[Stereotactic radiotherapy for lung cancer].

Area of Science:

• Oncology
• Radiation Oncology
• Pulmonology

Background:

• Historically, surgery was the primary treatment for early-stage T1-T2N0M0 non-small cell lung cancers (NSCLC).
• A significant portion of patients (20-25%) are inoperable due to medical conditions, age, or personal choice.
• Stereotactic body radiation therapy (SBRT) emerged as the standard of care for inoperable NSCLC patients in 2018.

Purpose of the Study:

• To review the current role of SBRT in treating early-stage NSCLC.
• To discuss the challenges in comparing SBRT with surgery for operable patients.
• To highlight considerations for SBRT dose, fractionation, toxicity, and post-treatment monitoring.

Main Methods:

• Review of clinical practice and phase III trial data for SBRT in early-stage NSCLC.
• Analysis of treatment outcomes, including local control and survival.
• Evaluation of toxicity profiles and imaging interpretation complexities.

Main Results:

• SBRT is the standard for inoperable early-stage NSCLC.
• Direct comparison trials between surgery and SBRT lack definitive conclusions on local control and survival.
• SBRT generally shows good tolerance, but caution is needed for ultra-central tumors and interstitial pneumonia.
• Post-treatment imaging interpretation can be complex, distinguishing pneumonitis from recurrence.

Conclusions:

• SBRT is a well-established treatment for inoperable early-stage NSCLC.
• Further research is needed to definitively compare SBRT with surgery.
• Treatment planning, including dose and fractionation, must be individualized.
• Monitoring for toxicity and disease progression requires careful interpretation, especially with combined SBRT and immunotherapy approaches.