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Reverberi et al . Mini-invasive Surg 2020;4:43 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.33

Review Open Access

Stereotactic radiotherapy for early-stage non-small
cell lung cancer

Chiara Reverberi, Marco Trovò
Radiotherapy Department, Santa Maria della Misericordia Hospital, Udine 33100, Italy.

Correspondence to: Dr. Chiara Reverberi, Radiotherapy Department, Santa Maria della Misericordia Hospital, Piazzale Santa
Maria della Misericordia 15, Udine 33100, Italy. E-mail: chiarareverberi87@gmail.com

How to cite this article: Reverberi C, Trovò M. Stereotactic radiotherapy for early-stage non-small cell lung cancer. Mini-
invasive Surg 2020;4:43. http://dx.doi.org/10.20517/2574-1225.2020.33
Received: 31 Mar 2020 First Decision: 9 May 2020 Revised: 24 May 2020 Accepted: 1 Jun 2020 Published: 12 Jul 2020

Academic Editor: Noriyoshi Sawabata Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

Abstract
Surgical resection is treatment of choice for early stage non-small cell lung cancer, even though 20%-30%
of patients do not undergo surgery. Compared to conventional fractionated radiotherapy, stereotactic body
radiotherapy (SBRT) has demonstrated excellent local control (LC) and overall survival (OS). Central and ultra-
central lesions present higher toxicity rates after SBRT because of their proximity to mediastinal structures. Dose
escalation studies have documented that 10-12 Gy per fraction is the maximal tolerable dose with acceptable rates
of treatment adverse events and survival. Peripheral lesions can be safely treated with high radiotherapy dose
(biologically equivalent dose of ≥ 150 Gy) and a different SBRT dose schedule has showed comparable results
with LC rates > 90% and OS comparable to surgical resection. Elderly patients, defined as 75 years or older, are
a subgroup of patients who may benefit the most from SBRT, as they have higher morbidity and mortality risks
because of comorbidities and decreased lung function. At present, there are no randomized studies comparing
SBRT with surgery for patients who are potential candidates for surgical removal. Retrospective studies and
systematic reviews have showed encouraging results in terms of cancer-specific survival and LC.

Keywords: SBRT, ablative radiotherapy, early stage non-small cell lung cancer, NSCLC

INTRODUCTION
International guidelines suggest that the cornerstone of treatment for early stage non-small cell lung
cancer (NSCLC) is surgical resection, with precise lobectomy and systematic mediastinal/hilar lymph
node dissection the standard of care. Nevertheless, roughly 20%-30% of patients with stage I NSCLC do
[1]
not undergo surgery . The 5-year cancer specific survival (CSS) rate for early-stage lung cancer patients
[2]
who do not receive any treatment is around 16% . All patients need to be discussed at a multidisciplinary
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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