• non‐small‐cell lung carcinoma
• pulmonary function tests
• residual volume
• survival
• total lung capacity

• Humans
• Carcinoma, Non-Small-Cell Lung/mortality
• Carcinoma, Non-Small-Cell Lung/diagnosis
• Carcinoma, Non-Small-Cell Lung/physiopathology
• Carcinoma, Non-Small-Cell Lung/pathology
• Male
• Female
• Lung Neoplasms/mortality
• Lung Neoplasms/diagnosis
• Lung Neoplasms/physiopathology
• Lung Neoplasms/pathology
• Aged
• Middle Aged
• Total Lung Capacity
• Prognosis
• Residual Volume
• Spirometry
• Longitudinal Studies
• Respiratory Function Tests
• Lung/physiopathology

• 5U01CA209414 NCI NIH HHS
• P30ES000002 NCI NIH HHS
• R01CA249096 NCI NIH HHS
• National Cancer Institute

• expert consensus
• high-risk
• stage I non-small cell lung cancer
• stereotactic ablative radiotherapy
• stereotactic body radiation treatment
• stereotactic radiosurgery
• systematic review

• Humans
• Carcinoma, Non-Small-Cell Lung/pathology
• Carcinoma, Non-Small-Cell Lung/radiotherapy
• Carcinoma, Non-Small-Cell Lung/mortality
• Carcinoma, Non-Small-Cell Lung/surgery
• Radiosurgery/adverse effects
• Radiosurgery/mortality
• Lung Neoplasms/pathology
• Lung Neoplasms/radiotherapy
• Lung Neoplasms/mortality
• Lung Neoplasms/surgery
• Neoplasm Staging
• Risk Factors
• Treatment Outcome
• Risk Assessment
• Time Factors
• Dose Fractionation, Radiation

• NSCLC
• lung cancer
• screening
• stereotactic body radiation therapy
• wedge resection

• Humans
• Carcinoma, Non-Small-Cell Lung/pathology
• Lung Neoplasms/pathology
• Radiosurgery/methods
• Kaplan-Meier Estimate
• Comorbidity

• Humans
• Carcinoma, Non-Small-Cell Lung/pathology
• Lung Neoplasms/pathology
• Dose Fractionation, Radiation
• Small Cell Lung Carcinoma
• Probability
• Radiosurgery/methods

• Humans
• Radiation Oncologists
• Lung Neoplasms/surgery
• Surgeons
• Practice Patterns, Physicians'
• Bias
• Neoplasms

• SBRT
• deep learning
• early-stage lung NSCLC
• local failure
• machine learning (ML)
• surgery

• Cancer bronchique non à petites cellules
• Early stage
• NSCLC
• Non-small cell lung cancer
• Radiation therapy
• Radiothérapie stéréotaxique
• Stade précoce
• Stereotactic body radiotherapy

• Humans
• Carcinoma, Non-Small-Cell Lung/radiotherapy
• Carcinoma, Non-Small-Cell Lung/surgery
• Carcinoma, Non-Small-Cell Lung/pathology
• Lung Neoplasms/radiotherapy
• Lung Neoplasms/surgery
• Lung Neoplasms/pathology
• Radiosurgery/methods
• Neoplasm Staging
• Treatment Outcome

• 19
• 21 l858r
• 67
• del
• egfr
• ki
• lung adenocarcinoma
• tkis (epidermal growth factor receptor
• tyrosine kinase inhibitors)

• Humans
• Ki-67 Antigen
• Retrospective Studies
• Adenocarcinoma of Lung/genetics
• Pleural Diseases
• ErbB Receptors/genetics
• Lung Neoplasms/genetics
• Mutation

• NSCLC
• lobectomy
• segmentectomy
• sub-lobar resection
• wedge resection

• BED, biological effective dose
• CCI, Charlson comorbidity index
• CSS, cancer-specific survival
• CT, computed tomography
• DM, distant metastasis
• FEV1, forced expiratory volume in the first second
• FVC, forced vital capacity
• ITV, internal target volume
• KPS, Karnofsky performance status
• LRR, locoregional recurrence
• Locoregional recurrence
• MPLC, multiple primary lung cancer
• Multiple primary lung cancers
• NSCLC, non-small cell lung cancer
• OS, overall survival
• PET/CT, positron emission tomography/computed tomography
• PTV, planning target volume
• Radical resection
• SBRT, stereotactic body radiation therapy
• Stereotactic body radiation therapy
• TTP, time to progression
• Toxicity
• VATS, video-assisted thoracoscopic surgery

This study aimed to explore the predictability of topological signatures linked to the locoregional relapse (LRR) and distant metastasis (DM) on pretreatment planning computed tomography images of stage I non‐small cell lung cancer (NSCLC) patients before treatment with stereotactic ablative radiotherapy (SABR).

We divided 125 primary stage I NSCLC patients (LRR: 34, DM: 22) into training (n = 60) and test datasets (n = 65), and the training dataset was augmented to 260 cases using a synthetic minority oversampling technique. The relapse predictabilities of the conventional wavelet‐based features (WF), topology‐based features [BF, Betti number (BN) map features; iBF, inverted BN map features], and their combined features (BWF, iBWF) were compared. The patients were stratified into high‐risk and low‐risk groups using the medians of the radiomics scores in the training dataset.

For the LRR in the test, the iBF, iBWF, and WF showed statistically significant differences (p < 0.05), and the highest nLPC was obtained for the iBF. For the DM in the test, the iBWF showed a significant difference and the highest nLPC.

The iBF indicated the potential of improving the LRR and DM prediction of stage I NSCLC patients prior to undergoing SABR.

• non-small cell lung cancer (NSCLC)
• radiotherapy
• relapse
• topology

• Carcinoma, Non-Small-Cell Lung/diagnostic imaging
• Carcinoma, Non-Small-Cell Lung/radiotherapy
• Carcinoma, Non-Small-Cell Lung/surgery
• Humans
• Lung Neoplasms/diagnostic imaging
• Lung Neoplasms/radiotherapy
• Lung Neoplasms/surgery
• Neoplasm Recurrence, Local/diagnostic imaging
• Neoplasm Recurrence, Local/pathology
• Neoplasm Staging
• Radiosurgery/methods
• Tomography, X-Ray Computed

• Lung cancer
• ablation
• quality-of-life (QOL)
• radiotherapy
• surgery

• UL1 TR001863 NCATS NIH HHS

• epidemiology
• lung cancer
• prognostic factor
• survival

• Early stage
• Lung cancer
• Radiofrequency ablation
• Stereotactic radiosurgery
• Sublobar resection
• Video-assisted thoracoscopic surgery

• Lung neoplasms
• Meta analysis
• Stereotactic body radiotherapy
• Surgery

• Humans
• Carcinoma, Non-Small-Cell Lung/radiotherapy
• Carcinoma, Non-Small-Cell Lung/surgery
• Lung Neoplasms/radiotherapy
• Lung Neoplasms/surgery
• Lung Neoplasms/mortality
• Radiosurgery/methods
• Treatment Outcome

To evaluate the overall survival of patients with operable stage IA non-small-cell lung cancer (NSCLC) who undergo “early” SBRT (within 0–30 days after diagnosis) versus “delayed” surgery (90–120 days after diagnosis).

During the COVID-19 pandemic, national guidelines have recommended patients with operable stage IA NSCLC to consider delaying surgery by at least 3 months or, alternatively, to undergo SBRT without delay. It is unknown which strategy is associated with better short- and long-term outcomes.

Multivariable Cox proportional hazards modeling and propensity score-matched analysis was used to compare the overall survival of patients with stage IA NSCLC in the National Cancer Data Base from 2004 to 2015 who underwent “early” SBRT (0–30 days after diagnosis) versus that of patients who underwent “delayed” wedge resection (90–120 days after diagnosis).

During the study period, 570 (55%) patients underwent early SBRT and 475 (45%) underwent delayed wedge resection. In multivariable analysis, delayed resection was associated with improved survival [adjusted hazard ratio 0.61; (95% confidence interval (CI): 0.50–0.76)]. Propensity-score matching was used to create 2 groups of 279 patients each who received early SBRT or delayed resection that were well-matched with regard to baseline characteristics. The 5-year survival associated with delayed resection was 53% (95% CI: 45%–61%) which was better than the 5-year survival associated with early SBRT (31% [95% CI: 24%–37%]).

In this national analysis, for patients with stage IA NSCLC, extended delay of surgery was associated with improved survival when compared to early treatment with SBRT.

Surgery and stereotactic body radiotherapy (SBRT) are both suitable treatment options for early stage Non-small cell lung cancer (NSCLC), which accounts for the majority of lung cancer. This study compared the outcomes of sublobar resection (SLR) and SBRT in patients with stage T1-2N0M0 NSCLC with tumor size ≤5 cm.

Patients with T1-2N0M0 lung cancer who underwent SLR or SBRT between January, 2012 and December, 2016 were included in this retrospective study. The survival outcomes and toxicity of the SLR and SBRT cohorts were compared using Kaplan-Meier survival plots. In a second exploratory analysis, propensity score matching (PSM) was applied to reduce selection bias between the two groups of patients.

A total of 121 SLR and 109 SBRT cases were included. The average follow-up was 49.4 months. Prior to PSM, the 5-year overall survival (OS) and cancer-specific survival (CSS) rates in the SLR group (82.8% and 89.0%, respectively) were superior to those in the SBRT group (67.0% and 75.3%; P=0.001 and P=0.013, respectively). There were no statistically significant differences in the five-year locoregional control and disease-free survival (DFS) rates between the groups. PSM identified 40 patients from each treatment group who shared similar characteristics. At 5 years, the OS rates in the SLR and SBRT groups were comparable (79.9% vs. 66.5%, respectively; P=0.154). After PSM, the rates of CSS, locoregional control, and DFS were also similar between the groups (P=0.458, 0.369, and 0.698, respectively). In the SBRT group, one patient developed grade 3 radioactive pneumonitis. No grade >3 toxicities or treatment-related deaths occurred in either group.

SBRT may be an alternative option to SLR for patients who cannot tolerate lobectomy because of medical comorbidities and has a similar level of effectiveness.

• Early-stage non-small cell lung cancer (early-stage NSCLC)
• adverse event
• propensity score matching (PSM)
• stereotactic body radiotherapy
• sublobar resection (SLR)
• treatment outcome

• NSCLC
• SBRT
• distant metastasis
• radiomics
• random survival forest

In early-stage Non-Small Cell Lung Cancer (NSCLC) patients, little is known about how to measure patient participation in Shared-Decision Making (SDM). We examined the psychometric properties and clinical acceptability of the Decision Self-Efficacy scale (DSE) in a cohort of patients undergoing to Stereotactic Ablative Radiotherapy (SABR) or Video-assisted Thoracoscopic Surgery (VATS) to capture patient involvement in treatment decisions.

In the context of a prospective longitudinal study (Life after Lung Cancer-LiLAC) involving 244 patients with early-stage NSCLC, 158 (64.7%) patients completed the DSE either on paper or electronically online prior to treatment with SABR or VATS pulmonary resection. DSE psychometric properties were examined using: principal components analysis of item properties and internal structure, and internal construct validity; we also performed a sensitivity analysis according to Eastern Cooperative Oncology Group Performance Status (ECOG PS), gender, age and treatment received (VATS or SABR) difference.

Exploratory factor analysis using polychoric correlations substantiated that the 11 item DSE is one scale accounting for 81% of the variance. We calculated a value of 0.96 for Cronbach’s alpha for the total DSE score.

DSE scores did not differ by gender (p = 0.37), between the two treatment groups (p = 0.09) and between younger and older patients (p = 0.4). However, patients with an ECOG PS > 1 have a DSE mean of 73.8 (SD 26) compared to patients with a PS 0–1 who have a DSE mean of 85.8 (SD 20.3 p = 0.002).

Findings provide preliminary evidence for the reliability and validity of the DSE questionnaire in this population. However, future studies are warranted to identify the most appropriate SDM tool for clinical practice in the lung cancer treatment field.

• Informed decision making
• Lung cancer
• Radiotherapy
• Self-efficacy
• Shared decision making
• Surgery

In recent years, advanced radiation therapy techniques, including stereotactic body radiotherapy and carbon–ion radiotherapy, have progressed to such an extent that certain types of cancer can be treated with radiotherapy alone. The therapeutic outcomes are particularly promising for early stage lung cancer, with results matching those of surgical resection. Nevertheless, patients may still experience local tumor recurrence, which might be exacerbated by the acquisition of radioresistance after primary radiotherapy. Notwithstanding the risk of tumors acquiring radioresistance, secondary radiotherapy is increasingly used to treat recurrent tumors. In this context, it appears essential to comprehend the radiobiological effects of repeated photon and particle irradiation and their underlying cellular and molecular mechanisms in order to achieve the most favorable therapeutic outcome. However, to date, the mechanisms of acquisition of radioresistance in cancer cells have mainly been studied after repeated in vitro X-ray irradiation. By contrast, other critical aspects of radioresistance remain mostly unexplored, including the response to carbon-ion irradiation of X-ray radioresistant cancer cells, the mechanisms of acquisition of carbon-ion resistance, and the consequences of repeated in vivo X-ray or carbon-ion irradiation. In this review, we discuss the underlying mechanisms of acquisition of X-ray and carbon-ion resistance in cancer cells, as well as the phenotypic differences between X-ray and carbon-ion-resistant cancer cells, the biological implications of repeated in vivo X-ray or carbon-ion irradiation, and the main open questions in the field.

• DNA repair
• X-ray radiation
• acquisition
• aggressiveness
• cancer
• carbon-ion radiation
• radioresistance
• repeated irradiation