Radiotherapy of lung cancer

Radiotherapy is the most common nonsurgical treatment for patients with lung cancer. Its value in controlling specific cancer related symptoms is undisputed and can be achieved with unsophisticated and undemanding schedules. However, these treatment regimens cannot be expected to produce durable local control or significant impact on survival. Their use cannot be generally accepted for all inoperable patients. The use of high-dose radiotherapy with curative intent has been brought into disrepute by often inappropriate patient selection and subsequently poor results. In a number of small pilot studies, survival comparable to surgical series can be achieved in operable patients. Safe delivery of high-dose radiotherapy to intrathoracic tumours represents a formidable technical challenge. The sophisticated treatment planning which is necessary and consistent diagnostic evaluation is often lacking in practice when the value of local therapy is perceived as minimal. Recent developments in radiation technology, tumour biology and understanding of normal tissue responses bring an opportunity to design new and more effective treatment schedules. New developments in systemic therapy far from making thoracic irradiation obsolete, demand higher rates of durable local control. The interrelationships between toxicities to normal tissues and potential advantage in antitumour activity bring further challenges in design of optimal combined modality schedules. The challenge facing the Radiation Oncologist interested in thoracic malignancies is how to balance the multiple and often conflicting possibilities and formulate novel schedules that can be evaluated in practice. A further challenge is how to facilitate the introduction of these resource-intensive strategies into the real world of shrinking resources and increasing waiting lists. The potential gains may be individually small but with the numerical importance of lung cancer may have a global impact.