Fifteen-Year National Trends in Single-Fraction Stereotactic Body Radiation Therapy Utilization for Stage I Non–Small Cell Lung Cancer

PURPOSE – To evaluate utilization trends and survival outcomes of single-fraction stereotactic body radiation therapy (SF-SBRT) for early-stage non–small cell lung cancer (NSCLC).METHODS – The National Cancer Database (2006-2021) was queried to identify patients with stage I NSCLC treated with either SF-SBRT or multifraction (MF) SBRT delivered in 3-5 fractions. Patients receiving chemotherapy or surgery were excluded. Utilization trends were assessed using the Cochran-Armitage test. Predictors of SF-SBRT use were evaluated via multivariable logistic regression. Overall survival (OS) was compared using the log-rank test.RESULTS – A total of 83, 377 patients were identified, of whom 937 (1.1%) received SF-SBRT. The proportion of SF-SBRT rose from 0% in 2006 to 1.6% in 2021 (P <.0001). The most frequent SF-SBRT prescriptions were 34 Gy (39%), 27 Gy (28%), and 30 Gy (28%); the most frequent MF-SBRT prescriptions were 10 Gy × 5 (42%), 18 Gy × 3 (14%), and 12 Gy × 4 (14%). The proportion of facilities delivering SF-SBRT increased from 0% in 2006 to 11% in 2021 (P <.0001) and, as of 2021, varied significantly by annual lung SBRT case volume: 6% for centers treating <10 patients, 25% for centers treating 10-19 patients, 41% for centers treating 20-29 patients, and 69% for centers treating ≥30 patients per year. Factors associated with SF-SBRT utilization included smaller tumor size (≤2 cm), treatment at a high-volume center or academic facility, and later year of treatment (all P <.0001). There was no difference in OS between patients treated with SF-SBRT and MF-SBRT (P =.89).CONCLUSION – Utilization of SF-SBRT for stage I NSCLC is increasing, particularly at high-volume and/or academic centers. Yet, its overall utilization remains low despite evidence supporting its safety and efficacy.