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(often on a daily basis) just before radiotherapy is delivered

to allow positional correction if necessary so that the dose is

correctly delivered to the target. This can be achieved with CT

imaging or by implanting radio-opaque seeds, which allows

the target to be identified using treatment x rays. This assures

accurate treatment of the tumour and potentially allows

smaller safety margins to be used, thereby sparing healthy


Stereotactic radiotherapy (SRT):

SRT involves highly

targeted treatment. It has been used for many years to treat

a variety of brain lesions, using traditional fractionations

such as 60 Gy in 30 fractions. More recently it has been used

to treat small discrete lesions in a limited number (one to

five) of higher dose fractions Stereotactic radiosurgery refers

to SRT delivered in just one session. Stereotactic ablative

radiotherapy (SABR), also known as stereotactic body

radiotherapy, refers to precise irradiation of extracranial

lesions. As a result of improvements in image guidance, it is

now increasingly offered for sites including the lung, prostate,

liver, and pancreas


Protonbeamtherapy isanestablished

technology that uses protons rather than photons to deliver

the radiation dose. The physical properties of protons enable

the dose to be deposited up to, but not beyond, a specific

depth within tissue. When compared with photons, this

limited range allows improved target volume coverage, with

reduced doses to the normal tissue beyond. This is expected

to reduce the risks of late effects, including second cancers

and cardiovascular risk, which are particularly relevant when

treating children and young adults.

The future of radiotherapy:

The evolution of radiotherapy

will continue, fuelled by improvements in imaging, computing,

and engineering, combined with a greater understanding of

tumour biology. Ensuring the availability of newly established

techniques to patients who would benefit from them poses

an important challenge, particularly in the face of economic

constraints. It is hoped that more precise delivery of

radiotherapy coupled with strategies to enhance tumour cell

killing, such as chemoradiation, will enable more cancers to

be cured with fewer side effects.

Global treatment time can also be shortened favoring those

patients facing logistical and socio-economic difficulties

(access to radiotherapy services, for example): several studies

support “hypofractionated regimens”, rapid treatment

schemes with higher daily doses and shorter total treatment

time, as a viable alternative to conventional radiotherapy,

generally delivered in 5–7 weeks.

Disclosure of interest:

None declared



Andrea Luciani

Ospedale S. Paolo, Medical Oncology, Milan, Italy

The speaker abstract has not been received at the time of






Andrea Luciani

Ospedale S. Paolo, Medical Oncology, Milan, Italy

Lung cancer is the leading cause of cancer death in most

countries. Non-small-cell lung cancer (NSCLC) accounts for

80% to 85% of lung cancer. The median age at the diagnosis

is 70 and less than 5% of patients are under 50 years old. A

recent evidence of more than 1500 patients with lung cancer

showed that the prognosis of patients 40 years or younger

with metastatic disease is no better than that of patients

older than 70 years, whereas patients in other age categories

have improved prognosis compared with the oldest age

group. As most patients with NSCLC are detected with locally

advanced or metastatic disease they have a poor survival.

In the metastatic setting guideline recommend, for patients

with performance status (PS) of 0 or 1, a combination of two

cytotoxic drugs with a preference of platinum combinations

over non-platinum therapy. Elderly patients are candidates

for monotherapy. However, in a clinical trial Carboplatin +

Taxol is superior to monotherapy in older people in terms

of overall survival and progression free survival but with a

worse toxicity profile. As most of lung cancer patients are

smokers or past smokers carrying with them some relevant

cardiovascular and respiratory comorbidities, they represent a

difficult population to be treated properly.The use of a geriatric

assessment (CGA) is mandatory and has a pivotal role for

risk assessment and tailoring treatment. It gives an estimate

of the residual life expectancy and evaluates the weight of

comorbidities, the social conditions and nutritional status.

Early evidence showed that baseline IADLs impairment are

predictive of overall survival in advanced non-small cell lung

cancer. The main challenge in older patients with advanced

non-small cell lung cancer is to balance the risk and the

benefit of a cancer treatment. The border between the benefit

and the harm in these patients is thin and PS alone cannot be

exhaustive. Frequently fit patients are undertreated even if the

evidence of the beneficial effect of palliative chemotherapy is

well known. Equally, unfit patients are generally over treated

with unacceptable toxicities, treatment related mortality and

use of resources. In a recent randomized trial a CGA-guided

approach seems to minimize undertreatment, by increasing

the percentage of patients who received standard-of-care

combination chemotherapy, as well as overtreatment, by

identifying patients who may be more appropriate for best

supportive care. Even if CGA-guided approach is not superior

to the standard approach, it demonstrated less toxicity.

The French group analyzed the impact of Quality of life at

the diagnosis and found that it seems to be an important

prognostic factor for overall survival.

Last and not least, the clinicians should consider early

palliative care support for these patients as it has demon-

strated to improve overall survival when considered at the

beginning of clinical course in advanced disease.

Small-cell lung cancer (SCLC) is a highly aggressive as well

as mortal disease both in younger and older patients. A recent