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In treating locally advanced non-small-cell lung cancer (NSCLC), radio-tolerance of the normal lung often limits the amount of dose that can be delivered to the primary cancer site. Radiation-related pneumonitis (RP) and other normal lung tissue complications have a significant impact on clinical outcome and patient quality of life. How to minimize treatment side effects while achieving desirable local control of lung cancers has been a continuous challenge. Functional imaging-guided radiotherapy, which can achieve a local boost of primary cancer site or functional avoidance of normal organs, has been increasingly utilized in clinics. Various imaging approaches have been employed to achieve functional imaging guidance and implemented in different treatment regimens. There are several on-going clinical trials aiming to evaluate the clinical outcomes that are utilizing functional imaging-guided photon radiation to spare the high functioning portions of the lungs. The main applications of functional imaging-guided radiotherapy in the management of NSCLC patients will be discussed in this review.

Functional Imaging-guided Radiotherapy for Locally Advanced Non-Small-Cell Lung Cancer: Review