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*Lung Cancer - Modern Multidisciplinary Management*

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604-5.

**40**

**43**

**Chapter 4**

**Abstract**

Surgery

*and Dirk Van Gestel*

radiation oncologist perspective.

**1. Introduction**

Radiotherapy: An Alternative to

Many major technical developments have occurred during the last decades in radiotherapy: our efficacy has improved with less toxicity. Nowadays, it allows us to challenge the role of surgery as a local modality for lung cancer both for early, advanced and even metastatic disease. In the present paper, we will mainly discuss the role of SBRT for stage I lung cancer, the place of conventional radiotherapy for stage III and we will review the current treatment of small cell lung cancer from a

**Keywords:** SBRT, trimodality stage III, small cell lung cancer chest RT, PCI

different clinical situations and presenting the current knowledge.

**2.1 Stereotactic radiotherapy for early stage lung cancer (SBRT)**

**2. Stage I lung cancer: radiotherapy as an alternative to surgery**

Surgery is the treatment of reference for early stage lung cancer and a lobectomy or an anatomical segmentectomy in selected cases coupled with a lymph node dissection is the preferred approach [1]. For early stages, surgery is generally technically less complex and associated with less toxicity and mortality than for more advanced stages. Still, some patients cannot undergo surgery due to medical comorbidities. In the past, conventional (long course) radiotherapy or even no treatment was often proposed to those patients; the outcome was very poor: in a review, the 2-year survival rates range from 22 to 72% and the 5-year survival rates from 0 to 42% [2]. In early 1990's, a new radiotherapy technique emerged in Europe and Japan, built on the experience with intracranial stereotactic treatments, called stereotactic

Radiation oncology is an important player in the treatment of lung cancer either alone taking advantage of the new technological developments (stereotactic radiotherapy, intensity modulated radiotherapy, image guide radiotherapy) or with surgery and systemic treatment (chemotherapy, immunotherapy, targeted drugs). To-day, radiotherapy may even challenge surgery as the loco-regional treatment both for stage I and III non-small cell lung cancer (NSCLC) and is the local treatment for small cell lung cancer (SCLC). In the present chapter, we will discuss those

*Paul Van Houtte, Charlier Florian, Luigi Moretti* 

## **Chapter 4**
