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David S. Ettinger, MD, FACP, FCCP


ASTRO 2022: Phase III Trial Compares Radiotherapy Regimens for Early-Stage NSCLC

By: Victoria Kuhr, BA
Posted: Monday, October 31, 2022

Anand Swaminath, MD, of Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada, and colleagues reported that the phase III LUSTRE trial showed an improvement in local tumor control with stereotactic body radiotherapy (SBRT) compared with conventionally hypofractionated radiotherapy (CRT) in patients with inoperable stage I non–small cell lung cancer (NSCLC). Additionally, there were no observable differences in disease-free and overall survival. These findings were presented at the 2022 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract LBA 08).

The study included patients from 16 Canadian centers whose disease was considered medically inoperable, with either histologically confirmed stage I NSCLC or a suspicious growing fluorodeoxyglucose PET–avid lesion. Patients were randomly assigned on a 2:1 basis to receive SBRT of either 48 Gy at four fractions (peripheral NSCLC) or 60 Gy at eight fractions (central NSCLC), compared with CRT.

A total of 233 patients were included in the study. Of them, 27% had tumors that were centrally located, 49% had biopsy-proven NSCLC, and 71% had lesions of up to 3 cm. The mean tumor diameter was 2.5 cm. The mean patient age was 75 years, and the median follow-up was 36 months. Local failures were observed in 34 patients, 18 of them were treated with SBRT and 16, with CRT. The 3-year local control rate was 87.6% with SBRT and 81.2% with CRT. There were no significant treatment effects for disease-free (P = .40) and overall survival (P = .40).  

One patient in each treatment group experienced grade 3 acute toxicity. No grade 4 or 5 toxicities were observed. Late grade 3 or 4 toxicities were reported in seven patients. One patient who received radiation treatment of 60 Gy at eight fractions for a central NSCLC experienced a possible hemoptysis.

Disclosure: To review Dr. Swaminath’s disclosures, visit

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