Stereotactic radiotherapy for nonsmall cell lung cancer

Hypofractionated stereotactic radiotherapy is a new technically complex approach to the treatment of early-stage nonsmall cell lung cancer. Its proponents claim that it is capable of delivering much higher doses to the cancer than is possible with standard techniques, and as a result, rates of tumour control are higher than observed in earlier studies and are similar to what can be achieved by surgical resection.

For peripherally located T1 tumours, carefully administered stereotactic radiotherapy appears to be safe with rates of local control in excess of 80%. This appears superior to historical data, but there has been no randomized comparison with conventional radiotherapy. The dose of radiation appears to be important for local control, but no consensus has emerged as to the best dose fractionation schedule. For centrally located tumours, stereotactic radiotherapy is associated with a risk of serious and sometimes fatal complications.

Refinements of technique and dose as well as randomized data are required before stereotactic radiotherapy can be endorsed as a standard of care for patients with inoperable peripherally located T1 nonsmall cell lung cancer. For centrally located tumours, the risks of hypofractionated stereotactic radiotherapy treatment need to be weighed carefully if it is to be further developed for this indication.