The Role of Radiotherapy in the Management of Lung Carcinoma

The aim of this chapter is to describe the role of radiotherapy in the management of lung carcinoma. The introduction covers general information about radiotherapy followed by a more detailed description of the basic principles of nuclear physics and radiotherapy treatment planning and delivery showing the influence of recent rapid progress in technology on the efficacy of this treatment modality. Following the introduction of technical aspects of radiation oncology, the role of radiotherapy, emphasising novel techniques of stereotactic ablative body radiotherapy, is described as the definitive treatment in early non-small cell lung carcinoma. The next part of the chapter presents the current role of radiotherapy with curative intent in locally advanced inoperable non-small cell lung cancer in combination with chemotherapy and immunotherapy. The use of radiotherapy in operable locally advanced lung carcinoma is also analysed to complete all clinical indications for this clinical entity. The role of radiotherapy in the management of small cell lung carcinoma is subsequently presented where consolidation chest radiotherapy and prophylactic cranial irradiation in combination with standard chemotherapy and its input to overall outcome are analysed for both limited and extensive disease. The basic principles of standard palliative radiotherapy are then presented with its input in the management of incurable stage of lung carcinoma in addition to palliative systemic treatment and the best supportive care. A brief description of new stereotactic techniques in the palliative setting is also presented. The chapter concludes with the management of radiotherapy related toxicity presenting most frequently observed side effects and their treatment.

Keywords: 3D-conformal radiotherapy, 4D-computer tomography, Adjuvant immunotherapy, Adjuvant radiotherapy, Chemo-radiotherapy, Consolidation chest radiotherapy, Intensity modulated radiotherapy, Non-small cell lung carcinoma, Palliative radiotherapy, Prophylactic cranial irradiation, Radiotherapy principles, Radiotherapy toxicity, Radiation oesophagitis, Radiation pneumonitis, Small cell lung carcinoma, Standard radiotherapy, Stereotactic radiotherapy, Volumetric modulated arc therapy.