The role of external radiation and brachytherapy in unresectable non-small cell lung cancer

The role of radiation therapy in the management of non-small cell lung cancer is rapidly changing. Preoperative radiation, with the exception of the superior sulcus tumor, has not been found to benefit patients. The issue of postoperative radiation in completely resected patients with non-small cell lung cancer remains controversial. Current postoperative trials suggest, however, that postoperative radiation in these patients prevents local recurrence and, in combination with chemotherapy, prolongs survival. Primary radiation therapy in inoperable non-small cell lung cancer is associated with a small but definite cure rate. Better definition of treatment volume, proper selection of dose-time, state-of-art treatment planning, and, whenever possible, intraoperative radiation have improved local control rates and decreased severe complications.