Conformal radiation therapy in non-small cell lung cancer

About one third of lung cancers initially present with a localised disease, without any curative surgery potential, because of local spread or co-morbidity. Definitive radiation, alone or combined with chemotherapy, then represents the treatment of choice for these patients. The results, however, are disappointing, with a biopsy-proven local control of 10% at two years and a 5-10% five-year survival rate. These poor results may be partially explained by the difficulties in delineating the tumour volume as well as the dose limitations due to poor tolerance of surrounding normal organs. Lung parenchyma sequelae remain daily worrying events for the oncologist. The advent of 3D conformal radiation therapy (3DRT) allows progress and innovations, including the use of modern imaging techniques, sophisticated dosimetry and treatment planning, efficient immobilisation devices and on-line verification procedures. With more precise (and time-consuming) procedures, 3DRT will allow a better tumour volume delineation, an increased tumour dose and a dose limitation in normal tissues. These improvements may help increase local control and survival results. 3DRT, which has been used for several years for prostate cancer and benefits from recent imaging improvements, will now allow treatment of other locations, such as lung cancer, with conformal therapy. The few preliminary results are encouraging. This work reviews the current data and remaining questions regarding lung cancer treated with 3DRT, and presents and discusses the literature before discussing future trends in this area. (author)