Tas Kerem Tuna, Lishewski Phillip, Sheikhzadeh Fatima Frosan, Smalec Edgar, Recknagel Niklas, Wündisch Thomas, Holland Angelique, Kirschbaum Andreas, Elsayad Khalid, Engenhart-Cabillic Rita, Zink Klemens, Vorwerk Hilke, Adeberg Sebastian, Gawish Ahmed
Department of Radiotherapy and Radiation Oncology, Marburg University Hospital, Marburg, Germany.
Department of Radiotherapy and Radiation Oncology, Philipps-Universität Marburg, Marburg, Germany.
Strahlenther Onkol. 2025 Sep 4. doi: 10.1007/s00066-025-02462-4.
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.
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.
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.
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.
单次立体定向体部放射治疗（SBRT）是不适于手术的非小细胞肺癌（NSCLC）患者的一种有效治疗选择。本研究调查高剂量单次SBRT的长期临床结局、预后因素及毒性。
我们回顾性分析了2000年至2023年间接受单次SBRT治疗的110例患者的116个NSCLC病灶。组织学亚型包括腺癌、鳞状细胞癌、大细胞癌以及CT定义的未经组织学证实的可疑病灶。使用Kaplan-Meier和Cox回归模型评估局部控制（LC）、无进展生存期（PFS）和总生存期（OS）。使用CTCAE v4.0评估毒性。
最常用剂量为30 Gy，76.7%的病灶采用此剂量。在接受≥30 Gy治疗的患者中，2年、3年和5年的LC分别为78%、74%和68%；PFS分别为63%、49%和37%；OS分别为84%、83%和60%。接受≥30 Gy治疗的患者LC和PFS显著更高（p<0.05）。2例患者（1.8%）发生急性肺炎，22例患者（20.0%）发生迟发性肺炎。采用3D-CT计划的患者肺炎发生率为26.8%，而采用深吸气屏气（DIBH）或4D-CT的患者为12.8%。未观察到≥3级毒性。
高剂量（≥ 30 Gy）单次SBRT对NSCLC可提供出色的长期肿瘤控制且毒性极小。先进的运动管理技术与降低肺部毒性相关。≥30 Gy剂量显著改善了LC、PFS和OS。较高的查尔森合并症指数（CCI）与较差的OS相关。这些发现支持在选定患者中使用高剂量单次分割SBRT，并强调了个体化治疗计划的必要性。需要进行前瞻性验证。
