The Role of Stereotactic Body Radiotherapy in the Management of Non-Small Cell Lung Cancer: An Emerging Standard for the Medically Inoperable Patient?

The standard of care for early-stage lung cancer is surgical resection. Many patients with this diagnosis have comorbidities that preclude oncologic resection. Randomized data show that limited resection is inadequate for local disease control and may negatively impact on survival. Stereotactic body radiotherapy (SBRT) has emerged as a novel radiation modality with significant applications in the inoperable, early-stage lung cancer population. Retrospective and prospective studies published in the past decade have established the feasibility, safety, and efficacy of SBRT in these patients using a variety of dose regimens and technologies. To date, lung SBRT results demonstrate excellent local control with very little acute toxicity, and suggest improved overall survival compared to historical controls of fractionated radiotherapy. Ongoing prospective trials are exploring dose and fractionation schedules in the inoperable population, and are starting to explore the role of SBRT for the operable patient.