***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background A phase III multi-centre r and omised trial ( ROSEL ) has been initiated to establish the role of stereotactic radiotherapy in patients with operable stage IA lung cancer . Due to rapid changes in radiotherapy technology and evolving techniques for image-guided delivery , guidelines had to be developed in order to ensure uniformity in implementation of stereotactic radiotherapy in this multi-centre study . Methods / Design A Quality Assurance Working Party was formed by radiation oncologists and clinical physicists from both academic as well as non-academic hospitals that had already implemented stereotactic radiotherapy for lung cancer . A literature survey was conducted and consensus meetings were held in which both the knowledge from the literature and clinical experience were pooled . In addition , a planning study was performed in 26 stage I patients , of which 22 were stage 1A , in order to develop and evaluate the planning guidelines . Plans were optimised according to parameters adopted from RTOG trials using both an algorithm with a simple homogeneity correction ( Type A ) and a more advanced algorithm ( Type B ) . Dose conformity requirements were then formulated based on these results . Conclusion Based on current literature and expert experience , guidelines were formulated for this phase III study of stereotactic radiotherapy versus surgery .  These guidelines can serve to facilitate the design of future multi-centre clinical trials of stereotactic radiotherapy in other patient groups and aid a more uniform implementation of this technique outside clinical trials PURPOSE To present the results of stereotactic body radiotherapy ( SBRT ) for medically inoperable patients with Stage I non-small-cell lung cancer ( NSCLC ) and contrast outcomes in patients with and without a pathologic diagnosis . METHODS AND MATERIAL S Between December 2004 and October 2008 , 108 patients ( 114 tumors ) underwent treatment according to the prospect i ve research ethics board-approved SBRT protocol s at our cancer center . Of the 108 patients , 88 ( 81.5 % ) had undergone pretreatment whole-body [18F]-fluorodeoxyglucose positron emission tomography/computed tomography .  A pathologic diagnosis was unavailable for 33 ( 28.9 % ) of the 114 lesions . The SBRT schedules included 48 Gy in 4 fractions or 54 - 60 Gy in 3 fractions for peripheral lesions and 50 - 60 Gy in 8 - 10 fractions for central lesions . Toxicity and radiologic response were assessed at the 3 - 6-month follow-up visits using conventional criteria . RESULTS The mean tumor diameter was 2.4-cm ( range , 0.9 - 5.7 ) . The median follow-up was 19.1 months ( range , 1 - 55.7 ) . The estimated local control rate at 1 and 4 years was 92 % ( 95 % confidence interval [ CI ] , 86 - 97 % ) and 89 % ( 95 % CI , 81 - 96 % ) . The cause-specific survival rate at 1 and 4 years was 92 % ( 95 % CI , 87 - 98 % ) and 77 % ( 95 % CI , 64 - 89 % ) , respectively . No statistically significant difference was found in the local , regional , and distant control between patients with and without pathologically confirmed NSCLC . The most common acute toxicity was Grade 1 or 2 fatigue ( 53 of 108 patients ) . No toxicities of Grade 4 or greater were identified . CONCLUSIONS Lung SBRT for early-stage NSCLC result ed in excellent local control and cause-specific survival with minimal toxicity . The disease-specific outcomes were comparable for patients with and without a pathologic diagnosis . SBRT can be considered an option for selected patients with proven or presumed early-stage NSCLC PURPOSE To evaluate the efficacy and adverse effects of image-guided stereotactic body radiation therapy ( SBRT ) in central ly/superiorly located non-small-cell lung cancer ( NSCLC ) . MATERIAL S AND METHODS We delivered SBRT to 27 patients , 13 with Stage I and 14 with isolated recurrent NSCLC . A central /superior location was defined as being within 2 cm of the bronchial tree , major vessels , esophagus , heart , trachea , pericardium , brachial plexus , or vertebral body , but 1 cm away from the spinal canal . All patients underwent four-dimensional computed tomography-based planning , and daily computed tomography-on-rail guided SBRT . The prescribed dose of 40 Gy ( n = 7 ) to the planning target volume was escalated to 50 Gy ( n = 20 ) in 4 consecutive days . RESULTS With a median follow-up of 17 months ( range , 6 - 40 months ) , the crude local control at the treated site was 100 % using 50 Gy . However , 3 of 7 patients had local recurrences when treated using 40 Gy . Of the patients with Stage I disease , 1 ( 7.7 % ) and 2 ( 15.4 % ) developed mediastinal lymph node metastasis and distant metastases , respectively . Of the patients with recurrent disease , 3 ( 21.4 % ) and 5 ( 35.7 % ) developed mediastinal lymph node metastasis and distant metastasis , respectively . Four patients ( 28.6 % ) with recurrent disease but none with Stage I disease developed Grade 2 pneumonitis . Three patients ( 11.1 % ) developed Grade 2 - 3 dermatitis and chest wall pain . One patient developed brachial plexus neuropathy . No esophagitis was noted in any patient . CONCLUSIONS Image-guided SBRT using 50 Gy delivered in four fractions is feasible and result ed in excellent local control PURPOSE This study analyzed patients enrolled in two large , prospect ively r and omized trials of systemic chemotherapy ( adjuvant/palliative setting ) for non-small-cell lung Cancer ( NSCLC ) . The main objective was to determine if age and /or the burden of chronic medical conditions ( comorbidity ) are independent predictors of survival , treatment delivery , and toxicity . PATIENTS AND METHODS Baseline comorbid conditions were scored using the Charlson comorbidity index ( CCI ) , a vali date d measure of patient comorbidity that is weighted according to the influence of comorbidity on overall mortality . The CCI score ( CCIS ) was correlated with demographic data , ( ie , age , sex , race ) , performance status ( PS ) , histology , cancer stage , patient weight , hemoglobin , alkaline phosphatase , lactate dehydrogenase , outcomes of chemotherapy delivery ( ie , type , total dose , and dose intensity ) , survival , and response . RESULTS A total of 1,255 patients were included in this analysis . The median age was 61 years ( range , 34 to 89 years ) ; 34 % of patients were elderly ( at least 65 years of age ) ; and 31 % had comorbid conditions at r and omization . Twenty-five percent of patients had a CCIS of 1 , whereas 6 % had a CCIS of 2 or greater . Elderly patients were more likely to have a CCIS equal to or greater than 1 compared with younger patients ( 42 % v 26 % ; P < .0001 ) , as were male patients ( 35 % v 21 % ; P < .0001 ) and patients with squamous histology ( 36 % v 29 % ; P = .001 ) . Although age did not influence overall survival , the CCIS appeared prognostic ( CCIS 1 v 0 ; hazard ratio 1.28 ; 95%CI , 1.09 to 1.5 ; P = .003 ) . CONCLUSION In these large , r and omized trials , the presence of comorbid conditions ( CCIS > or = 1 ) , rather than age more than 65 years , was associated with poorer survival PURPOSE To compare the efficacy of three lung stereotactic body radiotherapy ( SBRT ) regimens in a large institutional cohort . METHODS Between 2004 and 2009 , 130 patients underwent definitive lung cancer SBRT to a single lesion at the Mallinckrodt Institute of Radiology . We delivered 18 Gy × 3 fractions for peripheral tumors ( n = 111 ) and either 9 Gy × 5 fractions ( n = 8) or 10 Gy × 5 fractions ( n = 11 ) for tumors that were central or near critical structures . Univariate and multivariate analysis of prognostic factors was performed using the Cox proportional hazard model . RESULTS Median follow-up was 11 , 16 , and 13 months for the 9 Gy × 5 , 10 Gy × 5 , and 18 Gy × 3 groups , respectively . Local control statistics for Years 1 and 2 were , respectively , 75 % and 50 % for 9 Gy × 5 , 100 % and 100 % for 10 Gy × 5 , and 99 % and 91 % for 18 Gy × 3 . Median overall survival was 14 months , not reached , and 34 months for the 9 Gy × 5 , 10 Gy × 5 , and 18 Gy × 3 treatments , respectively . No difference in local control or overall survival was found between the 10 Gy × 5 and 18 Gy × 3 groups on log-rank test , but both groups had improved local control and overall survival compared with 9 Gy × 5 . Treatment with 9 Gy × 5 was the only independent prognostic factor for reduced local control on multivariate analysis , and increasing age , increasing tumor volume , and poor performance status predicted independently for reduced overall survival . CONCLUSION Treatment regimens of 10 Gy × 5 and 18 Gy × 3 seem to be efficacious for lung cancer SBRT and provide superior local control and overall survival compared with 9 Gy × 5 OBJECTIVE Sublobar resection ( SR ) is commonly used for patients considered high risk for lobectomy . Nonoperative therapies are increasingly being reported for patients with similar risk because of perceived lower morbidity . We report 30- and 90-day adverse events ( AEs ) from American College of Surgeons Oncology Group Z4032 , a multicenter phase III study for high-risk patients with stage I non-small cell lung cancer . METHODS Data from 222 evaluable patients r and omized to SR ( n = 114 ) or SR with brachytherapy ( n = 108 ) are reported . AEs were recorded using the Common Terminology Criteria for Adverse Events , Version 3.0 , at 30 and 90 days after surgery . Risk factors ( age , percent baseline carbon monoxide diffusion in the lung [ DLCO% ] , percent forced expiratory volume in 1 second [ FEV1 % ] , upper lobe vs lower lobe resections , performance status , surgery approach , video-assisted thoracic surgery vs open and extent , and wedge vs segmentectomy ) were analyzed using a multivariable logistic model for their impact on the incidence of grade 3 or higher ( G3 + ) AEs . Respiratory AEs were also specifically analyzed . RESULTS Median age , FEV1 % , and DLCO% were similar in the 2 treatment groups . There was no difference in the location of resection ( upper vs lower lobe ) or the use of segmental or wedge resections . There were no differences between the groups with respect to " respiratory " G3 + AEs ( 30 days : 14.9 % vs 19.4 % , P = .35 ; 0 - 90 days : 19.3 % vs 25 % , P = .31 ) and " any " G3 + AEs ( 30 days : 25.4 % vs 30.6 % , P = .37 ; 0 - 90 days : 29.8 % vs 37 % , P = .25 ) . Further analysis combined the 2 groups . Mortality occurred in 3 patients ( 1.4 % ) by 30 days and in 6 patients ( 2.7 % ) by 90 days . Four of the 6 deaths were thought to be due to surgery . When considered as continuous variables , FEV1 % was associated with " any " G3 + AE at days 0 to 30 ( P = .03 ; odds ratio [ OR ] = 0.98 ) and days 0 to 90 ( P = .05 ; OR = 0.98 ) , and DLCO% was associated with " respiratory " G3 + AE at days 0 to 30 ( P = .03 ; OR = 0.97 ) and days 0 to 90 ( P = .05 ; OR = 0.98 ) . Segmental resection was associated with a higher incidence of any G3 + AE compared with wedge resection at days 0 to 30 ( 40.3 % vs 22.7 % ; OR = 2.56 ; P < .01 ) and days 0 to 90 ( 41.5 % vs 29.7 % ; OR = 1.96 ; P = .04 ) . The median FEV1 % was 50 % , and the median DLCO% was 46 % . By using these median values as potential cutpoints , only a DLCO% of less than 46 % was significantly associated with an increased risk of " respiratory " and " any " G3 + AE for days 0 to 30 and 0 to 90 . CONCLUSIONS In a multicenter setting , SR with brachytherapy was not associated with increased morbidity compared with SR alone . SR/SR with brachytherapy can be performed safely in high-risk patients with non-small cell lung cancer with low 30- and  
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Tumour location ( central versus peripheral ) did not impact overall survival .
Grade 3 or 4 toxicities may be more common following SABR for central tumours , but occurred in less than 9 % of patients .
Post-SABR survival for early-stage NSCLC is not affected by tumour location .
SABR achieves high local control with limited toxicity when appropriate fractionation schedules are used for central tumours