The role of radiation therapy in non-small cell lung cancer

Thoracic irradiation historically plays a strong role in the management of non-small cell lung cancer (NSCLC). Though surgery is the mainstay of early-stage (I and II) disease, adjuvant radiation therapy confers better local control than surgery alone in advanced disease (III). Combining chemotherapy with radiation can help decrease systemic tumor burden and confer an overall survival advantage. Patients with medically inoperable early-stage disease can be treated with radiation alone, and bulky advanced-stage tumors can be treated definitively with platinum-based concurrent chemotherapy and radiation. The success of chemotherapy with radiation together has led to trials of induction treatment for borderline surgical candidates, allowing for downstaging and more complete resection. Local control remains a challenge, and dose escalation as well as more conformal treatment planning studies need to be explored to overcome this problem.