Abstract

<h3>Purpose/Objective(s)</h3> We hereby present the toxicity data related to using single-fraction stereotactic ablative body radiation (SABR) of up to 34 Gy for peripheral non-small cell lung cancer (NSCLC) in our institution. With two recently published landmark trials, single-fraction SABR is now considered an acceptable treatment choice for Stage I NSCLC. However, to our knowledge, the adoption of that regimen has been hindered by concerns over the toxicity of such high doses. We hypothesized that the toxicity profile of single-fraction SABR is similar to what has been published and can be considered a safe alternative to the more commonly used fractionated approaches. <h3>Materials/Methods</h3> We retrospectively reviewed the charts of 125 consecutive patients treated with a single-fraction SABR for a total of 137 NSCLC lesions treated between May 16, 2018, and November 29, 2021. Most patients (81%) were treated with either a single fraction of 30 Gy or 34 Gy (range 15 Gy-34 Gy). All were treated with a PTV margin of 5 mm expansion from the ITV. We extracted patients' characteristics, comorbidities, dosimetric values (chest wall D 0.03 cc, D 1 cc, D 5 cc, and V 30 Gy), ITV volume, ITV to chest wall distance, and physician-reported toxicity outcomes. Toxicities were evaluated using the CTCAE v5.0 criteria. Research ethics board approval was obtained to conduct this research. Data were analyzed using statistical software (IBM Corp., Armonk, NY). <h3>Results</h3> The median follow-up of the 125 patients was 12.5 months (range 7-17). Forty-five patients (36%) were current smokers, and 64 (51.2%) were former or lifelong non-smokers (16 unknown). Eight patients (5.9%) reported grade 1, and 6 (4.4%) reported grade 2 chest wall toxicity. There was no grade > 2 chest wall toxicity. There were one (0.7%) grade 1, 2 (1.5%) grade 2, and one (0.7%) grade 3 lung toxicities. There was no grade > 3 treatment-related toxicity. On univariate analysis, only current smoking status was associated with a trend toward a protective effect on chest wall toxicity (p = 0.07). Median ITV volume was 4.1 cc range (0.2-44.2). There was no correlation between ITV volume and toxicities. Despite 58 (42.6%) lesions ITV being less than 5 mm from the chest wall, no commonly used dosimetric parameters were associated with chest wall or lung toxicity. <h3>Conclusion</h3> Single-fraction lung SABR can safely be delivered outside of a clinical trial with a favorable toxicity profile similar to what has been recently published. A longer follow-up is needed to confirm these findings.

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