Skip to main content

Stereotactic body radiotherapy for early-stage non-small cell lung cancer: a multicentre study by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society)



Stereotactic body radiotherapy (SBRT) has become the standard of care for patients with medically inoperable early-stage non-small cell lung cancer (NSCLC) and for patients who refuse surgery. The aim of this study was to evaluate the effectiveness and safety of primary SBRT in patients with early-stage NSCLC.


Retrospective multicenter study of 397 patients (416 primary lung tumours) treated with SBRT at 18 centres in Spain. 83.2% were men. The median age was 74.4 years. In 94.4% of cases, the tumour was inoperable. The pathological report was available in 54.6% of cases. SPSS vs 22.0. was used to perform all statistical analyses.


Complete response was obtained in 53.6% of cases. Significant prognostic factors were standard CT planning (p = 0.014) and 4D cone beam CT (p = 0.000). Acute and chronic toxicity ≥ grade 3 was observed in 1.2% of cases. At a median follow-up of 30 months, local relapse was 9.6%, lymph node relapse 12.8%, distant metastasis 16.6%, and another lung tumour 11.5%. Complete response was the only significant prognostic factor for local relapse (p = 0.012) and distant metastasis (p = 0.001). The local relapse-free survival was 88.7%. The overall survival was 75.7%. The cancer-specific survival was 92.7%. The disease-free survival was 78.7%.


SBRT is an effective and well-tolerated treatment option for patients with early-stage lung cancer who are not suitable for surgery. The most important prognostic factor for local and distant recurrence was complete response, which in our sample depended on the type of CT planning and the IGRT technique.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. Las cifras del cáncer en España 2020. Informe SEOM (Sociedad Española de Oncología Médica). 2020.

  2. The National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395–409.

    Article  PubMed Central  Google Scholar 

  3. Garry Mc, et al. Observation only management of early stage medically inoperable lung cancer: poor outcome. Chest. 2002;121:1155.

    Article  Google Scholar 

  4. Rowell NP, et al. Radical radiotherapy for stage I/II non-small cell lung cancer in patients not sufficiently fit for or declining surgery (medically inoperable). Cochrane Database Syst Rev. 2001.

    Article  PubMed  Google Scholar 

  5. Uematsu M, Shioda A, Tahara K, et al. Focal, high dose, and fractionated modified stereotactic radiation therapy for lung carcinoma patients: a preliminary experience. Cancer. 1998;82(6):1062–70.

    Article  CAS  Google Scholar 

  6. Timmerman R, Papiez L, McGarry R, et al. Extracranial stereotactic radioablation: results of a Phase I study in medically inoperable Stage I non-small-cell lung cancer. Chest. 2009;124(5):1946–55.

    Article  Google Scholar 

  7. Baumann P, Nyman J, Hoyer M, et al. Outcome in a prospective phase II trial of medically inoperable stage I non-small-cell lung cancer patients treated with stereotactic body radiotherapy. J Clin Oncol. 2009;27(20):3290–6.

    Article  PubMed  Google Scholar 

  8. Fakiris AJ, McGarry RC, Yiannoutsos CT, et al. Stereotactic body radiation therapy for early-stage non-small-cell lung carcinoma: four-year results of a prospective phase II study. Int J Radiat Oncol Biol Phys. 2009;75:677–82.

    Article  Google Scholar 

  9. Ricardi U, Filippi AR, Guarneri A, et al. Stereotactic body radiation therapy for early stage non-small cell lung cancer: results of a prospective trial. Lung Cancer. 2010;68:72–7.

    Article  Google Scholar 

  10. Bral S, Gevaert T, Linthout N, et al. Prospective, riskadapted strategy of stereotactic body radiotherapy for early-stage non-small-cell lung cancer: results of a Phase II trial. Int J Radiat Oncol Biol Phys. 2011;80:1343–9.

    Article  Google Scholar 

  11. Timmerman R, Paulus R, Galvin J, Michalski J, Straube W, Bradley J, et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA. 2010;303(11):1070–6.

    Article  CAS  Google Scholar 

  12. Onishi H, Araki T, Shirato H, et al. Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma: clinical outcomes in 245 subjects in a Japanese multiinstitutional study. Cancer. 2004;101:1623–31.

    Article  Google Scholar 

  13. Onishi H, Shirato H, Nagata Y, et al. Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I nonsmall cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study. J Thorac Oncol. 2007;2:S94-100.

    Article  Google Scholar 

  14. Grills IS, Hope AJ, Guckenberger M, et al. A collaborative analysis of stereotactic lung radiotherapy outcomes for early-stage non-small-cell lung cancer using daily online cone-beam computed tomography image-guided radiotherapy. J Thorac Oncol. 2012;7:1382–93.

    Article  Google Scholar 

  15. Senthi S, Haasbeek CJ, Slotman BJ, et al. Outcomes of stereotactic ablative radiotherapy for central lung tumours: a systematic review. Radiother Oncol. 2013;106:276–82.

    Article  Google Scholar 

  16. Guckenberger M, Allgäuer M, Appold S, et al. Safety and efficacy of stereotactic body radiotherapy for stage 1 non-small-cell lung cancer in routine clinical practice: a patterns-of-care and outcome analysis. J Thorac Oncol. 2013;8:1050–8.

    Article  CAS  Google Scholar 

  17. Louie AV, van Werkhoven E, Chen H, Smit EF, Paul MA, Widder J, Groen HJ, van den Borne BE, De Jaeger K, Slotman BJ, Senan S. Patient reported outcomes following stereotactic ablative radiotherapy or surgery for stage IA non-small-cell lung cancer: Results from the ROSEL multicenter randomized trial. Radiother Oncol. 2015;117(1):44–8.

    Article  PubMed  Google Scholar 

  18. Randomized Study to Compare CyberKnife to Surgical Resection In Stage I Non-small Cell Lung Cancer (STARS). identifier (NCT number): NCT00840749

  19. Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg. 2006;81:1013–101.

    Article  Google Scholar 

  20. Chang JY, Senan S, Paul MA, et al. Stereotactic ablative radiotherapy versus lobectomy for operable Stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol. 2015;16(6):630–7.

    Article  Google Scholar 

  21. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer. Version 8.2020. 2020.

  22. Gregory M, Videtic M, Jessica D, et al. Stereotactic body radiation therapy for early-stage non-small cell lung cancer: executive summary of an ASTRO evidence-based guideline. Pract Radiat Oncol. 2017;7(5):295–301.

    Article  Google Scholar 

  23. Sun B, Brooks ED, Komaki RU, et al. 7-year follow-up after stereotactic ablative radiotherapy for patients with stage I non–small cell lung cancer: results of a phase 2 clinical trial. Cancer. 2017;123:3031–9.

    Article  Google Scholar 

  24. Nagata Y, Hiraoka M, Shibata T, 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 Radiat Oncol Biol Phys. 2015;93:989–96.

    Article  Google Scholar 

  25. Umberto R, Giovanni F, Andrea RF, et al. Stereotactic Ablative Radiotherapy for stage I histologically proven non-small cell lung cancer: an Italian multicenter observational study. Lung Cancer. 2014;84(3):248–53.

    Article  Google Scholar 

  26. Allibhai Z, Taremi M, Bezjak A, et al. The impact of tumour size on outcomes after stereotactic body radiation therapy for medically inoperable early-stage non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2013;87(5):1064–70.

    Article  Google Scholar 

  27. Caitlin AS, Marina H, Abigail D, et al. Five-year long-term outcomes of stereotactic body radiation therapy for operable versus medically inoperable stage I non-small-cell lung cancer: analysis by operability, fractionation regimen, tumour size, and tumour location. Clin Lung Cancer. 2019;20(1):e63–71.

    Article  Google Scholar 

  28. Larry K, Inga G, Matthias G, Jose B, Andrew JH, Maria W-W, Jan-Jakob S, Jean-Pierre B, Ying X, Di Y, Elekta Lung Research Group. Dose-response relationship with clinical outcome for lung stereotactic body radiotherapy (SBRT) delivered via online image guidance. Radiother Oncol. 2014;110(3):499–504.

    Article  Google Scholar 

  29. van Baardwijk A, Tomé WA, van Elmpt W, Bentzen SM, Reymen B, Wanders R, Houben R, Öllers M, Lambin P, De Ruysscher D. Is high-dose stereotactic body radiotherapy (SBRT) for stage I non-small cell lung cancer (NSCLC) overkill? A systematic review. Radiother Oncol. 2012;105:145–9.

    Article  Google Scholar 

  30. Zhang J, Yang F, Li B, Li H, Liu J, Huang W, Wang D, Yi Y, Wang J. Which is the optimal biologically effective dose of stereotactic body radiotherapy for Stage I non-small-cell lung cancer? A meta-analysis. Int J Radiat Oncol Biol Phys. 2011;81(4):e305–16.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to P. Mª Samper Ots.

Ethics declarations

Conflict of interest

There is no Conflict of Ethics and Consent State-ments.

Ethical approval

The study was approved by the Clinical Research Ethics Committees of all participating institutions and complied with all data protection regulations.

Informed consent

For this tipe the study is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Samper Ots, P.M., Vallejo Ocaña, C., Martin Martin, M. et al. Stereotactic body radiotherapy for early-stage non-small cell lung cancer: a multicentre study by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society). Clin Transl Oncol 24, 342–349 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • SBRT
  • Lung cancer
  • Prognostic factors