Pretreatment SUVmax Stratifies the Benefit of Consecutive Daily SBRT in Early-Stage Non-Small Cell Lung Cancer

IF 3.9 3区医学 Q2 ONCOLOGY

Clinical lung cancer Pub Date : 2026-07-01 Epub Date: 2026-06-08 DOI:10.1016/j.cllc.2026.06.002

Yupeng Di, Haifeng Pang, Xuan Wang, Lingling Meng

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引用次数: 0

Abstract

Objective

To investigate the prognostic value of pretreatment SUVmax in early-stage NSCLC treated with stereotactic body radiotherapy (SBRT) and evaluate whether metabolic activity modulates the impact of overall treatment time (OTT) on outcomes.

Methods

We retrospectively analyzed 186 patients with stage I NSCLC treated with SBRT (48 Gy/4 fractions). Patients were stratified into high (SUVmax ≥ 5.0, n = 73) and low (SUVmax < 5.0, n = 113) metabolic groups. Schedules were categorized as consecutive (OTT 4-5 days) or non-consecutive (OTT 6-10 days). Primary endpoints were local control (LC) and overall survival (OS).

Results

With a median follow-up of 41 months, high SUVmax was associated with inferior outcomes; the 3-year LC rates were 92.1% in the low metabolic group compared to 63.4% in the high metabolic group (P < .0001). On multivariate analysis, SUVmax ≥ 5.0 independently predicted local failure (HR 3.70, 95% CI, 1.48-9.24, P = .005) and mortality (HR 2.38, 95% CI, 1.41-4.01, P = .001). Crucially, a formal interaction test revealed that metabolic activity significantly modulated the impact of scheduling on LC (P-interaction = .042). Subgroup analysis demonstrated that consecutive treatment significantly improved LC in the high-SUVmax group (P = .035), whereas no significant difference between schedules was observed in the low-SUVmax group (P = .57).

Conclusion

Pretreatment SUVmax is a robust prognostic biomarker for SBRT outcomes. High-metabolic tumors exhibit heightened sensitivity to treatment prolongation, likely driven by factors such as accelerated repopulation during gaps. Consequently, relatively short or consecutive SBRT courses may be beneficial for this “high-risk” metabolic subgroup. However, biological prioritization must be balanced against safety; non-consecutive schedules remain viable for indolent tumors and are mandatory when technical limitations, prior radiotherapy, or central/ultra-central tumor locations preclude the safe delivery of highly compressed ablative doses.

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预处理SUVmax对早期非小细胞肺癌患者连续每日SBRT的获益进行分层

目的：探讨预处理SUVmax在早期NSCLC立体定向放射治疗（SBRT）中的预后价值，并评估代谢活动是否调节总治疗时间（OTT）对预后的影响。方法：我们回顾性分析了186例接受SBRT （48 Gy/4次）治疗的I期非小细胞肺癌患者。将患者分为高代谢组（SUVmax≥5.0,n = 73）和低代谢组（SUVmax < 5.0, n = 113）。时间表分为连续（OTT 4-5天）或非连续（OTT 6-10天）。主要终点为局部控制（LC）和总生存期（OS）。结果：中位随访41个月，高SUVmax与较差的预后相关；低代谢组3年LC率为92.1%，高代谢组为63.4% （P < 0.0001）。在多因素分析中，SUVmax≥5.0独立预测局部衰竭（HR 3.70, 95% CI, 1.48 ~ 9.24, P = 0.005）和死亡率（HR 2.38, 95% CI, 1.41 ~ 4.01, P = 0.001）。重要的是，一个正式的相互作用检验显示，代谢活性显著调节了调度对LC的影响（p -相互作用= 0.042）。亚组分析显示，连续治疗显著改善了高suvmax组的LC (P = 0.035)，而低suvmax组的不同治疗方案之间无显著差异（P = 0.57）。结论：预处理SUVmax是SBRT预后的可靠生物标志物。高代谢肿瘤表现出对延长治疗的高度敏感性，可能是由诸如间隔期间加速再繁殖等因素驱动的。因此，相对较短或连续的SBRT疗程可能对这一“高风险”代谢亚群有益。然而，生物优先级必须与安全性相平衡；对于惰性肿瘤，非连续计划仍然是可行的，当技术限制、先前的放疗或中心/超中心肿瘤位置排除了高压缩消融剂量的安全输送时，非连续计划是强制性的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical lung cancer 医学-肿瘤学

CiteScore

7.00

自引率

2.80%

发文量

159

审稿时长

24 days

期刊介绍： Clinical Lung Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of lung cancer. Clinical Lung Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of lung cancer. The main emphasis is on recent scientific developments in all areas related to lung cancer. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.