Stereotactic ablative radiotherapy (SABR) for lung cancer: What does the future hold?

While radiation therapy has long been one of the pillars of therapy for potentially curable stages of lung cancer, outcomes have largely remained disappointing overall. The best outcomes in lung cancer have been achieved with surgery and only in early stage disease, because in early stages complete tumor ablation by surgery is possible in most patients who can tolerate the appropriate resection (lobectomy). Even so, many patients with anatomically resectable early lung cancer are not treated with surgery: in the United States, up to over one third of such patients do not have surgery for reasons including older age and multiple comorbidities (1). Conventional radiation therapy, while modestly effective, does not approach surgical cure rates because it has not been possible or practical to achieve ablative radiation dose intensities tolerably using such techniques (2).