Radiotherapy for Primary and Metastatic Lung Cancer

Alongside surgery, radiotherapy (RT) serves as a cornerstone for locoregional management of lung cancer. Modern treatment technologies (IMRT, SBRT, and particle therapy) provide improved disease control and reduced morbidity relative to traditional approaches. There is active investigation to define the expanding role of aggressive localized radiotherapy in combination with systemic targeted agents or immunotherapy. Consolidative durvalumab following aggressive chemoradiotherapy has become a new standard of care for good-performance stage III non-small cell lung cancer (NSCLC). Clinical trial evidence has reproducibly demonstrated equivalent survival outcomes for ablative RT compared with surgical resection for early-stage NSCLC. Ablative treatment is associated with limited morbidity and excellent tolerance in medically compromised patients unfit for surgery. Current clinical trials are studying potential new indications for ablative treatment to control limited metastatic disease. RT remains an important local treatment modality for small cell lung cancer, including advanced cases.