Selection criteria for definitive treatment approach in thoracic malignancies: radiation oncology perspective

Abstract

Although surgical resection is directly related with anatomic boundaries and as a summary an all-or-none modality, even surgical prognosticators to define post-resection functional status could remain suboptimal. Radiotherapy, on the other site, is not an anatomical dissection, not a straightforward modality, and cannot be easily defined in numbers because of lack of correlation of effected anatomic units and heterogeneity of the effect on each unit. So evaluation before radiotherapy is overall a risk assessment with the baseline functional status and radiotherapy-induced expected loss in the function. Radiotherapy-triggered changes are gradual over time, sometimes as unusual reactions or hypersensitivity pneumonitis, and the compensation by the unirradiated lung is unpredictable. Overall, a radiation oncologist is expected to minimize the potential toxicity risks in an environment of various combinations of medical inoperability, poor pulmonary functionality, riskily localized or large parenchyma endangering bulky tumors, etc. and is mostly asked to be prepared to accept potential morbidities in this referred population with great expectations who will face a certain death if not treated.