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@ARTICLE{Degerli:303373,
      author       = {E. Degerli and K. El-Marouk and L. Käsmann$^*$ and K.
                      Khaltar and S. Mansoorian and C. Richlitzki and D.
                      Kauffmann-Guerrero and A. Tufman and N. Reinmuth and T.
                      Duell and N.-S. Schmidt-Hegemann and F. Manapov and C.
                      Belka$^*$ and C. Eze},
      title        = {{E}mpiric stereotactic body radiotherapy for presumed
                      early-stage lung cancer : {P}ulmonary function changes,
                      treatment-related toxicity and survival outcome.},
      journal      = {Strahlentherapie und Onkologie},
      volume       = {nn},
      issn         = {0179-7158},
      address      = {Heidelberg},
      publisher    = {Springer Medizin},
      reportid     = {DKFZ-2025-01622},
      pages        = {nn},
      year         = {2025},
      note         = {epub},
      abstract     = {Due to demographic shifts, the population is aging, and
                      patients are experiencing more comorbidities. Stereotactic
                      body radiotherapy (SBRT) offers high rates of local control
                      for patients with medically inoperable early-stage non-small
                      cell lung cancer (NSCLC). However, obtaining
                      histopathological confirmation can be challenging due to
                      severe comorbidities, small tumors, or unfavorable
                      anatomical locations.Between 2011 and 2022, we
                      retrospectively analyzed a cohort of patients who underwent
                      lung SBRT for presumed early-stage NSCLC at our institution.
                      Out of 486 consecutive patients treated during this period,
                      56 patients $(11.5\%)$ with a total of 61 lesions were
                      identified and included in this retrospective study. All
                      included patients lacked histopathological confirmation
                      prior to treatment and had no evidence of other active
                      malignancies. The primary objective of this analysis was to
                      evaluate pulmonary function tests before and after SBRT,
                      including long-term follow-up.The median overall survival
                      (OS) after empiric SBRT was 50.7 months $(95\%$ confidence
                      interval [CI] 12.8-88.7). Survival rates at 1 year and 2
                      years were 88.4 and $71.1\%,$ respectively. The 1‑, 2‑
                      and 3‑year local control rates were $96.6\%,$ $92.3\%$ and
                      $87.1\%.$ Pulmonary function tests indicated a relative
                      increase in the mean forced expiratory volume in 1 s (FEV1)
                      of $0.55\%$ (SD 13.5) and $2.0\%$ (SD: 20.0) at 6 and 12
                      months, respectively. In contrast, the mean diffusing
                      capacity of the lungs for carbon monoxide (DLCO) showed a
                      relative decline of $7.4\%$ (SD 16.6) and $6.3\%$ (SD 26.1)
                      at 6 and 12 months, respectively. Patients with lower
                      comorbidity scores (CCI ≤ 5) exhibited significantly
                      improved OS (p = 0.011). Long-term oxygen therapy (LTOT)
                      prior to SBRT was associated with shorter OS (p = 0.02) and
                      a relatively high incidence of grade 2-3 pulmonary
                      disorders. Chronic obstructive pulmonary disease (COPD) was
                      identified as a possible risk factor for severe
                      treatment-related toxicity. Notably, all patients who
                      experienced grade 3 pulmonary disorders required LTOT before
                      SBRT.Empiric SBRT is a safe and effective treatment for
                      presumed early-stage NSCLC in patients without
                      histopathological confirmation. Even in patients requiring
                      oxygen therapy and with severe comorbidities, long-term
                      survival is feasible with acceptable treatment-related
                      toxicity. Optimal dose fractionation and biologically
                      effective dose (BED) levels for frail patients without
                      histological confirmation remain undefined. Prospective
                      trials are warranted to determine the most effective and
                      safe SBRT regimens for this vulnerable patient population.},
      keywords     = {Lung function (Other) / Lung neoplasms (Other) / Pathologic
                      confirmation (Other) / Radiographic (Other) / Stereotactic
                      ablative radiotherapy (SABR) (Other)},
      cin          = {MU01},
      ddc          = {610},
      cid          = {I:(DE-He78)MU01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40760181},
      doi          = {10.1007/s00066-025-02434-8},
      url          = {https://inrepo02.dkfz.de/record/303373},
}