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Lung: Radical RT/SABR for early NSCLC

Free question published 20 July 2026

RespiratoryRadical RT/SABR for early NSCLC

A 78-year-old man with severe COPD (FEV1 38% predicted) is found to have a 2.4 cm peripheral right upper lobe nodule. Biopsy confirms adenocarcinoma. FDG-PET-CT shows no nodal or distant uptake, staged T1cN0M0. The respiratory MDT and cardiothoracic surgeons agree he is medically inoperable. He has WHO performance status 1. What is the most appropriate radical treatment?

  1. AStereotactic ablative body radiotherapy (SABR)
  2. BConventionally fractionated radiotherapy 66 Gy in 33 fractions
  3. CConcurrent chemoradiotherapy
  4. DRadiofrequency ablation
  5. EBest supportive care alone

Why A is correct

NICE NG122 recommends offering SABR to people with stage I-IIA NSCLC who decline surgery or in whom surgery is contraindicated. The CHISEL trial showed SABR (54 Gy in three fractions for peripheral lesions) improved freedom from local treatment failure compared with conventional radiotherapy (HR 0.32) without increased major toxicity, supporting SABR as the treatment of choice for inoperable peripheral stage 1 NSCLC.

And why the others are not

  • BConventional radiotherapy is the fallback only if SABR is contraindicated; CHISEL showed it gives inferior local control, so it is not first choice for a peripheral lesion amenable to SABR.
  • CConcurrent chemoradiotherapy is reserved for locally advanced (stage III) disease, not a single small node-negative tumour, and would add unjustified toxicity in a frail patient.
  • DRadiofrequency ablation is not the NICE-recommended radical modality for stage I NSCLC; SABR has the stronger evidence base for local control.
  • EBest supportive care alone forgoes a curative-intent option in a patient with good performance status and a small early-stage tumour.

Source NICE NG122 - Lung cancer: diagnosis and management — National Institute for Health and Care Excellence. Lung cancer: diagnosis and management. NICE guideline NG122. Published 28 March 2019, last updated 08 March 2024.

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