For patients with early (stage I/II) non-small cell lung cancer (NSCLC) surgery is considered as the standard treatment of choice, although recent data on additional chemotherapy (CHT) showed that it may be beneficial in this setting. There is, however, a subset of patients that never undergo surgery. These patients are considered technically operable, but medically inoperable, due to existing comorbidities. In addition, frequently elderly patients with early NSCLC are denied surgery due to expected peri- and/or postoperative complications. Finally, in recent years there has been an increase in the incidence of patients refusing surgery. For all these patients, radiation therapy (RT) was traditionally considered as the standard treatment option. Data accumulated over the last 5 decades showed that RT alone can produce median survival times of up to > 30 months and 5-year survival of up to 30%. When cancer-unrelated deaths were taken into account, cause-specific survival rates were usually higher for some 10–15%. Accumulated experience seems to suggest that doses of at least 65 Gy with standard fractionation or its equivalent when altered fractionation is used are necessary for control of the disease. Smaller tumors seem to have favorable prognosis, while the issue of elective nodal RT continues to be controversial. Patterns of failure have clearly identified local failure as the predominant one. Although a number of potential pretreatment patient- and tumor-related prognostic factors have been examined, none has been shown to clearly influenced survival. Toxicity was usually low.
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