Systematic Review of Single-Fraction Stereotactic Body Radiation Therapy for Early Stage Non-Small-Cell Lung Cancer and Lung Oligometastases: How to Stop Worrying and Love One and Done

SIMPLE SUMMARY: Adoption of single-fraction stereotactic body radiation therapy for lung tumors has been limited among different institutions even during the coronavirus disease 2019 (COVID-19) pandemic. Potential reasons may include a lack of familiarity and concerns regarding potential toxicities. To address this knowledge gap, we performed a systematic review of prospective literature on single-fraction SBRT. Our PubMed search of prospective trials resulted in nine studies that showed favorable local control and survival outcomes among peripheral tumors. Many toxicities were grade 1–2, with 0–17% of patients experiencing grade ≥3 toxicity. Encouraging outcomes suggest that the utility of single-fraction stereotactic body radiation therapy may extend beyond the current COVID-19 pandemic. ABSTRACT: Adoption of single-fraction lung stereotactic body radiation therapy (SBRT) for patients with medically inoperable early stage non-small-cell lung cancer (NSCLC) or oligometastatic lung disease, even during the coronavirus disease 2019 (COVID-19) pandemic, was limited despite encouraging phase II trial results. Barriers to using single-fraction SBRT may include lack of familiarity with the regimen and lack of clarity about the expected toxicity. To address these concerns, we performed a systematic review of prospective literature on single-fraction SBRT for definitive treatment of early stage and oligometastatic lung cancer. A PubMed search of prospective studies in English on single-fraction lung SBRT was conducted. A systematic review was performed of the studies that reported clinical outcomes of single-fraction SBRT in the treatment of early stage non-small-cell lung cancer and lung oligometastases. The current prospective literature including nine trials supports the use of single-fraction SBRT in the definitive treatment of early stage peripheral NSCLC and lung oligometastases. Most studies cite local control rates of >90%, mild toxicity profiles, and favorable survival outcomes. Most toxicities reported were grade 1–2, with grade ≥3 toxicity in 0–17% of patients. Prospective trial results suggest potential consideration of utilizing single-fraction SBRT beyond the COVID-19 pandemic.