Patients with NSCLC or small-cell lung cancer (SCLC) may benefit from radiation therapy as outlined below.

Curative intent radiation therapy may be of benefit to patients who:

• have early-stage (I-II) NSCLC and are unsuitable or unwilling to have surgery
• have locally advanced (III) NSCLC that is inoperable
• have limited-stage (I-III) SCLC and:
  • are having combined modality treatment with chemotherapy
  • may benefit from prophylactic cranial irradiation.

Radiation therapy modalities include stereotactic radiation therapy (eVIQ 2019a).

Palliative intent radiation therapy may benefit all patients with NSCLC or SCLC for palliation of the chest and extrathoracic symptoms.

Timeframe for starting treatment

Radiation therapy should begin within six weeks of the initial specialist referral.

Training and experience required of the appropriate specialists

Fellowship of the Royal Australian and New Zealand College of Radiologists or equivalent, with adequate training and experience, institutional credentialing and agreed scope of practice in lung cancer (ACSQHC 2015).

The training and experience of the radiation oncologist should be documented.

Health service unit characteristics

To provide safe and quality care for patients having radiation treatment, health services should have these features:

• linear accelerator (LINAC) capable of image-guided radiation therapy (IGRT)
• dedicated CT planning
• access to MRI and PET imaging
• automatic record-verify of all radiation treatments delivered
• a treatment planning system
• trained medical physicists, radiation therapists and nurses with radiation therapy experience
• coordination for combined therapy with systemic therapy, especially where facilities are not co-located
• participation in Australian Clinical Dosimetry Service audits
• an incident management system linked with a quality management system