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Lung Cancer. 2014 Jun;84(3):248-53. doi: 10.1016/j.lungcan.2014.02.015. Epub 2014 Mar 13.

Stereotactic Ablative Radiotherapy for stage I histologically proven non-small cell lung cancer: an Italian multicenter observational study.

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Department of Oncology, Radiation Oncology, University of Torino, via Genova 3, 10126 Torino, Italy.
Bellaria Hospital, Radiation Oncology, via Altura 3, 40139 Bologna, Italy.
Department of Oncology, Radiation Oncology, University of Torino, via Genova 3, 10126 Torino, Italy. Electronic address:
Humanitas Cancer Center, Radiotherapy and Radiosurgery Unit, via Manzoni 56, 20089 Rozzano, Italy.
Institute of Cancer Research and Treatment-IST, University of Genova, Radiation Oncology, Largo Benzi 10, 16132 Genova, Italy.
Institute of Cancer Research and Treatment-CRO, Radiation Oncology, via Gallini 2, 33081 Aviano, Italy.



Aim of this retrospective multicenter observational study was to provide data on outcomes and prognostic factors in patients affected with stage I histologically confirmed NSCLC treated with Stereotactic Ablative Radiotherapy (SABR, or Stereotactic Body Radiotherapy, SBRT) outside clinical trials.


We analyzed a cohort of 196 patients with histological/cytological diagnosis of NSCLC. Median age at treatment was 75 years old; median tumor diameter was 2.48 cm, and median GTV 13.3 cc. One hundred fifty-five patients had stage IA disease (79.1%) and 41 patients stage IB disease (20.9%). Total doses ranged from 48 to 60 Gy in 3-8 fractions. Primary endpoints of the study were safety (acute and late toxicity) and efficacy (Local Control, Disease-Free Survival, Overall and Cancer-Specific Survival).


Median follow-up time was 30 months. The percentage of grade ≥2 pulmonary toxicity was 3%, and the 30 and 60 days mortality rate was 0%. Local Recurrence-Free Survival was 89.7% at 3 years. Fifty-nine patients (30.1%) had at least one failure (local and/or nodal and/or distant), with a Disease-Free Survival (DFS) rate at 3 years of 65.5%. Overall Survival (OS) and Cancer-Specific Survival (CSS) rates were 68% and 82.1% at 3 years, respectively. Median time to any recurrence was 15 months, while median overall survival time was 54 months. At multivariate analysis, stage IB was the only variable associated to a decrease in DFS, OS and CSS (HR 2.77, p = 0.006; HR 2.38, p = 0.009; HR 4.06, p ≤ 0.001, respectively). A difference in survival according to stage was also evident at the log-rank test (p ≤ 0.0001 for CSS and OS).


The results of the present study support the routine use of SABR for stage I NSCLC in a daily practice environment. The only prognostic factor that has been confirmed by our analysis was tumor stage (IA vs. IB).


Early stage; Lung cancer; Non-small cell lung cancer; Radiotherapy; Stereotactic ablative radiotherapy; Stereotactic body radiotherapy

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