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We acknowledge the contributions of Ms. Barbara Husic in the administrative preparation of this chapter.

Approximately 85% of lung cancers are non-small cell lung cancers (NSCLC), a heterogeneous group that is further divided into squamous cell and adenocarcinoma, the latter of which has numerous clinicopathologic–biologic subtypes. Unlike the situation for systemic treatment of NSCLC, presently, radiotherapy (RT) management differs very little among the various subtypes. It is anticipated that this will change in the future, as clinically useful predictive biomarkers for RT emerge but currently, and disappointingly, they do not yet exist. Conversely, however, this means that RT is a predictable, highly broad-spectrum agent against NSCLC. Most NSCLC patients receive RT at some point in the course of their illness; this may be thoracic RT and/or RT against metastatic sites, including though not limited to brain or bone metastases. Thoracic RT can be used for one of three treatment indications: (1) Definitive: An attempt at cure without surgery, using radiation as the primary local modality. (2) Palliative: Efforts directed toward short-term and/or long-term relief of cancer-related symptoms. (3) (Neo)-adjuvant: The integration of radiation prior to (neoadjuvant) or after (adjuvant) surgery, to improve the chance for permanent locoregional control.

There can be considerable overlap among these categories, and goals of treatment may change based on the patient’s trajectory and disease course. A major example of this is the evolutionary use of stereotactic RT for patients with selected (oligometastatic or oligoprogressive) stage IV NSCLC who are doing well with systemic therapy; we describe this is as a hybrid between definitive and palliative treatment. Table 115-1 summarizes the different types of RT for lung cancer, with the typical associated radiation doses, treatment time, and other considerations.

TABLE 115-1Summary of Radiotherapy for NSCLC

The decision to use thoracic RT should usually occur in a multidisciplinary “tumor board” process in order to optimize integration of RT with other modalities. The factors most ...

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