Stereotactic Radiosurgery for Early Stage Non-Small Cell Lung Cancer: Rationale, Patient Selection, Results, and Complications

Lung cancer is the most common cause of cancer-related mortality in the United States. Lobectomy is the current standard of care for early stage lung cancer. For nonoperative candidates, standard radiation has been offered but generally with little hope for cure. Advanced radiation techniques with three-dimensional planning, multiple beam paths, and respiratory-motion compensation have resulted in the ability to administer high-dose radiation or stereotactic radiosurgery to lung tumors. Stereotactic radiosurgery is likely to be more effective than standard external beam radiation and there is evidence that in appropriately selected medically inoperable patients such therapy may offer a chance for cure. Early results are encouraging but these results are not mature and, recently, severe late toxicity has been reported. Prospective trials are underway in our institution and others to evaluate stereotactic radiosurgery for early stage lung neoplasm. This article summarizes the role of stereotactic radiosurgery for the treatment of lung cancer.