Evidence map›Paper›PMID 40760181›Full record

ArticleStrahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]2026

Empiric stereotactic body radiotherapy for presumed early-stage lung cancer : Pulmonary function changes, treatment-related toxicity and survival outcome.

Esra Degerli, Karim El-Marouk, Lukas Käsmann, Khulangaa Khaltar, Sina Mansoorian, Cedric Richlitzki, Diego Kauffmann-Guerrero, Amanda Tufman, Niels Reinmuth, Thomas Duell and 4 more

Abstract read
In one paragraph

Article in Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al], 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Esra DegerliDepartment of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany.
Karim El-MaroukDepartment of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany.
Lukas KäsmannDepartment of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany. Lukas.Kaesmann@med.uni-muenchen.de.ORCID 0000-0001-6260-5249
Khulangaa KhaltarDepartment of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany.
Sina MansoorianDepartment of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany.
Cedric RichlitzkiDepartment of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany.
Diego Kauffmann-GuerreroGerman Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany.
Amanda TufmanGerman Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany.
Niels ReinmuthAsklepios Fachkliniken Munich, Asklepios Kliniken GmbH, Gauting, Germany.
Thomas DuellAsklepios Fachkliniken Munich, Asklepios Kliniken GmbH, Gauting, Germany.
Nina-Sophie Schmidt-HegemannDepartment of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany.
Farkhad ManapovDepartment of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany.
Claus BelkaDepartment of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany.
Chukwuka EzeDepartment of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDue 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.

methodsBetween 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.

resultsThe 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.

conclusionEmpiric 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.

Indexed as

Carcinoma, Non-Small-Cell LungLung NeoplasmsRadiation InjuriesRadiosurgeryAgedAged, 80 and overComorbidityFemaleFollow-Up StudiesHumansMaleMiddle AgedNeoplasm StagingRespiratory Function TestsRetrospective StudiesSurvival RateLung functionLung neoplasmsPathologic confirmationRadiographicStereotactic ablative radiotherapy (SABR)

Identifiers

PMID40760181
PMCPMC12953386

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.