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Review
. 2019 Sep;8(Suppl 2):S124-S134.
doi: 10.21037/tlcr.2019.09.05.

Pathologic response after modern radiotherapy for non-small cell lung cancer

Simon F Roy  1 , Alexander V Louie  2 , Moishe Liberman  3 , Philip Wong  4 , Houda Bahig  4
Affiliations
Review

Pathologic response after modern radiotherapy for non-small cell lung cancer

Simon F Roy et al. Transl Lung Cancer Res. 2019 Sep.

Abstract

In non-small cell lung cancer (NSCLC), pathologic complete response (pCR) following radiotherapy treatment has been shown to be an independent prognostic factor for long-term survival, progression-free survival and locoregional control. PCR is considered a surrogate to therapeutic efficacy, years before survival data are available, and therefore can be used to guide treatment plans and additional therapeutic interventions post-surgical resection. Given the extensive fibrotic changes induced by radiotherapy in the lung, radiological assessment of response can potentially misrepresent pathologic response. The optimal timing for assessment of pathologic response after conventionally fractionated radiotherapy and stereotactic ablative radiotherapy (SABR) remains poorly understood. In this review, we summarize recent literature on pathologic response after radiotherapy for early stage and locally advanced NSCLC, we discuss current controversies around radiobiological considerations, and we present upcoming trials that will provide insight into current knowledge gaps.

Keywords: Stereotactic ablative radiotherapy (SABR); non-small cell lung cancer (NSCLC); pathologic complete response (pCR).

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Conflict of interest statement

Conflicts of Interest: H Bahig received a research grant from Varian Medical Systems and honoraria from Siemens Healthineers and Bristol Myers Squibb. AV Louie has received honoraria from Varian Medical Systems Inc. and AstraZeneca. P Wong has research grants from AstraZeneca and Bristol-Myers Squibb. The other authors have no conflicts of interest to declare.

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