Stereotactic body radiation therapy with higher biologically effective dose is associated with improved survival in stage II non-small cell lung cancer

Abstract Objectives The role of stereotactic body radiation therapy (SBRT) in treating stage II non-small cell lung cancer (NSCLC) remains unclear. This study evaluates SBRT dose prescription patterns and survival outcomes in Stage II NSCLC using the National Cancer Database (NCDB). Materials and methods Patients diagnosed with Stage II NSCLC and treated with SBRT between 2004–2013 were identified in NCDB. The biologically effective dose with α/β = 10 Gy (BED 10 ) was calculated. Overall survival (OS) was analyzed using the Kaplan-Meier method and Cox regression models. Results Of 56,543 patients with Stage II NSCLC, 451 (0.8%) received SBRT. There were 360 patients (79.8%) with node-negative and 91 patients (20.2%) with node-positive disease. The most common prescriptions were 10 Gy x 5 (35.9%) and 12 Gy x 4 (19.3%). The mean and median BED 10 were 114.9 Gy and 105.6 Gy, respectively. With median follow-up of 19.3 months, overall median survival was 23.7 months. Median survival was 22.4 months for those treated with BED 10 10  ≥ 114.9 Gy (p = 0.036). On multivariate analysis, BED 10 as a continuous variable (hazard ratio [HR] 0.991, p = 0.009) and ≥ 114.9 Gy (HR 0.63, p = 0.015) were associated with improved survival in node-negative patients. BED 10 as a continuous variable (HR 0.997, p = 0.465) and ≥ 114.9 Gy (HR 0.81, p = 0.546) were not significant factors for predicting survival in node-positive patients. Conclusion SBRT is infrequently utilized to treat Stage II NSCLC in the United States. Treatment with higher BED 10 was associated with improved survival, and the benefit was limited to patients with node-negative disease.