Updated February 2008

Guideline: The value of radical radiotherapy alone in unresectable Stage III NSCLC is questionable. Local therapy alone rarely results in a 5 year survival greater than 5% and thus in most instances is palliative in intent. There may be an increased likelihood of local control with the use of higher radiation doses.

Level of Evidence: Ib

Grade of Recommendation: A

Patients with good performance status and minimal weight loss who decline or are unsuitable for combined modality/altered fractionation schemes and whose disease can be readily encompassed in a reasonable radiotherapy volume may be candidates for radical radiotherapy.

The use of radical radiotherapy alone in unresectable Stage III disease is controversial. Radical radiotherapy alone using conventional fractionation (2 Gy or equivalent to a total dose of 60 Gy) has been associated with a median survival of 9 – 12 months. This is not markedly different from that observed with the use of palliative radiotherapy alone in the BCCA experience. Preliminary data regarding the use of altered fractionation schemes (hyperfractionation or CHART) suggests an improvement in the median survival of between 2 – 4 months (similar to combined chemoradiation).