Stereotactic radiotherapy: Indication and results in early stages

Stereotactic radiotherapy of primary pulmonary lesions has become the standard treatment for early stage NSCLC T1 T2a N0 in inoperable patients. Its superiority over conventional radiotherapy was demonstrated in the randomized CHISEL trial, with a local 2-year relapse rate of 14 vs. 31%. The results in terms of local control > 80-90% with low toxicity in the many published series and prospective trials argue for the expansion of its indications, which until now were mainly reserved for fragile patients with high surgical risk. The choice of doses and fractionation and the stereotactic radiotherapy technique should be considered taking into account the patient's clinical situation, previous treatments and the tumour to be treated (size and topography). Iterative treatments, catch-up treatments in case of failure of other local treatments and reirradiations offer new perspectives for patients, replacing or delaying the use of systemic treatment. Finally, improved knowledge of response patterns on scan and metabolic imaging has helped to ensure safe and reliable patient follow-up.