EDITOR—I chair the clinical oncology information network (COIN), the group that produced the COIN guidelines on the management of lung cancer on behalf of the Royal College of Radiologists.1 These guidelines were the subject of an editorial by Simmonds 2 and later correspondence.3 I wish to add a few comments.

In their letter Ardizzoni et al take the guidelines to task on three specific issues. We carefully reviewed the evidence on the value of adding chemotherapy to radical radiotherapy for locally advanced non-small cell lung cancer. We thought that the evidence for a clinically important effect was not compelling, and we therefore recommended including patients in clinical trials but said, “If these are not available, induction chemotherapy is recommended.”

The issue of chemotherapy for patients with stages IIIb and IV non-small cell lung cancer is more complex. At the time of writing we had strong (level Ia) evidence of only a modest effect on survival, with no clear evidence of benefit in terms of quality of …