Stereotactic radiation therapy: changing treatment paradigms for stage I nonsmall cell lung cancer

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Abstract
To review recent developments in stereotactic body radiation therapy (SBRT) for stage I nonsmall cell lung cancer (NSCLC). In stage I tumors measuring up to 5 cm in diameter, SBRT can achieve local tumor control rates of up to 97%. SBRT has a favorable toxicity profile and has been safely applied in elderly patients, after previous pneumonectomy, or with severe chronic obstructive airways disease. Population studies indicate that the introduction of SBRT was associated with increased treatment rates for elderly patients and improved overall survival. In patients with stage I NSCLC who do not undergo surgery, SBRT achieves superior survival as compared to treatment using conventionally fractionated radiotherapy. The role of SBRT in operable patients remains to be defined within randomized trials. In patients identified to be at high risk for surgical complications, SBRT appears to provide an effective alternative with low risks of hospitalization and 30-day mortality. Future treatment algorithms should include individualized assessment of surgical risks, and the consideration of SBRT for high-risk patients, in order to develop a personalized treatment approach.