The role of radiotherapy in the management of lung cancer is growing in magnitude and significance. Modem radiotherapy planning and delivery systems allow more precise delivery of higher doses of ionizing radiation to desired tumor volumes with preferential sparing of sensitive uninvolved tissues. This provides a hope of cure for the patient with non-resectable or inoperable nonmetastatic lung cancer, improves the thoracic control rate in nodepositive resected patients, and provides ever elongating high-quality palliation for the patient with a metastatic disease.
Adjuvant Radiation Therapy
Operable Non-Small Cell Lung Cancer
Despite great efforts, the success of radiation therapy as an adjunct to surgery in the management of non-small cell lung cancer has been limited. Several selected series of patients have suggested an advantage for preoperative, intraoperative, or postoperative radiation therapy, but no controlled trial to date has demonstrated a survival benefit. In general, the high rate of distant failure common in lung cancer masks the improved local control provided by the radiation therapy. Preoperative Radiation Therapy: Preoperative radiation therapy is currently advocated for 2 groups of patients: those with superior sulcus tumors and those with other marginally resectable tumors (Table 1).
Table 1—Indications for Preoperative Radiation Therapy
|Superior sulcus tumors|
|Marginally resectable tumors|
|Chest wall adherence|
|Aortopulmonary window involvement|
|Proximate to carina|