Stereotactic radiotherapy in stage I non-small cell lung cancer

For patients with inoperable stageI non-small cell lung cancer (NSCLC) stereotactic body radiotherapy (SBRT) has evolved as the standard of care. As anon-invasive method, SBRT has led to asignificant progress with high local control rates regularly amounting to nearly 90% and a high disease-specific (actuarial) survival after 5years of approximately 75%. The application of SBRT has now been widely adopted in many radiation units; however, its use places high demands on the technical apparative equipment and asophisticated quality assurance in the individual centers. The choice of appropriate fractionation schemes depends primarily on the distinction between a central and aperipheral tumor location. With appropriately adjusted dose regimens very good treatment tolerance can be achieved. In comparison to sublobar resection for patients with advanced chronic obstructive pulmonary disease (COPD, GOLDIII orIV), SBRT is superior in terms of post-interventional morbidity and mortality. For the operable stage I the results of SBRT treatment in small collectives are as effective as those of patients who received a guideline-conform lobar resection. This is the conclusion of the analysis of two prospective randomized trials, which were terminated early; however, clinical evidence is still limited in this context. Promising currently running clinical trials are examining the application of SBRT as aboost after chemoradiotherapy in stageIII NSCLC and also the combination of SBRT and immunotherapeutic approaches in stageI.