{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T13:28:09Z","timestamp":1784640489025,"version":"3.55.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T00:00:00Z","timestamp":1752710400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T00:00:00Z","timestamp":1752710400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Radiat Oncol"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Lung cancer primarily affects elderly individuals and is the leading cause of cancer-related death in people aged 80 years and older. In addition, the incidence of multiple primary lung cancer (MPLC) is increasing worldwide. Although surgery is recommended as the standard of care, many elderly patients are considered medically unsuitable, or they refuse surgery. The role of stereotactic body radiotherapy (SBRT) as an alternative treatment option for these elderly patients, particularly those with multiple primary lung cancer, has not been fully elucidated. Therefore, the aim of this study was to report the outcome and toxicities associated with SBRT for histologically confirmed early-stage non-small cell lung cancer (NSCLC) and synchronous and metachronous multiple primary lung cancer in patients aged\u2009\u2265\u200980 years.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This retrospective study included 118 patients aged\u2009\u2265\u200980 years with a total of 141 SBRT-treated primary lung cancers (19 patients with MPLC). We assessed local control (LC), progression-free survival (PFS), overall survival (OS) and cancer-specific survival (CSS). We further evaluated toxicities and factors impacting therapeutic efficacy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The median follow-up after SBRT was 47 months (range 3\u2013169 months). The LC rate was 96.2% (95% CI: 90.1 to 98.6%) two years and 86.4% (71.8 to 93.8%) five years after SBRT for NSCLC\/MPLC. The PFS and OS rates were 67.0% (57.4 to \u2212\u200974.9%) and 74.7% (65.4 to \u2212\u200981.1%), respectively, after two years and 24.7% (14.5 to 35.6%) and 30.2% (19.4 to 41.7%), respectively, after five years. The CSS rate was 88.6% (80.3\u201393.6%) at two years and 76.6% (61.4\u201386.4%) at 5 years after SBRT. Age and the Charlson Comorbidity Index score were found to be independent predictors of OS and PFS. Predictors other than these patient-related factors could not be identified. Toxicities higher than Grade 2 after SBRT of NSCLC and MPLC were not observed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>This study emphasises the efficacy and safety of SBRT in the treatment of early-stage NSCLC in patients aged\u2009\u2265\u200980 years, including those with MPLC. SBRT proves to be an appropriate treatment modality for this frail patient group, as it provides favourable LC and CSS rates with low toxicity.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s13014-025-02693-w","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T17:59:45Z","timestamp":1752775185000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Stereotactic body radiotherapy for single and multiple early-stage non-small cell lung cancer in patients aged\u2009\u2265\u200980 years"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1711-1604","authenticated-orcid":false,"given":"Samuel M.","family":"Vorbach","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Seppi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan C.","family":"Peeken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Sarcletti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Pointner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"H\u00f6rmandinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Mangesius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meinhard","family":"Nevinny-Stickel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ute","family":"Ganswindt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,17]]},"reference":[{"issue":"3","key":"2693_CR1","first-page":"335","volume":"102","author":"AL Oliver","year":"2022","unstructured":"Oliver AL. Lung cancer: epidemiology and screening. Surg Clin. 2022;102(3):335\u201344.","journal-title":"Surg Clin"},{"issue":"3","key":"2693_CR2","doi-asserted-by":"publisher","first-page":"220","DOI":"10.21037\/tlcr.2018.05.06","volume":"7","author":"PM de Groot","year":"2018","unstructured":"de Groot PM, Wu CC, Carter BW, Munden RF. The epidemiology of lung cancer. Translational Lung cancer Res. 2018;7(3):220.","journal-title":"Translational Lung cancer Res"},{"issue":"1","key":"2693_CR3","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/S1010-7940(02)00661-9","volume":"23","author":"K Yamamoto","year":"2003","unstructured":"Yamamoto K, Padilla Alarc\u00f3n J, Calvo Medina V, Garc\u00eda-Zarza A, Pastor Guillen J, Blasco Armengod E, et al. Surgical results of stage I non-small cell lung cancer: comparison between elderly and younger patients. Eur J Cardiothorac Surg. 2003;23(1):21\u20135.","journal-title":"Eur J Cardiothorac Surg"},{"key":"2693_CR4","doi-asserted-by":"publisher","first-page":"1912","DOI":"10.1245\/s10434-009-0475-8","volume":"16","author":"K Sigel","year":"2009","unstructured":"Sigel K, Bonomi M, Packer S, Wisnivesky J. Effect of age on survival of clinical stage I non-small-cell lung cancer. Ann Surg Oncol. 2009;16:1912\u20137.","journal-title":"Ann Surg Oncol"},{"key":"2693_CR5","doi-asserted-by":"crossref","unstructured":"Aoki S, Onishi H, Karube M, Yamamoto N, Yamashita H, Shioyama Y et al. Comparative analysis of photon stereotactic radiotherapy and Carbon-Ion radiotherapy for elderly patients with stage I Non-Small-Cell lung cancer: A multicenter retrospective study. Cancers (Basel). 2023;15(14):3633","DOI":"10.3390\/cancers15143633"},{"issue":"1","key":"2693_CR6","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s13014-021-01769-7","volume":"16","author":"K Watanabe","year":"2021","unstructured":"Watanabe K, Katsui K, Sugiyama S, Yoshio K, Kuroda M, Hiraki T, et al. Lung stereotactic body radiation therapy for elderly patients aged\u2009\u2265\u200980 years with pathologically proven early-stage non-small cell lung cancer: a retrospective cohort study. Radiat Oncol. 2021;16(1):39.","journal-title":"Radiat Oncol"},{"key":"2693_CR7","doi-asserted-by":"crossref","unstructured":"Kimura T, Nagata Y, Eba J, Ozawa S, Ishikura S, Shibata T, et al. A randomized phase III trial of comparing two dose-fractionations stereotactic body radiotherapy (SBRT) for medically inoperable stage IA non-small cell lung cancer or small lung lesions clinically diagnosed as primary lung cancer: Japan clinical oncology group study JCOG1408 (J-SBRT trial). Oxford University Press; 2017.","DOI":"10.1093\/jjco\/hyw198"},{"issue":"5","key":"2693_CR8","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1016\/j.ijrobp.2018.11.051","volume":"103","author":"GM Videtic","year":"2019","unstructured":"Videtic GM, Paulus R, Singh AK, Chang JY, Parker W, Olivier KR, et al. Long-term follow-up on NRG oncology RTOG 0915 (NCCTG N0927): a randomized phase 2 study comparing 2 stereotactic body radiation therapy schedules for medically inoperable patients with stage I peripheral non-small cell lung cancer. Int J Radiation Oncology* Biology* Phys. 2019;103(5):1077\u201384.","journal-title":"Int J Radiation Oncology* Biology* Phys"},{"issue":"5","key":"2693_CR9","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1016\/j.ijrobp.2015.07.2278","volume":"93","author":"Y Nagata","year":"2015","unstructured":"Nagata Y, Hiraoka M, Shibata T, Onishi H, Kokubo M, Karasawa K, et al. Prospective trial of stereotactic body radiation therapy for both operable and inoperable T1N0M0 non-small cell lung cancer: Japan clinical oncology group study JCOG0403. Int J Radiation Oncology* Biology* Phys. 2015;93(5):989\u201396.","journal-title":"Int J Radiation Oncology* Biology* Phys"},{"issue":"10","key":"2693_CR10","doi-asserted-by":"publisher","first-page":"1448","DOI":"10.1016\/S1470-2045(21)00401-0","volume":"22","author":"JY Chang","year":"2021","unstructured":"Chang JY, Mehran RJ, Feng L, Verma V, Liao Z, Welsh JW, et al. Stereotactic ablative radiotherapy for operable stage I non-small-cell lung cancer (revised STARS): long-term results of a single-arm, prospective trial with prespecified comparison to surgery. Lancet Oncol. 2021;22(10):1448\u201357.","journal-title":"Lancet Oncol"},{"issue":"5","key":"2693_CR11","doi-asserted-by":"publisher","first-page":"1352","DOI":"10.1016\/j.ijrobp.2009.07.1751","volume":"81","author":"H Onishi","year":"2011","unstructured":"Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi K, et al. Stereotactic body radiotherapy (SBRT) for operable stage I non\u2013small-cell lung cancer: can SBRT be comparable to surgery? Int J Radiation Oncology* Biology* Phys. 2011;81(5):1352\u20138.","journal-title":"Int J Radiation Oncology* Biology* Phys"},{"issue":"5","key":"2693_CR12","doi-asserted-by":"publisher","first-page":"725","DOI":"10.17219\/acem\/68631","volume":"27","author":"AM Romaszko","year":"2018","unstructured":"Romaszko AM, Doboszy\u0144ska A. Multiple primary lung cancer: a literature review. Adv Clin Exp Med. 2018;27(5):725\u201330.","journal-title":"Adv Clin Exp Med"},{"issue":"4","key":"2693_CR13","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1016\/S0022-5223(19)40289-4","volume":"70","author":"N Martini","year":"1975","unstructured":"Martini N, Melamed MR. Multiple primary lung cancers. J Thorac Cardiovasc Surg. 1975;70(4):606\u201312.","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2693_CR14","doi-asserted-by":"publisher","first-page":"1392969","DOI":"10.3389\/fonc.2024.1392969","volume":"14","author":"H Dong","year":"2024","unstructured":"Dong H, Tian Y, Xin S, Jiang S, Guo Y, Wan Z, et al. Diagnosis and management of multiple primary lung cancer. Front Oncol. 2024;14:1392969.","journal-title":"Front Oncol"},{"issue":"3","key":"2693_CR15","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1016\/j.radonc.2013.04.026","volume":"107","author":"GH Griffioen","year":"2013","unstructured":"Griffioen GH, Lagerwaard FJ, Haasbeek CJ, Smit EF, Slotman BJ, Senan S. Treatment of multiple primary lung cancers using stereotactic radiotherapy, either with or without surgery. Radiother Oncol. 2013;107(3):403\u20138.","journal-title":"Radiother Oncol"},{"issue":"3","key":"2693_CR16","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1016\/j.athoracsur.2008.05.041","volume":"86","author":"M Riquet","year":"2008","unstructured":"Riquet M, Cazes A, Pfeuty K, Ngabou UD, Foucault C, Dujon A, et al. Multiple lung cancers prognosis: what about histology? Ann Thorac Surg. 2008;86(3):921\u20136.","journal-title":"Ann Thorac Surg"},{"issue":"7","key":"2693_CR17","doi-asserted-by":"publisher","first-page":"930","DOI":"10.1097\/JTO.0b013e3181e15d8c","volume":"5","author":"H Asamura","year":"2010","unstructured":"Asamura H. Multiple primary cancers or multiple metastases, that is the question. J Thorac Oncol. 2010;5(7):930\u20131.","journal-title":"J Thorac Oncol"},{"issue":"3","key":"2693_CR18","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1159\/000503095","volume":"12","author":"F Azam","year":"2019","unstructured":"Azam F, Latif MF, Farooq A, Tirmazy SH, AlShahrani S, Bashir S, et al. Performance status assessment by using ECOG (Eastern cooperative oncology Group) score for Cancer patients by oncology healthcare professionals. Case Rep Oncol. 2019;12(3):728\u201336.","journal-title":"Case Rep Oncol"},{"issue":"2","key":"2693_CR19","doi-asserted-by":"publisher","first-page":"e0148076","DOI":"10.1371\/journal.pone.0148076","volume":"11","author":"C-M Chang","year":"2016","unstructured":"Chang C-M, Yin W-Y, Wei C-K, Wu C-C, Su Y-C, Yu C-H, et al. Adjusted age-adjusted Charlson comorbidity index score as a risk measure of perioperative mortality before cancer surgery. PLoS ONE. 2016;11(2):e0148076.","journal-title":"PLoS ONE"},{"issue":"4","key":"2693_CR20","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1097\/JTO.0000000000000453","volume":"10","author":"JY Chang","year":"2015","unstructured":"Chang JY, Bezjak A, Mornex F, Committee IART. Stereotactic ablative radiotherapy for centrally located early stage non\u2013small-cell lung cancer: what we have learned. J Thorac Oncol. 2015;10(4):577\u201385.","journal-title":"J Thorac Oncol"},{"key":"2693_CR21","doi-asserted-by":"crossref","unstructured":"Giuliani ME, Filion E, Faria S, Kundapur V, Vu TTTT, Lok BH et al. Stereotactic radiation for ultra-central non-small cell lung cancer: A safety and efficacy trial (SUNSET). Int J Radiation Oncology* Biology* Phys 2024;120(3):669\u2013677.","DOI":"10.1016\/j.ijrobp.2024.03.050"},{"issue":"2","key":"2693_CR22","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/j.ejca.2008.10.026","volume":"45","author":"EA Eisenhauer","year":"2009","unstructured":"Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228\u201347.","journal-title":"Eur J Cancer"},{"issue":"3","key":"2693_CR23","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1016\/S1053-4296(03)00031-6","volume":"13","author":"A Trotti","year":"2003","unstructured":"Trotti A, Colevas AD, Setser A, Rusch V, Jaques D, Budach V, et al. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol. 2003;13(3):176\u201381.","journal-title":"Semin Radiat Oncol"},{"issue":"5","key":"2693_CR24","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1016\/j.jgo.2017.07.002","volume":"8","author":"P Kreinbrink","year":"2017","unstructured":"Kreinbrink P, Blumenfeld P, Tolekidis G, Sen N, Sher D, Marwaha G. Lung stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer in the very elderly (\u2265\u200980years old): extremely safe and effective. J Geriatr Oncol. 2017;8(5):351\u20135.","journal-title":"J Geriatr Oncol"},{"key":"2693_CR25","doi-asserted-by":"crossref","unstructured":"Cassidy RJ, Patel PR, Zhang X, Press RH, Switchenko JM, Pillai RN et al. Stereotactic Body Radiotherapy for Early-stage Non-small-cell Lung Cancer in Patients 80 Years and Older: A Multi-center Analysis. Clin Lung Cancer. 2017;18(5):551-8.e6.","DOI":"10.1016\/j.cllc.2017.03.006"},{"issue":"2","key":"2693_CR26","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1016\/j.ijrobp.2013.01.006","volume":"86","author":"A Takeda","year":"2013","unstructured":"Takeda A, Sanuki N, Eriguchi T, Kaneko T, Morita S, Handa H, et al. Stereotactic ablative body radiation therapy for octogenarians with non-small cell lung cancer. Int J Radiation Oncology* Biology* Phys. 2013;86(2):257\u201363.","journal-title":"Int J Radiation Oncology* Biology* Phys"},{"issue":"4","key":"2693_CR27","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1093\/jrr\/rraa027","volume":"61","author":"Y Bei","year":"2020","unstructured":"Bei Y, Murakami N, Nakayama Y, Okuma K, Kashihara T, Raturi VP, et al. Stereotactic body radiation therapy for early-stage non\u2013small-cell lung cancer in octogenarians and older: an alternative treatment. J Radiat Res. 2020;61(4):586\u201393.","journal-title":"J Radiat Res"},{"issue":"11","key":"2693_CR28","doi-asserted-by":"publisher","first-page":"1550","DOI":"10.1016\/j.jtho.2024.07.016","volume":"19","author":"PSN van Rossum","year":"2024","unstructured":"van Rossum PSN, Wolfhagen N, van Bockel LW, Coremans IEM, van Es CA, van der Geest AM, et al. Real-World acute toxicity and 90-Day mortality in patients with stage I NSCLC treated with stereotactic body radiotherapy. J Thorac Oncol. 2024;19(11):1550\u201363.","journal-title":"J Thorac Oncol"}],"container-title":["Radiation Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13014-025-02693-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13014-025-02693-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13014-025-02693-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T13:14:31Z","timestamp":1757250871000},"score":1,"resource":{"primary":{"URL":"https:\/\/ro-journal.biomedcentral.com\/articles\/10.1186\/s13014-025-02693-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,17]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["2693"],"URL":"https:\/\/doi.org\/10.1186\/s13014-025-02693-w","relation":{},"ISSN":["1748-717X"],"issn-type":[{"value":"1748-717X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,17]]},"assertion":[{"value":"11 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the institutional ethics committee of the Medical University of Innsbruck (EC No. approval: 1343\/2024). All procedures conducted in this study involving human participants were in accordance with the ethical standards of the institutional review board as well as with the Helsinki Declaration (1964) and its later amendments or equivalent ethical standards. Patients provided written informed consent for undergoing treatment and for further retrospective analyses.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"JCP received Honoraria from AstraZeneca and Brainlab. The other authors declare no conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"113"}}