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Background <p>Single-fraction stereotactic body radiotherapy (SBRT) is an effective treatment option for patients with non-small cell lung cancer (NSCLC) who are ineligible for surgery. This study investigates long-term clinical outcomes, prognostic factors, and toxicity associated with high-dose single-fraction SBRT.</p> Materials and methods <p>We retrospectively analyzed 110 patients with 116 NSCLC lesions treated with single-fraction SBRT between 2000 and 2023. Histologic subtypes included adenocarcinoma, squamous cell carcinoma, large cell carcinoma, and CT-defined suspicious lesions without histological confirmation. Local control (LC), progression-free survival (PFS), and overall survival (OS) were assessed using Kaplan-Meier and Cox regression models. Toxicity was evaluated using CTCAE v4.0.</p> Results <p>The most common dose was 30 Gy, prescribed in 76.7% of lesions. Among patients who received ≥ 30 Gy, LC at&#xa0;2, 3, and 5&#xa0;years was 78%, 74%, and 68%; PFS was 63%, 49%, and 37%; and OS was 84%, 83%, and 60%, respectively. LC and PFS were significantly higher in patients treated with ≥ 30 Gy (<i>p</i> &lt; 0.05).</p> <p>Acute pneumonitis occurred in 2&#xa0;patients (1.8%), and 22&#xa0;patients (20.0%) developed late-onset pneumonitis. Pneumonitis incidence was 26.8% in patients planned with 3D-CT, compared to 12.8% with DIBH or 4D-CT. No grade ≥ 3&#xa0;toxicity was observed.</p> Conclusion <p>High-dose (≥ 30 Gy) single-fraction SBRT provides excellent long-term tumor control with minimal toxicity with NSCLC. Advanced motion management techniques were associated with reduced pulmonary toxicity. A ≥ 30 Gy dose significantly improved LC, PFS, and OS. Higher Charlson Comorbidity Index (CCI) was associated with worse OS. These findings support the use of high-dose SF-SBRT in selected patients and highlight the need for individualized treatment planning. Prospective validation is warranted.</p>

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From protocol to practice: long-Term outcomes of single-Fraction stereotactic body radiotherapy for primary non-Small cell lung cancer

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月4日

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  • Kerem Tuna Tas,
  • Philipp Lishewski,
  • Fatima Frosan Sheikhzadeh,
  • Edgar Smalec,
  • Niklas Recknagel,
  • Thomas Wündisch,
  • Angelique Holland,
  • Andreas Kirschbaum,
  • Khaled Elsayad,
  • Rita Engenhart-Cabillic,
  • Klemens Zink,
  • Hilke Vorwerk,
  • Sebastian Adeberg,
  • Ahmed Gawish

摘要

Background

Single-fraction stereotactic body radiotherapy (SBRT) is an effective treatment option for patients with non-small cell lung cancer (NSCLC) who are ineligible for surgery. This study investigates long-term clinical outcomes, prognostic factors, and toxicity associated with high-dose single-fraction SBRT.

Materials and methods

We retrospectively analyzed 110 patients with 116 NSCLC lesions treated with single-fraction SBRT between 2000 and 2023. Histologic subtypes included adenocarcinoma, squamous cell carcinoma, large cell carcinoma, and CT-defined suspicious lesions without histological confirmation. Local control (LC), progression-free survival (PFS), and overall survival (OS) were assessed using Kaplan-Meier and Cox regression models. Toxicity was evaluated using CTCAE v4.0.

Results

The most common dose was 30 Gy, prescribed in 76.7% of lesions. Among patients who received ≥ 30 Gy, LC at 2, 3, and 5 years was 78%, 74%, and 68%; PFS was 63%, 49%, and 37%; and OS was 84%, 83%, and 60%, respectively. LC and PFS were significantly higher in patients treated with ≥ 30 Gy (p < 0.05).

Acute pneumonitis occurred in 2 patients (1.8%), and 22 patients (20.0%) developed late-onset pneumonitis. Pneumonitis incidence was 26.8% in patients planned with 3D-CT, compared to 12.8% with DIBH or 4D-CT. No grade ≥ 3 toxicity was observed.

Conclusion

High-dose (≥ 30 Gy) single-fraction SBRT provides excellent long-term tumor control with minimal toxicity with NSCLC. Advanced motion management techniques were associated with reduced pulmonary toxicity. A ≥ 30 Gy dose significantly improved LC, PFS, and OS. Higher Charlson Comorbidity Index (CCI) was associated with worse OS. These findings support the use of high-dose SF-SBRT in selected patients and highlight the need for individualized treatment planning. Prospective validation is warranted.