ABSTRACT
Locally advanced non-small cell lung cancer (NSCLC) encompasses a heterogeneous collection of tumour and nodal stages. Despite recent advances, the overall survival for this group remains poor. Radical radiotherapy remains the mainstay of treatment. The complexities involved in the delivery of radical radiotherapy to the lung pertain to tumour volume definition, intra- and inter-fraction motion (namely tumour motion caused by respiration and GTV migration during treatment) and the proximity of organs at risk to the high-dose region. Here we discuss a selection of strategies to manage these complexities. Motion management can be addressed by 4D CT planning, radiotherapy gating and on-board imaging, including cone beam CT. Advanced planning methods such as intensity modulated radiotherapy may potentially allow dose escalation and sparing of normal tissue toxicity. Functional imaging has already improved our ability to stage tumours and more carefully select appropriate candidates for radical treatment. Better imaging also improves GTV definition. However, the complexities of image acquisition and interpretation need to be accounted for and agreed consensus protocols have yet to be defined. Novel imaging methods such as 4D PET-CT and 4D MRI may also yield improvements for the future and these are briefly discussed.