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Review
. 2019 Dec;92(1104):20190524.
doi: 10.1259/bjr.20190524. Epub 2019 Sep 19.

The evolving role of radiotherapy in non-small cell lung cancer

Sean Brown  1 , Kathryn Banfill  1   2 , Marianne C Aznar  1   2   3 , Philip Whitehurst  4 , Corinne Faivre Finn  1   2
Affiliations
Review

The evolving role of radiotherapy in non-small cell lung cancer

Sean Brown et al. Br J Radiol. 2019 Dec.

Abstract

Lung cancer is the most commonly diagnosed cancer and biggest cause of cancer mortality worldwide with non-small cell lung cancer (NSCLC) accounting for most cases. Radiotherapy (RT) plays a key role in its management and is used at least once in over half of patients in both curative and palliative treatments. This narrative review will demonstrate how the evolution of RT for NSCLC has been underpinned by improvements in RT technology. These improvements have facilitated geometric individualization, increasingly accurate treatment and now offer the ability to deliver truly individualized RT. In this review, we summarize and discuss recent developments in the field of advanced RT in early stage, locally advanced and metastatic NSCLC. We highlight limitations in current approaches and discuss future potential treatment strategies for patients with NSCLC.

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Figures

Figure 1.
Figure 1.
The improving (median) survival of patients with Stage 3 NSCLC (based on trial data). This is presented with a timeline showing the introduction of technologies that have been attributed to improving the accuracy of RT (note this does not necessarily correlate with implementation into the clinical workflow). Yellow numbers: percentage of patients within each trial staged with PET-CT, this information was NS by the PACIFIC investigators. *PACIFIC survival data: This is from the control arm only. The median figure has not yet been reached in the durvalumab arm. Note randomization occurred post chemoradiation. Therefore, survival is measured from this point onwards. 4DCT,four-dimensional CT; CBCT, cone beam CT; IMRT, intensity modulated radiotherapy;MR-linac, magnetic resonance linear accelerator; NS, not supplied; NSCLC, non-smallcell lung cancer; PET-CT, positron emissiontomography-CT; RT, radiotherapy; SABR, stereotactic ablative radiotherapy.
Figure 2.
Figure 2.
Treatment adaptation. (1) RTP CT demonstrates locally advanced lung cancer, tumour (T) and lymph node (L). (2) RTP CT with PTV covering T and L. (3) On-treatment image shows baseline shift causing tumour to move outside of PTV and high risk of geographical miss. (4) Treatment adapted to produce new PTV covering new position of L and T. PTV, planning target volume; RTP, radiotherapy treatment planning.
None
See this image and copyright information in PMC

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