{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T13:24:34Z","timestamp":1786973074128,"version":"build-2736575974"},"reference-count":36,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Stereotactic body radiation therapy (SBRT) is increasingly used for oligometastatic lung cancer. However, standard ablative SBRT (BED10 of 100 Gy or higher) is not feasible when lesions abut critical organs or patients have poor performance status. This study aimed to evaluate the efficacy and safety of moderate-dose SBRT (BED10 below 100 Gy but exceeding conventional palliative doses) in patients with oligometastatic lung cancer unfit for standard ablative SBRT. Methods: We retrospectively analyzed patients treated at a single institution between October 2019 and March 2025. Eligible patients had pathologically confirmed lung cancer with extracranial oligometastasis and received 25\u201340 Gy in 4\u20137 fractions. Patients with brain or bone metastases were excluded. The primary endpoint was local control. Secondary endpoints were event-free survival, disseminated disease-free survival, overall survival, and treatment-related toxicity. Results: Forty-three patients with 55 lesions were analyzed. The mean age was 66 years, and lymph node metastases were the most frequent site (69.1%). The most common regimen was 35 Gy in 5 fractions (63.6%). At a median follow-up of 14.7 months, objective response (complete or partial) was achieved in 54 of 55 lesions (98.2%). The 1-year and 2-year local recurrence-free survival rates were 89.7% and 86.9%, respectively, and the 1-year and 2-year overall survival rates were 83.2% and 56.1%, respectively. Local control differed by metastatic site, with 2-year rates of 95.5% for lymph node lesions and 56.2% for lesions of the lung and chest wall (p = 0.002), whereas smaller differences were observed by BED10 and oligometastatic subtype. Treatment-related toxicities occurred in 8 of 43 patients (18.6%), all of grade 1\u20132, and radiation pneumonitis was the most common (9.3%). No grade 3 or higher events occurred. Conclusions: In this preliminary single-center experience, moderate-dose SBRT achieved favorable local control with acceptable toxicity in oligometastatic lung cancer patients unfit for standard ablative SBRT, supporting a risk-adapted approach.<\/jats:p>","DOI":"10.3390\/jcm15166337","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:01:26Z","timestamp":1786968086000},"page":"6337","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and Safety of Moderate-Dose Stereotactic Body Radiation Therapy (SBRT) for Patients with Oligometastatic Lung Cancer Unfit for Standard SBRT: A Preliminary Single-Center Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2546-4808","authenticated-orcid":false,"given":"Jaehyeon","family":"Park","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu 42415, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1683-2907","authenticated-orcid":false,"given":"Bong Kyung","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7962-7054","authenticated-orcid":false,"given":"Min Kyu","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7004-8128","authenticated-orcid":false,"given":"Jongmoo","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1016\/S1470-2045(19)30718-1","article-title":"Characterisation and classification of oligometastatic disease: A European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation","volume":"21","author":"Guckenberger","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.radonc.2020.04.003","article-title":"Defining oligometastatic disease from a radiation oncology perspective: An ESTRO-ASTRO consensus document","volume":"148","author":"Lievens","year":"2020","journal-title":"Radiother. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3339","DOI":"10.21037\/tlcr-20-982","article-title":"Epidemiology of oligometastatic non-small cell lung cancer: Results from a systematic review and pooled analysis","volume":"10","author":"Gobbini","year":"2021","journal-title":"Transl. Lung Cancer Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.lungcan.2019.02.006","article-title":"Radical consolidative treatment provides a clinical benefit and long-term survival in patients with synchronous oligometastatic non-small cell lung cancer: A phase II study","volume":"130","author":"Arrieta","year":"2019","journal-title":"Lung Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/j.ijrobp.2022.04.050","article-title":"Characterization of Metastatic Non-Small Cell Lung Cancer and Oligometastatic Incidence in an Era of Changing Treatment Paradigms","volume":"114","author":"No","year":"2022","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2830","DOI":"10.1200\/JCO.20.00818","article-title":"Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial","volume":"38","author":"Palma","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.prro.2023.04.004","article-title":"Treatment of Oligometastatic Non-Small Cell Lung Cancer: An ASTRO\/ESTRO Clinical Practice Guideline","volume":"13","author":"Iyengar","year":"2023","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4833","DOI":"10.1200\/JCO.2006.07.5937","article-title":"Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer","volume":"24","author":"Timmerman","year":"2006","journal-title":"J. Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1016\/j.jtho.2021.03.019","article-title":"The HILUS-Trial-a Prospective Nordic Multicenter Phase 2 Study of Ultracentral Lung Tumors Treated with Stereotactic Body Radiotherapy","volume":"16","author":"Lindberg","year":"2021","journal-title":"J. Thorac. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e620","DOI":"10.1016\/S1470-2045(14)70345-6","article-title":"High-dose re-irradiation following radical radiotherapy for non-small-cell lung cancer","volume":"15","author":"Peeters","year":"2014","journal-title":"Lancet Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3824","DOI":"10.1200\/JCO.2014.56.7412","article-title":"Phase II trial of stereotactic body radiation therapy combined with erlotinib for patients with limited but progressive metastatic non-small-cell lung cancer","volume":"32","author":"Iyengar","year":"2014","journal-title":"J. Clin. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e173501","DOI":"10.1001\/jamaoncol.2017.3501","article-title":"Consolidative Radiotherapy for Limited Metastatic Non-Small-Cell Lung Cancer: A Phase 2 Randomized Clinical Trial","volume":"4","author":"Iyengar","year":"2018","journal-title":"JAMA Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.ejca.2008.10.026","article-title":"New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1)","volume":"45","author":"Eisenhauer","year":"2009","journal-title":"Eur. J. Cancer"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2051","DOI":"10.1016\/S0140-6736(18)32487-5","article-title":"Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): A randomised, phase 2, open-label trial","volume":"393","author":"Palma","year":"2019","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1200\/JCO.19.00201","article-title":"Local Consolidative Therapy vs. Maintenance Therapy or Observation for Patients with Oligometastatic Non-Small-Cell Lung Cancer: Long-Term Results of a Multi-Institutional, Phase II, Randomized Study","volume":"37","author":"Gomez","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1186\/s13063-019-3837-y","article-title":"Pulmonary Metastasectomy versus Continued Active Monitoring in Colorectal Cancer (PulMiCC): A multicentre randomised clinical trial","volume":"20","author":"Treasure","year":"2019","journal-title":"Trials"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"7971","DOI":"10.3390\/curroncol31120588","article-title":"The Role of Stereotactic Body Radiotherapy in Oligometastatic Non-Small Cell Lung Cancer","volume":"31","author":"Wan","year":"2024","journal-title":"Curr. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.ijrobp.2017.12.288","article-title":"Local Control After Stereotactic Body Radiation Therapy for Liver Tumors","volume":"110","author":"Ohri","year":"2021","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.ijrobp.2020.01.017","article-title":"Stereotactic Body Radiation Therapy of Adrenal Metastases: A Pooled Meta-Analysis and Systematic Review of 39 Studies with 1006 Patients","volume":"107","author":"Chen","year":"2020","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"107284","DOI":"10.1016\/j.lungcan.2023.107284","article-title":"Stereotactic Body Radiotherapy for Lung Oligo-metastases: Systematic Review and International Stereotactic Radiosurgery Society Practice Guidelines","volume":"182","author":"Mayinger","year":"2023","journal-title":"Lung Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/j.prro.2025.06.011","article-title":"Stereotactic Body Radiation Therapy for the Treatment of Adrenal Metastases\u2014A Case-Based Radiosurgery Society Practice Guide and Review","volume":"15","author":"Ehret","year":"2025","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1001\/jamaoncol.2020.6146","article-title":"Safety and Survival Rates Associated with Ablative Stereotactic Radiotherapy for Patients with Oligometastatic Cancer: A Systematic Review and Meta-analysis","volume":"7","author":"Lehrer","year":"2021","journal-title":"JAMA Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"109817","DOI":"10.1016\/j.radonc.2023.109817","article-title":"Reirradiation with stereotactic body radiotherapy for primary or secondary lung malignancies: Tumor control probability and safety analyses","volume":"187","author":"Wang","year":"2023","journal-title":"Radiother. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1007\/s00384-013-1717-6","article-title":"Severe intestinal toxicity after stereotactic ablative radiotherapy for abdominopelvic malignancies","volume":"28","author":"Bae","year":"2013","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e257013","DOI":"10.6004\/jnccn.2025.7013","article-title":"Lessons Learned About Acute and Late Toxicity After Two Decades of Experience with Pancreatic SBRT","volume":"23","author":"Ellsworth","year":"2025","journal-title":"J. Natl. Compr. Canc Netw."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cllc.2011.04.004","article-title":"Consensus statement on palliative lung radiotherapy: Third international consensus workshop on palliative radiotherapy and symptom control","volume":"13","author":"Rodrigues","year":"2012","journal-title":"Clin. Lung Cancer"},{"key":"ref_27","first-page":"Cd002143","article-title":"Palliative radiotherapy regimens for patients with thoracic symptoms from non-small cell lung cancer","volume":"1","author":"Stevens","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/S1470-2045(17)30380-7","article-title":"Previous radiotherapy and the clinical activity and toxicity of pembrolizumab in the treatment of non-small-cell lung cancer: A secondary analysis of the KEYNOTE-001 phase 1 trial","volume":"18","author":"Shaverdian","year":"2017","journal-title":"Lancet Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"15618","DOI":"10.1038\/ncomms15618","article-title":"DNA exonuclease Trex1 regulates radiotherapy-induced tumour immunogenicity","volume":"8","author":"Alard","year":"2017","journal-title":"Nat. Commun."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1001\/jamaoncol.2019.1478","article-title":"Effect of Pembrolizumab After Stereotactic Body Radiotherapy vs Pembrolizumab Alone on Tumor Response in Patients with Advanced Non-Small Cell Lung Cancer: Results of the PEMBRO-RT Phase 2 Randomized Clinical Trial","volume":"5","author":"Theelen","year":"2019","journal-title":"JAMA Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Caivano, D., Bonome, P., Pezzulla, D., Rotondi, M., Sigillo, R.C., De Sanctis, V., Valeriani, M., and Osti, M.F. (2023). Stereotactic body radiation therapy for the treatment of lymph node metastases: A retrospective mono-institutional study in a large cohort of patients. Front. Oncol., 13.","DOI":"10.3389\/fonc.2023.1163213"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1016\/j.ijrobp.2020.10.004","article-title":"Stereotactic Body Radiation Therapy for Mediastinal and Hilar Lymph Node Metastases","volume":"109","author":"Shahi","year":"2021","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1016\/j.ijrobp.2025.08.060","article-title":"Five-Year Survival and Safety of SABR in Patients with Unresectable Locally Advanced Non-Small Cell Lung Cancer unfit for Concurrent Radio-chemotherapy: Focus on Patterns of Local Recurrence from the START-NEW-ERA Non-randomized Phase 2 Trial","volume":"124","author":"Arcidiacono","year":"2026","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1007\/s00259-021-05624-5","article-title":"Joint EANM\/SNMMI\/ESTRO practice recommendations for the use of 2-[(18)F]FDG PET\/CT external beam radiation treatment planning in lung cancer V1.0","volume":"49","author":"Vaz","year":"2022","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"4073","DOI":"10.1200\/JCO.21.01440","article-title":"Management of Immune-Related Adverse Events in Patients Treated with Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update","volume":"39","author":"Schneider","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e1822","DOI":"10.1002\/onco.13900","article-title":"Radiation Versus Immune Checkpoint Inhibitor Associated Pneumonitis: Distinct Radiologic Morphologies","volume":"26","author":"Chen","year":"2021","journal-title":"Oncologist"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6337\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:28:00Z","timestamp":1786969680000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6337"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,16]]},"references-count":36,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166337"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166337","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,16]]}}}