Stereotactic ablative radiotherapy for stage I NSCLC: Successes and existing challenges

Stereotactic ablative radiotherapy (SABR) has emerged as a standard treatment of peripherally located medically inoperable stage I non-small cell lung cancer (NSCLC) (1-5). With SABR, local control of primary tumors is greater than 90% in tumors up to 5 cm, and regional lymph node recurrence within the chest is low (5% to 10%). Distant metastasis remains a dominant pattern of failure (10% to 20%). SABR has been accepted by the National Comprehensive Cancer Network (NCCN) and is included in the NCCN treatment guidelines, and SABR is widely used (>75%) by radiation oncology centers, including community hospitals, according to a recent survey by the American Society for Radiation Oncology (ASTRO)