In 30% of patients with non-small cell lung cancer, a palliative radiotherapy of the primary tumor is carried out. This is an effective means to achieve lasting symptom control and can lead to a limited prolongation of life. Thus, the indication for palliative radiotherapy can be derived from symptomatic disease both in stage III, without curative treatment options, and in stage IV, while in asymptomatic cases a ‘wait and see’ strategy is justified. In terms of dose prescription, performance status (PS) is one of the most important selection criteria. While patients with a good PS, and especially those with stage III disease, should receive higher doses of, for example, 10×3 Gy, those with disseminated disease and a poor PS are adequately treated with 4×5 Gy.
In addition to further optimization of selection criteria, research is still required to determine a potential benefit for simultaneous radiochemotherapy or the additional administration of novel biologic agents in such patients.