Adding cetuximab to stereotactic radiotherapy for non-small cell lung cancer might reduce local failure rates.

Encouraging results have been obtained with stereotactic body radiation therapy (SBRT) for early stage non-small cell lung cancer (NSCLC). However, local control rates decrease in larger volume disease. Several studies have found a correlation between T stage or tumor volume and local progression-free survival. In many cases with larger tumor volume, sufficiently high radiation doses can not be administered because the tolerance of surrounding normal tissues must be respected. Under such circumstances, simultaneous administration of radiosensitizing agents, which increase tumor cell kill, might improve the therapeutic ratio. Based on sound preclinical evidence and recent data from patients with stage III NSCLC and head and neck cancer, we hypothesize that cetuximab might be an investigational agent that merits further evaluation. The aim of prospective studies of SBRT and cetuximab would be to examine the toxicity profile of the drug in combination with high-dose hypofractionated thoracic radiotherapy and eventually to prove the superiority of combined treatment over SBRT alone. If improved local control rates could be observed, overall survival might improve accordingly.