Retrospective cohort study of safety and efficacy of stereotactic body radiotherapy for central and ultracentral early stage lung tumors

Lung stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) is associated with good clinical outcomes with acceptable toxicities. A retrospective study at the University of Manitoba (Winnipeg, Canada) evaluated SBRT for central and ultracentral early-stage lung tumors. The study included 103 patients (median age 76 years; range 49-90; 64% female) with stage I-IIA central or ultracentral lung tumors who received SBRT at a dose of either 60 Gy in 8 fractions (63.1% of patients) or 50 Gy in 5 fractions (26.9%) from 2013 to 2023. The median tumor size was 2.3 cm (range 1.0-5.0), and 44.7% had cT1b disease, followed by 29.1% with cT2a disease. Fifty-nine patients (57.3%) were diagnosed based on FDG-avid disease, whereas 26 (25.2%) had adenocarcinoma, 17 (16.5%) had squamous cell carcinoma, and one had an adenosquamous tumor. The cohort included 49.5% ultracentral and 50.5% central tumors. The https://www.clinical-lung-cancer.com/cms/10.1016/j.cllc.2026.11.001/asset/feacfee9-92e0-4384-b01b-1aea1ae78f50/main.assets/gr2.jpg 3-year overall survival rate was 54.8%, the 3-year local control rate (with death as competing event) was 84.7%, and the 3-year progression-free survival rate was 44.2%. On multivariable analysis, female sex was associated with improved overall survival and progression-free survival, and ECOG performance status ≥1 with worse overall survival. Ten patients (9.7%) developed late grade 3 dyspnea; no grade 4 or 5 toxicities were seen. The authors conclude that SBRT is an effective treatment for central and ultracentral NSCLC.