The clinical practice of lung oncology has undergone a radical change within the last 20 years, with the establishment of a multidisciplinary team working to ensure guideline-recommended staging procedures and treatments. A prospective national audit program showed a significant improvement in survival across all disease stages and improvements documented in all treatment modalities in the UK. This article focuses on the planning and delivery of radiotherapy, which has benefited from several significant developments. Four-dimensional computed tomography scanning and intensity-modulated radiotherapy have transformed treatment planning, and online imaging with cone-beam computed tomography has significantly improved the accuracy of delivery.
In the absence of similar reported outcomes for the sequentially treated patients, these data and the recently reported gain in survival with durvalumab after concurrent chemoradiotherapy should be swinging us towards using the contemporary approach at least for those patients who meet the trial eligibility criteria. Outdated practices and nihilist attitudes in multidisciplinary teams need to change, and access to optimal radiotherapy with intravenous contrast, motion management, and intensity-modulated radiotherapy planning in addition to cone-beam computed tomography image-guided delivery need to be ensured. It is essential to note the completeness of the dataset reported in these two important articles. With the methods to continue assessing the data on an annual basis, the team involved in the National Lung Cancer Audit over the next few years stands to contribute significantly to ensuring practice-changing evidence is implemented widely for our patients’ benefit.