Definitive radiotherapy for non-small-cell lung cancer: current practice and future directions

Lung cancer is one of the malignancies for which new clinical evidence has accumulated most rapidly in recent years. In parallel with advances in systemic therapy, radiotherapy has also evolved substantially with the development of high-precision techniques such as stereotactic body radiotherapy (SBRT), intensity-modulated radiotherapy, and particle therapy. These technological innovations, together with the introduction of immunotherapy and targeted therapies, have reshaped the role of radiotherapy within multidisciplinary treatment strategies for non-small cell lung cancer (NSCLC). This review summarizes current clinical practice and emerging perspectives in radiotherapy for NSCLC across disease stages. In early-stage disease, the established role of SBRT and the potential advantages of particle therapy as curative strategies for medically inoperable patients and for operable patients who refuse surgery are outlined. For locally advanced NSCLC, evolving treatment paradigms in the era of immunotherapy are reviewed, including concurrent chemoradiotherapy followed by consolidation immunotherapy, as well as ongoing efforts to reduce treatment-related toxicity through advances in radiotherapy techniques. In addition, the emerging role of radiotherapy as local consolidative therapy for oligometastatic stage IV NSCLC is highlighted, with attention to recent randomized trials and the challenges of patient selection. As treatment strategies for NSCLC continue to evolve rapidly, radiotherapy is expected to play an increasingly important role in multidisciplinary management. Further research is required to optimize treatment sequencing, identify patients most likely to benefit from radiotherapy, and refine its integration with modern systemic therapies. Radiotherapy remains a key component of multidisciplinary management for non-small cell lung cancer (NSCLC). This review summarizes current clinical evidence and the evolving roles of radiotherapy across disease stages, including early-stage, locally advanced, and oligometastatic NSCLC.