[Stereotactic radiotherapy for lung cancer]

The treatment of early stage T1-T2N0M0 non-small cell lung cancers (NSCLC) was previously based on surgery. However, 20 to 25% of patients are inoperable due to their age, comorbidities or refuse surgery. Since 2018, stereotactic body radiation therapy (SBRT) has become the standard treatment for these patients. For operable patients, the comparison surgery - SBRT is difficult without a clear conclusion, the different phase III trials have not yet permitted to provide a formal answer in terms of local control and survival by default of inclusion. Dose and fractionation need to be selected according to tumor location. Tolerance is usually good, with few grade ≥3 toxicities; however, caution is advised for ultra-central tumors and in case of interstitial pneumonia. Post-therapeutic imaging monitoring is complex, sometimes with uncertainties between radiation-induced pneumonitis and relapse. This complexity may increase in ongoing trials combining SBRT and immunotherapy.