PURPOSE Stereotactic body radiotherapy (SBRT) results in excellent local control of stage I non-small cell lung cancer (NSCLC). Radiobiology models predict greater tumor response when higher biologically effective doses (BED10) are given. Prior studies support a BED10 ≥100 Gy with SBRT; however, data is limited comparing outcomes after various SBRT regimens. We therefore sought to evaluate national trends and the effect of using "low" versus "high" BED10 SBRT courses on overall survival (OS). METHODS This retrospective study used the National Cancer Data Base to identify patients diagnosed with clinical stage I (cT1-2aN0M0) NSCLC from 2004 to 2014 treated with SBRT. Patients were categorized into LowBED (100-129 Gy) or HighBED (≥130 Gy) groups. A 1:1 matched analysis based on patient and tumor characteristics was used to compare OS by BED10 group. Tumor centrality was not assessed. RESULTS Out of 25,039 patients treated with LowBED (n=14,756; 59%) or HighBED (n=10,283; 41%) SBRT, 20,542 were matched. Shifts in HighBED to LowBED SBRT regimen use correlated with key publications in the literature. In the matched cohort, 5-year OS rates were 26% for LowBED and 34% for HighBED groups (P=0.039). On multivariate analysis, receipt of LowBED was associated with significantly worse survival (hazard ratio 1.046, 95% confidence interval 1.004-1.090, P=0.032). CONCLUSIONS LowBED SBRT for treating stage I NSCLC is becoming more common. However, our findings suggest SBRT regimens with BED10 ≥130 Gy may confer an additional survival benefit. Additional studies are required to evaluate the dose-response relationship and toxicities associated with modern highBED SBRT.

中文翻译：

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立体定向放射治疗早期非小细胞肺癌患者的生物有效剂量和生存期

目的立体定向放疗 (SBRT) 可对 I 期非小细胞肺癌 (NSCLC) 进行出色的局部控制。当给予更高的生物有效剂量 (BED10) 时，放射生物学模型预测更大的肿瘤反应。先前的研究支持 SBRT 的 BED10 ≥100 Gy；然而，比较各种 SBRT 方案后的结果的数据有限。因此，我们试图评估全国趋势以及使用“低”与“高”BED10 SBRT 课程对总生存率 (OS) 的影响。方法 这项回顾性研究使用国家癌症数据库来确定 2004 年至 2014 年间诊断为临床 I 期 (cT1-2aN0M0) NSCLC 并接受 SBRT 治疗的患者。患者被分为 LowBED (100-129 Gy) 或 HighBED (≥130 Gy) 组。一：使用基于患者和肿瘤特征的 1 个匹配分析来比较 BED10 组的 OS。未评估肿瘤中心性。结果 在接受 LowBED（n=14,756；59%）或 HighBED（n=10,283；41%）SBRT 治疗的 25,039 名患者中，有 20,542 名匹配。HighBED 到 LowBED SBRT 方案使用的转变与文献中的关键出版物相关。在匹配的队列中，LowBED 组的 5 年 OS 率为 26%，HighBED 组为 34%（P=0.039）。在多变量分析中，接受 LowBED 与生存率显着降低相关（风险比 1.046，95% 置信区间 1.004-1.090，P=0.032）。结论 用于治疗 I 期 NSCLC 的 LowBED SBRT 正变得越来越普遍。然而，我们的研究结果表明，BED10 ≥130 Gy 的 SBRT 方案可能会带来额外的生存益处。