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High local control rates can be achieved using stereotactic radiotherapy in Stage I non–small-cell lung cancer (NSCLC), but reports have suggested that toxicity may be of concern. We evaluated early clinical outcomes of “risk-adapted” fractionation schemes in patients treated in a single institution.

Of 206 patients with Stage I NSCLC, 81% were unfit to undergo surgery and the rest refused surgery. Pathologic confirmation of malignancy was obtained in 31% of patients. All other patients had new or growing 18F-fluorodeoxyglucose positron emission tomography positive lesions with radiologic characteristics of malignancy. Planning four-dimensional computed tomography scans were performed and fractionation schemes used (3 × 20 Gy, 5 × 12 Gy, and 8 × 7.5 Gy) were determined by T stage and risk of normal tissue toxicity.

Median overall survival was 34 …