N2 disease; 45% complete tumor response) is as good, or better, than any previous report. The potential for improved local control and specifically for improved N2 node sterilization, which has been shown to be a very important contributor to survival, would appear to be offered by this well-tolerated modification of preoperative therapy. The overall survival and disease-free survival data, while lacking statistical power due to small numbers, are suggestive of benefit when compared with previous reports. The several limitations of this study, however, argue for considerable caution. As is acknowledged by the authors, this is a very heterogeneous group of highly selected patients. The report includes only those patients who completed the full trimodality strategy; there is no information concerning patients that might have dropped out of the protocol before resection due to, for example, complications of the induction therapy or progression of disease. The resulting “diminishing denominator” could have critical implications in the more widespread application of this treatment strategy. In addition, full surgical staging was not universally applied, thus compromising some of the conclusions (although the documented results in the surgically staged subset of patients are excellent). Finally, the study was unfortunately unable to document a survival advantage for those patients with a complete response to therapy, although this could be a reflection of the relatively small numbers of patients in each group. Despite these limitations, the results presented herein are sufficiently compelling to argue for a prospective multiinstitutional clinical trial investigating differing doses of preoperative radiation in these patients. The hope of the authors is that improved local control of these cancers will translate into improved survival, and such may well prove to be the case with wider careful analysis and application of this strategy. The sobering fact of lung cancer, unfortunately, is that most of these patients will die with systemic disease, once again reminding us of what is really needed.