Practical considerations of lung stereotactic ablative radiotherapy in the developing world

Lung cancer is the most common cause of cancer-related death in the world with a disproportionally high burden of disease in low- and middle-income countries (LMICs). Stereotactic ablative radiotherapy (SABR) is the standard of care treatment for inoperable patients with early-stage non-small cell lung cancer (ES-NSCLC) and is currently being evaluated in several randomized control trials in the operable patient setting. SABR for ES-NSCLC has been widely implemented throughout high-income countries (HICs), yet its implementation in LMICs, where the burden of disease is highest, has been limited. The purpose of this report is to provide a practical outline for practitioners to implement SABR for ES-NSCLC while addressing potential barriers that may arise in LMICs. We ultimately aim to describe the essential infrastructure, patient selection, human resources, technical requirements, radiation therapy (RT) planning, RT delivery, patient follow up, quality assurance (QA), and cost considerations required to effectively and safely deliver SABR for ES-NSCLC.