Consult Lung SBRT

Complete surgical resection is the standard treatment for stage I, II, and resectable IIA NSCLC. EBRT is the definitive treatment of choice for medically inoperable patients or patients who decline surgery.

Fractionated radiation therapy remains the standard treatment for patients with early stage but medically inoperable NSCLC, and for patients who decline surgery. Local failure rates are 50-70% even with dose escolation to 70-90 Gy in 2-Gy fractions. SBRT is the emerging optimal treatment for T1/T2 N0 NSCLC. Local control rates were > 90% at 2-year follow-up, with only 3% serious morbidity. 5-year survival for medically operable patients who refused surgery was 88% (Onishi et al. 2004, 2007)

BED10 of 100 Gy is required to offer local control of lesions ≤ 4 cm. BED10 of 100 Gy can be delivered safely by 12 Gy x 4, 10 Gy x 5, or 20 Gy x 3 which can be toxic for central lesions. Vac-Loc bag and Tbar minimizes motion to 7 mm or less, > 95% of the time.

Radiosurgery morbidities were discussed in detail. Acute morbidity is rare. Late complications include:
fistula, bleeding, fibrosis, pneumonitis, pneumonia, brachial plexopathy for upper lobe lesions and liver toxicity for lower lobe lesions.

For stage IB, IIA, and IIB; cisplatin-based chemotherapy has been shown to improve treatment outcome in adjuvant settings and is usually recommended.

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