Stereotactic body radiation therapy for early-stage non-small cell lung cancer: a single-institutional retrospective analysis of outcomes and prognostic factors

Résumé fourni par la source

Background Stereotactic body radiotherapy (SBRT) is a definitive treatment for medically inoperable early-stage non-small cell lung cancer (NSCLC), yet optimal dose selection and prognostic factors in elderly, high-risk populations remain debated. This study evaluates long-term outcomes and predictors of survival in a real-world cohort. Methods We retrospectively analyzed 258 patients with T1-2N0M0 NSCLC treated with SBRT at Shandong Cancer Hospital (2017–2022). Inclusion criteria: tumors ≤5 cm, medically inoperable or surgery-refused. Survival outcomes (LC, PFS, CSS, OS) were estimated using Kaplan-Meier curves with log-rank tests. Competing risk regression (Fine-Gray model) was used for cancer-specific survival (CSS), with non-cancer deaths as competing events. Prognostic factors of OS via univariable and multivariable Cox regression. Dose fractionation was individualized (median BED10=100 Gy, range: 75–144 Gy), with strict adherence to RTOG 0236 constraints, using 4D-CT for motion management and daily CBCT for image guidance. Results The cohort comprised predominantly elderly patients (median age: 73 years; 41.5% ≥75 years, 21.3% ≥80 years). At a median follow-up of 38.8 months, 5-year OS, progression-free survival (PFS), local control (LC), and CSS rates were 74.2%, 71.9%, 83.8%, and 84.5% respectively. Competing risks analysis revealed cumulative 5-year cancer-specific mortality of 14.1% (7.6%–20.5%) versus non-cancer mortality of 11.6% (6.8%–16.4%). Multivariable analysis identified lower lobe lung cancer (HR = 2.218, p = 0.014), central tumor location (HR = 2.664, p = 0.003), the larger tumor length (HR = 1.415, p = 0.039), smoking history (HR = 2.328, p = 0.008) and medical inoperable (HR = 2.572, p = 0.007) as independent predictors of poor OS. Despite 21.3% central tumors, toxicity was minimal (grade 3 pneumonitis: 1.6%). Conclusion SBRT achieves durable survival in early-stage NSCLC at our center. Central/lower lobe tumors, bigger tumors, smoking history, and medical inoperable independently predict inferior survival, emphasizing the need for personalized dose escalation strategies or combined treatment modalities.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.