For radiation oncologists the treatment of lung cancer patients has become a challenge because we are working in a ‘moving field’. The conventionally used large irradiation fields (elective nodal irradiation) can be safely omitted in 18FDG PET staged non-small cell lung cancer (NSCLC) patients.
With the omission of these large fields, escalation of the radiation dose in small-volume lung tumors is safe up to 94.5 Gy in 42 fractions within six weeks overall treatment time. Increasing the radiation dose significantly improved the failure-free interval and overall survival for the patients with small-volume NSCLC.
Jose Belderbos has developed in collaboration with Lon Uitterhoeve (AMC) a treatment scheme of high dose accelerated radiotherapy (66 Gy in 24 fractions). This treatment scheme given concurrently with daily cisplatin or after two courses of gemcitabine and cisplatin was well tolerated in a large group of inoperable NSCLC patients.