Efficacy and safety of stereotactic body radiotherapy vs. conventional radiotherapy for early-stage non-small cell lung cancer: A systematic review.

Abstract

e20079 Background: Stereotactic body radiotherapy (SBRT) has gained widespread acceptance as a treatment modality for medically inoperable early-stage non-small cell lung cancer (NSCLC), but its efficacy compared to conventionally fractionated radiotherapy (CRT) remains a topic of investigation. This systematic review aims to compare SBRT and CRT in terms of local control (LC), overall survival (OS), disease-free survival (DFS), and toxicity outcomes based on available randomized controlled trials (RCTs) and retrospective studies from 2015 to 2025. Methods: A comprehensive literature search was done across multiple databases, including PubMed (MEDLINE), Google Scholar, Cochrane Library, PLOS Medicine, and ClinicalTrials.gov. Studies comparing SBRT and CRT in early-stage NSCLC were selected based on predefined inclusion criteria and exclusion criteria. A total of four randomized controlled trials (RCTs) and 3 retrospective observational studies were included in the analysis. Key outcomes analyzed were local disease control, OS, DFS, and treatment-related toxicity (grade 3/4 adverse events). Results: All four RCTs and one retrospective cohort study demonstrated improved local disease control with SBRT compared to CRT. Three of the 4 RCTs studied and found that SBRT caused fewer serious side effects (grade 3/4 toxicity). All three retrospective studies consistently showed improved OS with SBRT. However, two RCTs reported no significant differences in OS and DFS between SBRT and CRT. Conclusions: The findings suggest that SBRT offers superior local disease control with a favorable toxicity profile compared to CRT. While retrospective data indicate a potential OS advantage with SBRT, results from RCTs remain inconclusive regarding long-term survival benefits. Based on the current evidence, SBRT should be considered a good option for early stage non small cell lung cancer patients who cannot have surgery, with further prospective studies needed to confirm its survival advantage over CRT.