Perspectives of stereotactic radiotherapy in primary and oligo-metastatic pulmonary tumors

Lung cancer (LC) is a common malignant neoplasm (MN) with high lethality, often detected at late stages. The implementation of lung cancer screening can change the ratio in favor of the early stages. Screening could help diagnose early-stage LC in 60% of patients. Multiple primary LCs occur in 4–10% of patients within five years after treatment. The presence of oligo-metastatic disease only in the lungs (up to 5 nodules) occurs in 6-40% of patients with malignant tumors, and complete resection could increase 5-year survival to 20-40%. Due to functional limitations, surgical treatment can be performed only in 65-70% of patients. Stereotactic radiation therapy gives an opportunity to accurately deliver a high dose of radiation to the tumor with minimal damage to the surrounding healthy tissues. Local control is possible in 85–95% of cases, and 3-year overall survival is about 60–80%. New algorithms for fractionation and dose determination (BED10 ≥ 100 Gy) could improve the treatment results for early-stage lung cancer and oligometastatic lesions. In this non-systematic review, we analyze a recent publication and our own experience. We consider the effectiveness and safety of stereotactic radiotherapy and planning, modeling, fractionation, dose restrictions on critical organs, radiation reactions, and adverse events. We conclude that randomized controlled trials can reveal the stereotactic radiation therapy's potential in patients with primary and oligo-metastatic pulmonary tumors.