Outcome of treatment in locally advanced non-small lung cancer (NSCLC) needs improvement. Surprisingly, the RTOG 0617 did not show benefit from dose escalation. Potential causes are now under investigation. In the last years further technologic improvements in radiotherapy equipment have made advanced dose painting possible and achievable. Several new strategies are under investigation from which these patients may do benefit. One such strategy is targeted isotoxic dose escalation only on the high FDG uptake region of the primary tumour prior to treatment with relatively sparing of mediastinal structures, such as the heart: the PET boost trial. Other strategies are the application of new radiosentizers, hypoxia modulators, and proton therapy. Furthermore, in early stage NSCLC with stereotactic ablative radiotherapy (SABR) high rates of local control are achieved comparable to surgery. Favorable results with SABR are also achieved in oligometastatic NSCLC in spinal metastases, lung metastases, brain metastases, and adrenal gland metastases. Randomized trials in NSCLC are needed to determine which patients do benefit from these new strategies. With the availability of advanced radiotherapy techniques, treatment in NSCLC will be more personalized in which the patient makes a more conscious choice between tumour control and toxicity with radiotherapy, systemic therapy, or surgery, or a combination of these treatments.
Zindler, J,
Radiation Oncology & Radiobiology Keynote Speaker: New Developments in Personalized Radiotherapy for Primary Lung Cancer. Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL.
http://archive.rsna.org/2014/14044563.html
