Stereotactic body radiation therapy (SBRT) of centrally located medically inoperable early-stage non-small cell lung cancer (T1-T3N0M0) − A subgroup analysis of the expanded HILUS study

Sara Lindberg; Vitali Grozman; Kristin Karlsson; Eva Onjukka; Elias Lindbäck; Joanna Östling Palme; Karam Al Jirf; Ingmar Lax; Peter Wersäll; Gitte Fredberg Persson; Mirjana Josipovic; Azza Ahmed Khalil; Ditte Sloth Møller; Lone Hoffmann; Marianne Marquard Knap; Jan Nyman; Ninni Drugge; Per Bergström; Jörgen Olofsson; Lotte Victoria Rogg; Tina Traa; Rebecca Knoph Hagen; Anne Sofie Frøland; Christina Ramberg; Charlotte Kristiansen; Stefan Starup Jeppesen; Tine Bjørn Nielsen; Britta Lödén; Hans Olov Rosenbrand; Silke Engelholm; André Änghede Haraldsson; Charlotte Billiet; Rolf Lewensohn; Karin Lindberg

doi:10.1016/j.lungcan.2025.108527

Stereotactic body radiation therapy (SBRT) of centrally located medically inoperable early-stage non-small cell lung cancer (T1-T3N0M0) − A subgroup analysis of the expanded HILUS study

Sara Lindberg^*, Vitali Grozman, Kristin Karlsson, Eva Onjukka, Elias Lindbäck, Joanna Östling Palme, Karam Al Jirf, Ingmar Lax, Peter Wersäll, Gitte Fredberg Persson, Mirjana Josipovic, Azza Ahmed Khalil, Ditte Sloth Møller, Lone Hoffmann, Marianne Marquard Knap, Jan Nyman, Ninni Drugge, Per Bergström, Jörgen Olofsson, Lotte Victoria RoggTina Traa, Rebecca Knoph Hagen, Anne Sofie Frøland, Christina Ramberg, Charlotte Kristiansen, Stefan Starup Jeppesen, Tine Bjørn Nielsen, Britta Lödén, Hans Olov Rosenbrand, Silke Engelholm, André Änghede Haraldsson, Charlotte Billiet, Rolf Lewensohn, Karin Lindberg

^*Corresponding author for this work

Department of Clinical Medicine - The Department of Oncology

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Introduction: Centrally located early-stage non-small cell lung cancer (ES NSCLC) with tumors close to the bronchi is potentially curable with stereotactic body radiation therapy (SBRT). To evaluate the clinical benefit of the treatment, both the risk of high-grade toxicity as well as the treatment efficacy need to be assessed. Material and methods: From the expanded HILUS cohorts, 72 patients with T1-T3N0M0 NSCLC were included in the current analysis. All patients had been treated with SBRT in 8 fractions to 56 Gy for a tumor located within 2 cm from the tracheobronchial tree. Primary endpoint was progression free survival (PFS) and secondary endpoints included pattern of failure, local control (LC), lung cancer-specific survival (LCSS), overall survival (OS) and toxicity. The Kaplan-Meier method and Cox regression analysis were used. Results: The median age of the cohort was 73 years and all patients suffered from comorbidities prior to SBRT. T2-T3 tumors were seen in 65 % of the patients. Seventeen patients relapsed after SBRT and distant recurrence was the most common form of relapse. Three-year PFS was 31 % (95 % CI 22–44) and largely explained by the short overall survival (38 % (95 % CI 22–44) at 3 years). Three-year rates of LC and LCSS were 97 % (95 % CI 92–100) and 76 % (95 % CI 65–89), respectively. Twelve patients (17 %) suffered from grade 5 toxicity, of which 9 were bronchopulmonary bleedings. Conclusion: The severe toxic profile limits the clinical benefit using SBRT with the investigated approach for patients with centrally located ES NSCLC.

Original language	English
Article number	108527
Journal	Lung Cancer
Volume	203
Number of pages	10
ISSN	0169-5002
DOIs	https://doi.org/10.1016/j.lungcan.2025.108527
Publication status	Published - May 2025

Keywords

Lung tumors
SBRT
Stereotactic body radiotherapy

Access to Document

10.1016/j.lungcan.2025.108527Licence: CC BY

Cite this

Lindberg, S., Grozman, V., Karlsson, K., Onjukka, E., Lindbäck, E., Palme, J. Ö., Jirf, K. A., Lax, I., Wersäll, P., Persson, G. F., Josipovic, M., Khalil, A. A., Møller, D. S., Hoffmann, L., Knap, M. M., Nyman, J., Drugge, N., Bergström, P., Olofsson, J., ... Lindberg, K. (2025). Stereotactic body radiation therapy (SBRT) of centrally located medically inoperable early-stage non-small cell lung cancer (T1-T3N0M0) − A subgroup analysis of the expanded HILUS study. Lung Cancer, 203, Article 108527. https://doi.org/10.1016/j.lungcan.2025.108527

@article{d435fc6d72384d2aa269042cf000d50b,

title = "Stereotactic body radiation therapy (SBRT) of centrally located medically inoperable early-stage non-small cell lung cancer (T1-T3N0M0) − A subgroup analysis of the expanded HILUS study",

abstract = "Introduction: Centrally located early-stage non-small cell lung cancer (ES NSCLC) with tumors close to the bronchi is potentially curable with stereotactic body radiation therapy (SBRT). To evaluate the clinical benefit of the treatment, both the risk of high-grade toxicity as well as the treatment efficacy need to be assessed. Material and methods: From the expanded HILUS cohorts, 72 patients with T1-T3N0M0 NSCLC were included in the current analysis. All patients had been treated with SBRT in 8 fractions to 56 Gy for a tumor located within 2 cm from the tracheobronchial tree. Primary endpoint was progression free survival (PFS) and secondary endpoints included pattern of failure, local control (LC), lung cancer-specific survival (LCSS), overall survival (OS) and toxicity. The Kaplan-Meier method and Cox regression analysis were used. Results: The median age of the cohort was 73 years and all patients suffered from comorbidities prior to SBRT. T2-T3 tumors were seen in 65 % of the patients. Seventeen patients relapsed after SBRT and distant recurrence was the most common form of relapse. Three-year PFS was 31 % (95 % CI 22–44) and largely explained by the short overall survival (38 % (95 % CI 22–44) at 3 years). Three-year rates of LC and LCSS were 97 % (95 % CI 92–100) and 76 % (95 % CI 65–89), respectively. Twelve patients (17 %) suffered from grade 5 toxicity, of which 9 were bronchopulmonary bleedings. Conclusion: The severe toxic profile limits the clinical benefit using SBRT with the investigated approach for patients with centrally located ES NSCLC.",

keywords = "Lung tumors, SBRT, Stereotactic body radiotherapy",

author = "Sara Lindberg and Vitali Grozman and Kristin Karlsson and Eva Onjukka and Elias Lindb{\"a}ck and Palme, {Joanna {\"O}stling} and Jirf, {Karam Al} and Ingmar Lax and Peter Wers{\"a}ll and Persson, {Gitte Fredberg} and Mirjana Josipovic and Khalil, {Azza Ahmed} and M{\o}ller, {Ditte Sloth} and Lone Hoffmann and Knap, {Marianne Marquard} and Jan Nyman and Ninni Drugge and Per Bergstr{\"o}m and J{\"o}rgen Olofsson and Rogg, {Lotte Victoria} and Tina Traa and Hagen, {Rebecca Knoph} and Fr{\o}land, {Anne Sofie} and Christina Ramberg and Charlotte Kristiansen and Jeppesen, {Stefan Starup} and Nielsen, {Tine Bj{\o}rn} and Britta L{\"o}d{\'e}n and Rosenbrand, {Hans Olov} and Silke Engelholm and {{\"A}nghede Haraldsson}, Andr{\'e} and Charlotte Billiet and Rolf Lewensohn and Karin Lindberg",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s)",

year = "2025",

month = may,

doi = "10.1016/j.lungcan.2025.108527",

language = "English",

volume = "203",

journal = "Lung Cancer",

issn = "0169-5002",

publisher = "Elsevier Ireland Ltd",

}

Lindberg, S, Grozman, V, Karlsson, K, Onjukka, E, Lindbäck, E, Palme, JÖ, Jirf, KA, Lax, I, Wersäll, P, Persson, GF, Josipovic, M, Khalil, AA, Møller, DS , Hoffmann, L, Knap, MM, Nyman, J, Drugge, N, Bergström, P, Olofsson, J, Rogg, LV, Traa, T, Hagen, RK, Frøland, AS, Ramberg, C, Kristiansen, C, Jeppesen, SS, Nielsen, TB, Lödén, B, Rosenbrand, HO, Engelholm, S, Änghede Haraldsson, A, Billiet, C, Lewensohn, R & Lindberg, K 2025, 'Stereotactic body radiation therapy (SBRT) of centrally located medically inoperable early-stage non-small cell lung cancer (T1-T3N0M0) − A subgroup analysis of the expanded HILUS study', Lung Cancer, vol. 203, 108527. https://doi.org/10.1016/j.lungcan.2025.108527

Stereotactic body radiation therapy (SBRT) of centrally located medically inoperable early-stage non-small cell lung cancer (T1-T3N0M0) − A subgroup analysis of the expanded HILUS study. / Lindberg, Sara; Grozman, Vitali; Karlsson, Kristin et al.
In: Lung Cancer, Vol. 203, 108527, 05.2025.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Stereotactic body radiation therapy (SBRT) of centrally located medically inoperable early-stage non-small cell lung cancer (T1-T3N0M0) − A subgroup analysis of the expanded HILUS study

AU - Lindberg, Sara

AU - Grozman, Vitali

AU - Karlsson, Kristin

AU - Onjukka, Eva

AU - Lindbäck, Elias

AU - Palme, Joanna Östling

AU - Jirf, Karam Al

AU - Lax, Ingmar

AU - Wersäll, Peter

AU - Persson, Gitte Fredberg

AU - Josipovic, Mirjana

AU - Khalil, Azza Ahmed

AU - Møller, Ditte Sloth

AU - Hoffmann, Lone

AU - Knap, Marianne Marquard

AU - Nyman, Jan

AU - Drugge, Ninni

AU - Bergström, Per

AU - Olofsson, Jörgen

AU - Rogg, Lotte Victoria

AU - Traa, Tina

AU - Hagen, Rebecca Knoph

AU - Frøland, Anne Sofie

AU - Ramberg, Christina

AU - Kristiansen, Charlotte

AU - Jeppesen, Stefan Starup

AU - Nielsen, Tine Bjørn

AU - Lödén, Britta

AU - Rosenbrand, Hans Olov

AU - Engelholm, Silke

AU - Änghede Haraldsson, André

AU - Billiet, Charlotte

AU - Lewensohn, Rolf

AU - Lindberg, Karin

PY - 2025/5

Y1 - 2025/5

N2 - Introduction: Centrally located early-stage non-small cell lung cancer (ES NSCLC) with tumors close to the bronchi is potentially curable with stereotactic body radiation therapy (SBRT). To evaluate the clinical benefit of the treatment, both the risk of high-grade toxicity as well as the treatment efficacy need to be assessed. Material and methods: From the expanded HILUS cohorts, 72 patients with T1-T3N0M0 NSCLC were included in the current analysis. All patients had been treated with SBRT in 8 fractions to 56 Gy for a tumor located within 2 cm from the tracheobronchial tree. Primary endpoint was progression free survival (PFS) and secondary endpoints included pattern of failure, local control (LC), lung cancer-specific survival (LCSS), overall survival (OS) and toxicity. The Kaplan-Meier method and Cox regression analysis were used. Results: The median age of the cohort was 73 years and all patients suffered from comorbidities prior to SBRT. T2-T3 tumors were seen in 65 % of the patients. Seventeen patients relapsed after SBRT and distant recurrence was the most common form of relapse. Three-year PFS was 31 % (95 % CI 22–44) and largely explained by the short overall survival (38 % (95 % CI 22–44) at 3 years). Three-year rates of LC and LCSS were 97 % (95 % CI 92–100) and 76 % (95 % CI 65–89), respectively. Twelve patients (17 %) suffered from grade 5 toxicity, of which 9 were bronchopulmonary bleedings. Conclusion: The severe toxic profile limits the clinical benefit using SBRT with the investigated approach for patients with centrally located ES NSCLC.

AB - Introduction: Centrally located early-stage non-small cell lung cancer (ES NSCLC) with tumors close to the bronchi is potentially curable with stereotactic body radiation therapy (SBRT). To evaluate the clinical benefit of the treatment, both the risk of high-grade toxicity as well as the treatment efficacy need to be assessed. Material and methods: From the expanded HILUS cohorts, 72 patients with T1-T3N0M0 NSCLC were included in the current analysis. All patients had been treated with SBRT in 8 fractions to 56 Gy for a tumor located within 2 cm from the tracheobronchial tree. Primary endpoint was progression free survival (PFS) and secondary endpoints included pattern of failure, local control (LC), lung cancer-specific survival (LCSS), overall survival (OS) and toxicity. The Kaplan-Meier method and Cox regression analysis were used. Results: The median age of the cohort was 73 years and all patients suffered from comorbidities prior to SBRT. T2-T3 tumors were seen in 65 % of the patients. Seventeen patients relapsed after SBRT and distant recurrence was the most common form of relapse. Three-year PFS was 31 % (95 % CI 22–44) and largely explained by the short overall survival (38 % (95 % CI 22–44) at 3 years). Three-year rates of LC and LCSS were 97 % (95 % CI 92–100) and 76 % (95 % CI 65–89), respectively. Twelve patients (17 %) suffered from grade 5 toxicity, of which 9 were bronchopulmonary bleedings. Conclusion: The severe toxic profile limits the clinical benefit using SBRT with the investigated approach for patients with centrally located ES NSCLC.

KW - Lung tumors

KW - SBRT

KW - Stereotactic body radiotherapy

UR - http://www.scopus.com/inward/record.url?scp=105001737010&partnerID=8YFLogxK

U2 - 10.1016/j.lungcan.2025.108527

DO - 10.1016/j.lungcan.2025.108527

M3 - Journal article

C2 - 40184836

AN - SCOPUS:105001737010

SN - 0169-5002

VL - 203

JO - Lung Cancer

JF - Lung Cancer

M1 - 108527

ER -

Stereotactic body radiation therapy (SBRT) of centrally located medically inoperable early-stage non-small cell lung cancer (T1-T3N0M0) − A subgroup analysis of the expanded HILUS study

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this