Radiotherapy for Locally Advanced Nonsmall Cell Lung Cancer Including Combined Modality

The present chapter presents the different treatment approaches for locally advanced non small cell lung cancer including radiation alone, targeted agents, combining chemotherapy and radiotherapy, the trimodality approach including surgery and prophylactic cranial irradiation. The chapter presents a large review of the different approaches outlining the progress made during the last years as well as discussing the option to be explored in the near future. Clearly, we have moved with the years from the classical radiotherapy approach using moderate dose and one daily fraction to chemoradiotherapy with or without surgery for selected cases. There are still many questions such as the optimal radiation schedule using classical or altered fractionation with or without adding chemotherapy, the role of new technical developments such as protons or stereotactic body radiotherapy (SBRT), the place of targeted agents, the role of PCI, how to use all the modern imaging technique and how to optimize the treatment for elderly or fraile patients. The management of a locally advanced lung cancer requires a true multimodal approach and a multidisciplinary discussion on each individual case to offer the best option. Last but not least, the quality of life remains a major issue to be preserved.