{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T05:23:57Z","timestamp":1791869037905,"version":"4.3.4"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2024,11,1]]},"abstract":"\n Importance<\/jats:title>\n Stereotactic body radiotherapy (SBRT) is widely used for stage I medically inoperable non\u2013small cell lung cancer (NSCLC), yet varied results from randomized clinical trials (RCTs) and concerns in treating centrally located tumors persist.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine whether SBRT would improve local control (LC) compared with hypofractionated conventional radiotherapy (CRT).<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This phase 3 RCT was conducted in 16 Canadian centers. Patients with medically inoperable stage I (\u22645 cm) NSCLC were randomized 2:1 to SBRT of 48 Gy in 4 fractions (peripheral NSCLC) or 60 Gy in 8 fractions (central NSCLC) vs CRT of 60 Gy in 15 fractions. Data were collected from May 2014 to January 2020, and data were analyzed from July 2022 to July 2023.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n SBRT or CRT.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary objective was to determine the effectiveness of SBRT compared with CRT based on LC at 3 years. Secondary outcomes included event-free survival, overall survival, and toxic effects. All radiation plans were subject to real-time\/final review. Local failures were centrally adjudicated. The study was designed to detect a 3-year LC improvement of SBRT from 75% to 87.5%. The target sample size was 324 patients.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 233 included patients, 119 (51.1%) were male, and the mean (SD) age was 75.4 (7.7) years; the median (IQR) follow-up was 36.1 (26.4-52.8) months. A total of 154 patients received SBRT and 79 received CRT. The 3-year LC was 87.6% (95% CI, 81.9%-93.4%) for SBRT and 81.2% (95% CI, 71.9%-90.5%) for CRT (hazard ratio [HR], 0.61; 95% CI, 0.31-1.20;\n P<\/jats:italic>\n \u2009=\u2009.15). The HR was 1.02 (95% CI, 0.72-1.45;\n P<\/jats:italic>\n \u2009=\u2009.87) for event-free survival and 1.18 (95% CI, 0.80-1.76;\n P<\/jats:italic>\n \u2009=\u2009.40) for overall survival. Minimal acute toxic effects were observed. Among those randomized to SBRT, late grade 3 or 4 toxic effects occurred in 5 of 45 (11%) with central NSCLC and 2 of 109 (1.8%) with peripheral NSCLC; among those randomized to CRT, in 1 of 19 (5%) with central NSCLC and 1 of 60 (2%) with peripheral NSCLC. One patient who received SBRT for an ultracentral lesion (target overlapping proximal bronchus) experienced a possible treatment-related grade 5 event (hemoptysis).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This RCT compared lung SBRT with hypofractionated CRT that included central\/ultracentral tumors. No difference was detected in LC between groups. Severe toxic effects were limited, including patients with central tumors. The trial provides important prospective data evaluating SBRT; however, further research is necessary to determine if SBRT is more effective than CRT for peripheral and central NSCLC.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03924869<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaoncol.2024.3089","type":"journal-article","created":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T11:59:57Z","timestamp":1726747197000},"page":"1571","source":"Crossref","is-referenced-by-count":37,"title":["Stereotactic vs Hypofractionated Radiotherapy for Inoperable Stage I Non\u2013Small Cell Lung Cancer"],"prefix":"10.1001","volume":"10","author":[{"given":"Anand","family":"Swaminath","sequence":"first","affiliation":[{"name":"Department of Oncology, McMaster University, and the Division of Radiation Oncology Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameer","family":"Parpia","sequence":"additional","affiliation":[{"name":"Department of Oncology, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"Wierzbicki","sequence":"additional","affiliation":[{"name":"Juravinski Cancer Centre, Department of Medical Physics, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijayananda","family":"Kundapur","sequence":"additional","affiliation":[{"name":"Saskatchewan Cancer Agency, Department of Radiation Oncology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Faria","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon S.","family":"Okawara","sequence":"additional","affiliation":[{"name":"Department of Oncology, McMaster University, and the Division of Radiation Oncology Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodoros K.","family":"Tsakiridis","sequence":"additional","affiliation":[{"name":"Department of Oncology, McMaster University, and the Division of Radiation Oncology Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naseer","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Section of Radiation Oncology, Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba and CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Bujold","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Radio-oncologie Clinique-Enseignement-Recherche, Centre int\u00e9gr\u00e9 universitaire de soins et services sociaux de l\u2019Est-de-l\u2019\u00cele-de-Montr\u00e9al - H\u00f4pital Maisonneuve-Rosemont, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Hirmiz","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Windsor Regional Cancer Centre, Windsor, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Owen","sequence":"additional","affiliation":[{"name":"Department of Oncology, Queen\u2019s University, Cancer Centre of Southeast Ontario at Kingston Health Sciences Centre, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson","family":"Leong","sequence":"additional","affiliation":[{"name":"Allan Blair Cancer Centre, Department of Radiation Oncology, University of Saskatchewan, Regina, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Ramchandar","sequence":"additional","affiliation":[{"name":"Department of Oncology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edith","family":"Filion","sequence":"additional","affiliation":[{"name":"Radiation Oncology Department, Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al, Notre Dame Hospital, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harold","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Oncology, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zsolt","family":"Gabos","sequence":"additional","affiliation":[{"name":"Department of Oncology, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Dalhousie University, Saint John, New Brunswick, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Yaremko","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selma","family":"Mehiri","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Radio-oncologie, CISSS Mont\u00e9r\u00e9gie, H\u00f4pital Charles Lemoyne, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander 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