Background: Stereotactic body radiotherapy (SBRT) is widely practiced in the management of peripheral early-stage non-small cell lung cancer (NSCLC); however, its utility for central tumors is controversial due to the risk of damaging major mediastinal organs. This study evaluates safety and tumor control for centrally located early NSCLC using a moderately hypofractionated SBRT protocol. Methods: Between January 2019 and December 2023, 41 patients with central NSCLC who were deemed unfit or declined surgery (T1-T2a N0 M0, tumor diameter ≤ 4 cm) were treated with SBRT (8 Gy × 8 fractions; total dose 64 Gy, BED₁₀ = 115.2 Gy). Central tumors were defined as lesions within 2 cm of the proximal bronchial tree or abutting mediastinal structures. The key outcome was freedom from local progression (FFLP) at three years. Secondary outcomes were regional recurrence-free survival (RRFS), distant recurrence-free survival (DRFS), overall survival (OS), and treatment-related adverse events. Results: The median age was 69.0 years (range: 40-89 years); 65.9% were male. Median tumor diameter was 2.5 cm, and 65.9% measured 2-4 cm. The three-year FFLP was 85.9% (95% CI: 66.1%-94.5%). Three-year OS, RRFS, and DRFS were 68.6% (95% CI: 48.7%-82.1%), 76.8% (95% CI: 56.6%-88.5%), and 83.6% (95% CI: 66.8%-92.3%), respectively. Local failure occurred in four (9.8%), regional failure in nine (22.0%), and distant failure in eight (19.5%) patients. Treatment-related toxicity was minimal (grade ≥ 2 occurrences in 1 patient (2.4%) and no grade ≥ 3 toxicity). Conclusions: A dose of 64 Gy delivered in eight fractions through SBRT exerts good local control and low toxicity for centrally located early-stage NSCLC. This hypofractionated regimen seems to be safe and effective for patients who refuse or are unsuitable for surgery and comparable to results achieved with surgery.
Ramesh et al. (2026) studied this question.