The role of radiation therapy in metastatic disease has evolved from palliative to potentially curative intent for selected oligometastases using highly conformal radiation techniques, including extracranial stereotactic body radiotherapy (SBRT) in the last decade.

SBRT has a potential to use small numbers of large doses aiming at achieving high rates of local control while preserving the quality of life even in highly pretreated patients. A wide range of techniques, doses, and dose fractionation schedules can be found. However, the 2-year local control is around 80% for lung metastases with corresponding 2-year survival of 50%, and a 5% rate of grade III or higher radiation toxicities. The 2-year local control varies between 57 and 92% for liver metastases and radiation-induced liver disease is exceptional provided that 700 cm3 of healthy liver are irradiated to less than 15 Gy in three fractions or more. Stereotactic radiation is also particularly interesting for spinal, and cranial metastases and reirradiations. Also, it has come into focus that associations of chemotherapy or targeted therapies and radiation may be used for optimized treatment of limited metastatic disease and that irradiation of the primary tumor may be recommended in the context of metastatic disease.

It also appears that the definition of target volumes for palliative radiation therapy and scores to assess for life expectancy-based need for irradiation should be improved.

Current estimates of the costs of cancer care in the United States are based on data from 2003 and earlier. However, incidence, survival, and practice patterns have been changing for the majority of cancers.

Neuroendocrine (NE) neoplasms of the lung are a spectrum of tumors including typicalcarcinoid (TC), atypical carcinoid tumor (ACT), small cell lung carcinoma (SCLC), and large cell NEcarcinoma (LCNEC). Given the overlapping features within these tumors, misclassification is a known risk, with significant treatment consequences.

Lung cancer is the leading cause of cancer-related deaths worldwide. Although treatment methods in surgery, irradiation, and chemotherapy have improved, prognosis remains unsatisfactory and developing new therapeutic strategies is still an urgent demand.

Immunotherapy is a novel therapeutic approach wherein activated immune cells can specifically kill tumor cells by recognition of tumor-associated antigens without damage to normal cells. Several lung cancer vaccines have demonstrated prolonged survival time in phase II and phase III trials, and several clinical trials are under investigation. However, many clinical trials involving cancer vaccination with defined tumor antigens work in only a small number of patients. Cancer immunotherapy is not completely effective in eradicating tumor cells because tumor cells escape from host immune scrutiny. Understanding of the mechanism of immune evasion regulated by tumor cells is required for the development of more effective immunotherapeutic approaches against lung cancer.

This paper discusses the identification of tumor antigens in lung cancer, tumor immune escape mechanisms, and clinical vaccine trials in lung cancer.