The role of radiotherapy in treatment of stage I non-small cell lung cancer

Factors important for efficacy of stereotactic body radiotherapy of medically inoperable stage I lung cancer. A retrospective analysis of patients treated in the Nordic countries

“…In the present retrospective study of medically inoperable stage I NSCLC analysis of local control as assessed during the follow-up time (median 33 month), showed that only 12% of the tumours failed locally, a figure similar to other SBRT studies on this group of patients [22,28 Á35]. In a recent review of 18 papers published 1988 Á2000, reporting results with conventional RT, the incidence of local failure of stage I tumours was 40% (6.4 Á70%) [10]. Local failure has been reported up to at least 3 years after RT treatment of stage I NSCLC [29,36,37].…”

“…The alternative treatment for these patients has been conventional fractionated external radiotherapy (RT) [6 Á9] with local control rates of 40 Á70% and 5-year survival rates of 5 Á30% [10Á13]. The most common site of relapse of early stage NSCLC treated with conventional RT is local failure [10]. Several studies report that large tumour size and insufficient dose of radiation are the main reasons for poor local control [7,9,10,12,14 Á17].…”

Intensity-modulated radiation therapy (IMRT) for inoperable non-small cell lung cancer: The Memorial Sloan-Kettering Cancer Center (MSKCC) experience

“…2 The treatment of lung cancer with radiotherapy is technically challenging and local tumor control with standard radiation doses and techniques is often difficult to achieve. 3 Given that local recurrence is a leading cause of death in this patient population, techniques for improving local control may have an impact on survival rates.…”

“…Results showed that with IMRT there was a 10% reduction in the predicted rate of radiation pneumonitis and an overall decrease in the MLD of >2 Gy. 12 Christian et al, in a study of 10 patients with NSCLC, retrospectively compared 5 different IMRT plans using different fields (3,5,7, and 9 coplanar field and a 6 noncoplanar field ) to a six-field noncoplanar 3D-CRT plan for each patient. They found that using IMRT reduced the V 20 when more than 3 fields were used as compared to the 3D-CRT plan.…”

The effect of beam arrangements and the impact of non‐coplanar beams on the treatment planning of stereotactic ablative radiation therapy for early stage lung cancer

“…However, 33% of patients present with co‐morbidities that make them unfit for surgery 2. For these patients, local failure following conventionally fractionated external beam radiation therapy is in the order of 40% and treatment involves 20–30 attendances over 4–6 weeks 3. Stereotactic ablative radiation therapy (SABR) has emerged as an alternative treatment option capable of delivering a higher biologically effective dose (BED) resulting in higher local control rates in excess of 85% 2, 4, 5, 6.…”