Stereotactic body radiotherapy for early stage lung cancer-historical developments and future strategies

The application of radiosurgery dose escalation extra-cranially in a moving target, surrounded by critical normal tissue, presents unique dosimetric and clinical challenges. Building on a strong foundation of robust technological advancements and well-planned clinical studies, lung stereotactic body radiotherapy (SBRT) has firmly established its place in the management of early stage non-small cell lung cancer (NSCLC). Nevertheless, favourable outcomes and long-term survival still evade a substantial proportion of patients, especially for central and larger peripheral lung tumours. In this review, we will document the historical developments of lung SBRT over the past decades, highlighting key studies, which have shaped current clinical practice. At the same time, we will address some of the recent advancements in radiation technology, molecular profiling and immunotherapy, and discuss how these important developments can lead to combinatorial strategies, which we hope will form the backbone of new clinical trials and drive better cure rates.