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Radiation Therapy in Non-small-Cell Lung Cancer

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Radiation Oncology

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Abstract

Radiotherapy is of outstanding importance for treatment of all stages of non-small-cell lung cancer (NSCLC). Estimates for patient proportions having an evidence-based indication for radiotherapy during treatment range from 60% to 75% overall. Stage and performance status are important factors for treatment guidance, comorbidities, or compromised respiratory function also influences the ability to deliver radiotherapy.

While stereotactic ablative radiotherapy (SABR) with BED>100 Gy represents a highly effective treatment for early-stage non-small-cell lung cancer with similar rates of primary tumor control between SABR and surgery, locally advanced tumors require multimodality treatment regimens with appropriate delivery of radiotherapy. Concurrent chemoradiation is a standard treatment strategy for fit patients not candidates for surgery. Combinations of radiotherapy with molecular targeted drugs are under investigation in clinical trials. Durvalumab consolidation after definitive chemoradiotherapy has achieved excellent rates of progression-free and overall survival and gained international treatment approval.

Options for radiotherapy optimization include dose escalation , alternative fractionation , and treatment schedules including surgery. Currently, 60–66 Gy in conventional fractionation are accepted doses for definitive radiotherapy. Evidence from prospective trials for a benefit of further dose increase is controversial and underscores the need for advanced technologies to avoid dose-limiting toxicity when aiming at treatment intensification.

Optimal palliation of incurable NSCLC patients requires coordinated interdisciplinary care. Effective symptom relief is achievable in various organ regions with conformal radiotherapy . In oligometastatic NSCLC, interdisciplinary guidelines have established a basis for the use of a definitive local therapy in addition to systemic therapy, if functional prerequisites are fulfilled.

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Authors and Affiliations

  1. Klinik für Radio-Onkologie, UniversitätsSpital Zürich, Zürich, Switzerland

    Matthias Guckenberger

  2. Klinik für Strahlentherapie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany

    Christoph Pöttgen & Martin Stuschke

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  1. Matthias Guckenberger
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  2. Christoph Pöttgen
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  3. Martin Stuschke
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Correspondence to Christoph Pöttgen .

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  1. Department of Radiation Oncology, University Hospital Mannheim, Mannheim, Germany

    Frederik Wenz

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Guckenberger, M., Pöttgen, C., Stuschke, M. (2019). Radiation Therapy in Non-small-Cell Lung Cancer. In: Wenz, F. (eds) Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-52619-5_34-1

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