Pros: should a medically inoperable patient with a T2N0M0 non-small cell lung cancer central in the lung hilus be treated using stereotactic body radiotherapy?
The view that surgery represents the only curative treatment for non-small cell lung cancer (NSCLC) still prevails today. Perhaps the greatest achievement of stereotactic body radiotherapy (SBRT) has been to challenge this, providing a platform to promote radiotherapy as an effective curative treatment that should be considered alongside surgery (1). The impact of this is clearest when considering populationbased outcomes from national cancer registries. In the Netherlands, the widespread implementation of SBRT has increased radiotherapy utilization, decreased the proportion of patients left untreated and as a consequence improved NSCLC survival (2). The logistic benefits of SBRT courses over conventional radiotherapy has clearly played a role in this, providing a treatment option for the elderly or those with significant comorbidities who might not otherwise be offered curative treatment. These patients represent the fastest growing population of lung cancer patients (3) and a proportion will have central tumors for which conventional radiotherapy is infeasible. The primary argument as to whether to use SBRT for central tumors rests with maintaining population survival gains and weighing the risks of harm against those of not offering curative treatment.