Mise au point sur la radiothérapie en conditions stéréotaxiques pour la prise en charge des cancers bronchiques non à petites cellules localisés

Abstract

Surgery remains the reference treatment for stage T1-T2 N0 primary non-small cell lung cancer (segmentectomy of lobectomy with lymph nodes dissection). For patients with surgical contraindication or refusing surgery, stereotactic radiotherapy is the standard alternative treatment allowing high local control rate and low toxicity for peripheral lesions. Some complex situations must be identified such as the presence of an interstitial lung fibrosis and the central location with the proximity of hollow organs (bronchi and esophagus), sensitive to high doses per fraction. The ultracentral location is particularly at risk of serious complications and should prompt a discussion about switching to a moderately hypofractionated treatment. The interest in combining stereotactic radiotherapy with systemic treatment, and in particular immunotherapy, is currently being evaluated. Radiological evaluation after stereotactic radiotherapy is quite challenging because of the presence of lesions of radiation pneumonitis which must not be confused with tumour recurrence.