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Peer-reviewedCC BY-NC-ND 4.0Advances in Radiation Oncology

Sequencing of Stereotactic Body Radiation Therapy and Chemotherapy in Stage I Small Cell Lung Cancer: Practice Patterns and Outcomes

  • Therese J. Ziaks1
  • Patrick Oh2
  • Daniel Hicks2
  • James H. Laird2
  • Nipun Verma2
  • Christin A. Knowlton2
  • Thomas J. Hayman2
  • Henry S. Park2
  1. 1Yale University School of Public Health, New Haven, Connecticut
  2. 2Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
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Abstract

Purpose: We evaluated practice patterns and survival outcomes associated with the sequencing of stereotactic body radiation therapy (SBRT) and chemotherapy in patients with clinical stage I small cell lung cancer (SCLC) in the United States.

Methods and Materials: Using a large national database, we identified patients with clinical stage I (cT1-2N0M0) SCLC treated with SBRT and chemotherapy between 2004 and 2020. To assess practice patterns in relation to survival outcomes, patients were categorized into 2 cohorts: “SBRT before chemotherapy” and “SBRT concurrent with or after chemotherapy.” χ2 tests and logistic regression models were used to determine patient characteristics associated with treatment sequencing. Univariable and multivariable Cox proportional hazard models were used to assess the association between patient characteristics and survival outcomes. Overall survival was analyzed using the Kaplan-Meier method and compared via the log-rank test. Sensitivity analyses were performed using multivariable logistic regressions and Cox proportional hazards models for treatments with a 30-day overlap and clinical T stage stratification.

Results: Among 631 patients with clinical stage I SCLC who were treated with SBRT and chemotherapy, 416 (65.9%) were categorized in “SBRT before chemotherapy” and 215 (34.1%) in “SBRT concurrent with or after chemotherapy.” Patients diagnosed after 2018 were less likely to receive SBRT concurrent with or after chemotherapy (odds ratio, 0.46; 95% CI, 0.32-0.66; P < .001). Patients diagnosed with clinical stage T2 were more likely to receive SBRT concurrent with or after chemotherapy (odds ratio, 1.76; 95% CI, 1.05-2.95; P = .03). No statistically significant difference in survival was observed between the 2 treatment sequencing cohorts (“SBRT before chemotherapy”: median, 40.5 months vs “SBRT concurrent with or after chemotherapy”: median, 35.6 months; log-rank P = .30). On multivariable analysis, SBRT sequencing was not associated with overall survival (hazard ratio = 1.11; P = .35; 95% CI, 0.89-1.37).

Conclusions: Our findings suggest that there is no statistically significant difference in survival outcomes for patients who receive SBRT before chemotherapy compared with those who receive SBRT concurrent with or after chemotherapy. Therefore, flexibility in treatment sequencing may be appropriate in this population.

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Cite

BibTeXRIS
BibTeX
@article{ziaks2026sequencing,
  title = {{Sequencing of Stereotactic Body Radiation Therapy and Chemotherapy in Stage I Small Cell Lung Cancer: Practice Patterns and Outcomes}},
  author = {Therese J. Ziaks and Patrick Oh and Daniel Hicks and James H. Laird and Nipun Verma and Christin A. Knowlton and Thomas J. Hayman and Henry S. Park},
  journal = {Advances in Radiation Oncology},
  year = {2026},
  month = sep,
  doi = {10.1016/j.adro.2026.102175},
  url = {https://doi.org/10.1016/j.adro.2026.102175},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Sequencing of Stereotactic Body Radiation Therapy and Chemotherapy in Stage I Small Cell Lung Cancer: Practice Patterns and Outcomes
AU  - Therese J. Ziaks
AU  - Patrick Oh
AU  - Daniel Hicks
AU  - James H. Laird
AU  - Nipun Verma
AU  - Christin A. Knowlton
AU  - Thomas J. Hayman
AU  - Henry S. Park
PY  - 2026
DA  - 2026/09/09
JO  - Advances in Radiation Oncology
DO  - 10.1016/j.adro.2026.102175
UR  - https://doi.org/10.1016/j.adro.2026.102175
AB  - Purpose: We evaluated practice patterns and survival outcomes associated with the sequencing of stereotactic body radiation therapy (SBRT) and chemotherapy in patients with clinical stage I small cell lung cancer (SCLC) in the United States.  Methods and Materials: Using a large national database, we identified patients with clinical stage I (cT1-2N0M0) SCLC treated with SBRT and chemotherapy between 2004 and 2020. To assess practice patterns in relation to survival outcomes, patients were categorized into 2 cohorts: “SBRT before chemotherapy” and “SBRT concurrent with or after chemotherapy.” χ2 tests and logistic regression models were used to determine patient characteristics associated with treatment sequencing. Univariable and multivariable Cox proportional hazard models were used to assess the association between patient characteristics and survival outcomes. Overall survival was analyzed using the Kaplan-Meier method and compared via the log-rank test. Sensitivity analyses were performed using multivariable logistic regressions and Cox proportional hazards models for treatments with a 30-day overlap and clinical T stage stratification.  Results: Among 631 patients with clinical stage I SCLC who were treated with SBRT and chemotherapy, 416 (65.9%) were categorized in “SBRT before chemotherapy” and 215 (34.1%) in “SBRT concurrent with or after chemotherapy.” Patients diagnosed after 2018 were less likely to receive SBRT concurrent with or after chemotherapy (odds ratio, 0.46; 95% CI, 0.32-0.66; P < .001). Patients diagnosed with clinical stage T2 were more likely to receive SBRT concurrent with or after chemotherapy (odds ratio, 1.76; 95% CI, 1.05-2.95; P = .03). No statistically significant difference in survival was observed between the 2 treatment sequencing cohorts (“SBRT before chemotherapy”: median, 40.5 months vs “SBRT concurrent with or after chemotherapy”: median, 35.6 months; log-rank P = .30). On multivariable analysis, SBRT sequencing was not associated with overall survival (hazard ratio = 1.11; P = .35; 95% CI, 0.89-1.37).  Conclusions: Our findings suggest that there is no statistically significant difference in survival outcomes for patients who receive SBRT before chemotherapy compared with those who receive SBRT concurrent with or after chemotherapy. Therefore, flexibility in treatment sequencing may be appropriate in this population.
SN  - 2452-1094
ER  -