TOPLINE: 

Among patients with medically inoperable stage I non-small cell lung cancer (NSCLC), stereotactic body radiotherapy (SBRT) produced a modest improvement in quality of life (QoL) outcomes at 2 weeks compared to conventionally hypofractionated radiotherapy, but that benefit in patient-reported outcomes was not sustained over 24 months. 

METHODOLOGY: 

• Radiotherapy is the preferred approach for treating medically inoperable stage I NSCLC, with SBRT now widely adopted for its efficacy and convenience. However, high‑quality prospective comparisons of patient‑reported QoL outcomes between SBRT and conventionally hypofractionated radiotherapy regimens are limited.
• Researchers conducted a secondary analysis of a multicenter, open-label, phase 3 randomized controlled trial involving 233 patients with medically inoperable stage I NSCLC who were randomly assigned in a 2:1 ratio to receive either SBRT or conventionally hypofractionated radiotherapy across 16 Canadian centers between 2014 and 2020.
• The SBRT arm (n = 154) received 48 Gy in four alternate-day fractions for peripheral tumors or 60 Gy in eight daily fractions for central tumors, and the conventionally hypofractionated radiotherapy arm (n = 79) received 60 Gy in 15 daily fractions.
• Researchers evaluated QoL outcomes using two questionnaires — the EORTC QLQ-C30 and Lung Cancer-Specific Module 13 — at 2 weeks post-radiotherapy and at 2 years after randomization. A change of at least 10 points on a 1-100 scale was considered the threshold for a clinically important difference.

TAKEAWAY: 

• At 2 weeks post-treatment, patients who received SBRT had a modest improvement in global health scores compared with those who received conventionally hypofractionated radiotherapy (68.93 vs 64.93; mean difference, 4.00; P < .01). The 4‑point advantage was below the trial's 10‑point threshold for clinical importance, indicating a modest short-term benefit, the researchers explained.
• By 24 months, global health scores slightly favored conventionally hypofractionated radiotherapy (62.88 vs 59.96; mean difference, -2.92; P < .01) but remained below the predefined clinical threshold.
• As for lung-specific symptoms, at 2 weeks, symptom scores were slightly lower with SBRT than with conventionally hypofractionated radiotherapy (15.70 vs 17.11; mean difference, -1.41; P < .01); however, by 24 months, scores were identical (mean difference, 0.14; P = .69).
• Acute toxicities of grade 3 or higher occurred rarely, with the same frequency in both arms (one patient per arm); late toxicity was uncommon overall but numerically slightly higher in the SBRT arm (8% vs 7%).

IN PRACTICE: 

"These findings suggest that while SBRT may confer improved QoL in the short term due to the shorter duration of therapy (and subsequent short term recovery), both SBRT and [conventionally hypofractionated radiotherapy] maintain similar long-term QoL, and that the choice of radiotherapy modality does not significantly impact patients’ well-being in the long run," the authors concluded.

SOURCE: 

The study, led by Qirui Hou, MSc, McMaster University, and the Juravinski Cancer Centre in Hamilton, Ontario, Canada, was published online in International Journal of Radiation Oncology, Biology, Physics. 

LIMITATIONS: 

The researchers noted limitations in attrition and compliance rates over time, with missing QOL assessments at later timepoints. Additionally, since the trial closed early for slow accrual, the study was underpowered to detect clinically meaningful differences at 2 weeks and later at 24 months.

DISCLOSURES: 

The study received funding from the Canadian Cancer Society Research Institute Impact Grant. One author disclosed receiving honoraria, including from Bristol-Myers Squibb. Another author reported being a member of speakers bureau from AstraZeneca. All other authors reported no disclosures.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.