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Stereotactic radiation therapy: changing treatment paradigms for stage I nonsmall cell lung cancer

Palma, Davida,b; Senan, Suresha

doi: 10.1097/CCO.0b013e328341ee11
Lung and mediastinum: Edited by Cesare Gridelli

Purpose of review To review recent developments in stereotactic body radiation therapy (SBRT) for stage I nonsmall cell lung cancer (NSCLC).

Recent findings In stage I tumors measuring up to 5 cm in diameter, SBRT can achieve local tumor control rates of up to 97%. SBRT has a favorable toxicity profile and has been safely applied in elderly patients, after previous pneumonectomy, or with severe chronic obstructive airways disease. Population studies indicate that the introduction of SBRT was associated with increased treatment rates for elderly patients and improved overall survival.

Summary In patients with stage I NSCLC who do not undergo surgery, SBRT achieves superior survival as compared to treatment using conventionally fractionated radiotherapy. The role of SBRT in operable patients remains to be defined within randomized trials. In patients identified to be at high risk for surgical complications, SBRT appears to provide an effective alternative with low risks of hospitalization and 30-day mortality. Future treatment algorithms should include individualized assessment of surgical risks, and the consideration of SBRT for high-risk patients, in order to develop a personalized treatment approach.

aDepartment of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands

bDepartment of Radiation Oncology, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada

Correspondence to Dr David Palma, MD, FRCPC, Department of Radiation Oncology, London Regional Cancer Program, 790 Commissioners Rd East, London, ON N6A4L6, Canada Tel: +1 519 685 8500 x58659; fax: +1 519 685 8627; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.