Radiotherapy in Treatment of Non-Small Cell Lung Cancer

Treatment of patients with lung cancer depends upon the cell type (non-small cell versussmall cell), tumor stage, molecular characteristics, and an assessment of the patient s overallmedical condition.Patients with stage I, II, or III non-small cell lung cancer (NSCLC) are generally treatedwith curative intent using surgery, chemotherapy, radiation therapy (RT), or a combined modalityapproach.Stage I plus stage II disease accounts for approximately 30 percent of patients with NSCLC.Complete surgical resection is the preferred approach for patients who are surgical candidates.Postoperative RT is indicated only for patients with positive surgical margins; it is not indicated forother patients with stage I or II disease.For those with pathologic stage III disease after resection, adjuvant chemotherapy isindicated, and sequential postoperative radiation therapy (RT) is generally recommended for thosewith mediastinal lymph node involvement to improve local control but should be deliveredsequentially after adjuvant chemotherapy. the impact of RT on overall survival is unclear. Metaanalysesand a SEER database analysis suggested that postoperative RT may have a detrimentaleffect on survival.Definitive RT is an alternative for patients who are not candidates for surgery based uponcomorbidities or who refuse surgery. Stereotactic body RT (SBRT) is preferred for those withlesions <5 cm if the expertise is available. Full dose conventional fractionation is indicated for thosewith larger lesions or if SBRT is not available.Systemic therapy is generally indicated for patients who present with advanced disease,including those who present with metastases (stage IV) or recur following initial definitivetreatment. For patients with a solitary metastasis, surgical resection or definitive irradiation of the metastasis may be appropriate. For example in bone metastases , treatment may include RT forlocalized painful lesions or surgical intervention to treat or prevent pathologic fractures in additionto systemic therapy or for brain metastases, the management of patients with brain metastases mayinclude surgical resection, RT, or systemic therapy.