Multicenter phase 3 trial of SBRT versus hypofractionated conventional radiotherapy for inoperable stage I non-small cell lung cancer

Stereotactic body radiotherapy (SBRT) is widely used for stage I inoperable non-small cell lung cancer (NSCLC), yet varied results from randomized trial and concerns in treating centrally located tumors persist. The phase 3 LUSTRE trial, at 16 centers in Canada, compared SBRT versus hypofractionated conventional radiotherapy (CRT) for inoperable stage I NSCLC. The trial randomized 233 patients 2:1 to receive SBRT of 48 Gy in 4 fractions for peripheral tumors or 60 Gy in 8 fractions for central tumors (n=154) or CRT of 60 Gy in 15 fractions (n=79). Among patients randomized to SBRT, there was a nonsignificant improvement in local control compared with CRT at 3 years, and severe toxic effects were low, including in patients with central disease. The authors conclude that SBRT resulted in acceptable tumor control compared with CRT with limited toxic effects (visual abstract).