WCLC 2025 - Posters & ePosters-EP.07.39 Simply the Best: Analysis Of 1000+ Patients Comparing Single-Fraction to Three-Fraction Lung SBRT for Early-Stage Inoperable Lung Cancer

EP.07.39 Simply the Best: Analysis Of 1000+ Patients Comparing Single-Fraction to Three-Fraction Lung SBRT for Early-Stage Inoperable Lung Cancer

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This retrospective single-institution study analyzed outcomes of 1,094 medically inoperable early-stage peripheral non-small cell lung cancer (ES-NSCLC) patients treated with stereotactic body radiation therapy (SBRT) over 21 years, comparing single-fraction (SF, mainly 34 Gy x1) versus three-fraction (TF, mainly 60 Gy and 54 Gy over 3 fractions) regimens. The cohort included 676 SF and 418 TF patients, with median follow-up of 24.4 and 39.8 months respectively. Patient demographics and tumor characteristics were similar across groups, including median age (~74 years), performance status, tumor size (~1.8 cm), and histology (majority adenocarcinoma).<br /><br />Key outcomes showed no statistically significant differences in overall survival (OS) between SF and TF groups: median OS was 43.6 vs 44.7 months, and 5-year OS was 37.5% vs 41.3% (p=0.27). Local failure rates were slightly higher in SF (5.2%) compared to TF (3.1%) with borderline significance (p=0.05), while distant failure rates were comparable (20.1% vs 24.1%, p=0.16). Grade 3 or higher toxicity occurred in 2.4% with no difference by fractionation, including low chest wall toxicity (SF 0.3%, TF 1%). Each group had one treatment-related death from pneumonitis.<br /><br />Multivariate analysis found no patient, tumor, or treatment factors linked to local failure; distant failure was significantly associated with tumor histology. Overall survival was influenced by age, performance status, gender, and tumor size but not fractionation schedule.<br /><br />The findings suggest that single-fraction SBRT is non-inferior to three-fraction regimens regarding survival, toxicity, and recurrence patterns in medically inoperable ES-NSCLC patients. Given similar efficacy and safety profiles, SF SBRT may be favored for its logistical and resource advantages. This analysis helps address the clinical question of optimal lung SBRT fractionation in the absence of a randomized phase III trial.

Asset Subtitle

Gregory Videtic

Meta Tag

Speaker Gregory Videtic

Topic Early-Stage Non-small Cell Lung Cancer

Keywords

non-small cell lung cancer

early-stage NSCLC

stereotactic body radiation therapy

single-fraction SBRT

three-fraction SBRT

overall survival

local failure

distant failure

toxicity

medically inoperable