Early Non-small Cell Lung Cancer: The Place of Radical Non-SABR Radiation Therapy

The evidence for radiotherapy as a potentially curative treatment for early lung cancer has gradually accumulated over the past 50 years with our conventional gold standard of 60 Gy in 30 fractions over 6 weeks established in the 1980s. A multimodality approach is now standard for the management of most presentations of lung cancer with concurrent chemoradiotherapy/immunotherapy combinations being standard of care for stage III disease. In parallel, technological developments enabled us to establish stereotactic ablative body radiotherapy (SABR) as the standard of care for inoperable stage I disease. Unfortunately, a significant proportion of patients presenting to our day-to-day practice will not be best served by the gold standard treatments of SABR or the concurrent chemoradiotherapy/immunotherapy combinations. For these patients, it is the use of non-SABR radiation schedules that offers potentially curative treatment as a single modality or combined with chemotherapy. Awareness and interest in an accelerated approach have been increased by the COVID-19 pandemic. This chapter reviews the evidence for non-SABR radiation schedules as they continue to have an important role in the management of early-stage NSCLC in combination with all other aspects of care in the control of symptoms and maintenance of quality of life.