Higher biologically effective dose is associated with improved survival in patients with squamous cell carcinoma of the lung treated with stereotactic body radiation therapy

•Higher BED was associated with improved OS in SCC lung patients undergoing SBRT.•BED escalation was not advantageous in patients with non-SCC NSCLC.•BED > 150 Gy may confer a survival benefit in patients with SCC. Multiple studies have suggested that patients with early-stage SCC of the lung treated with SBRT are more susceptible to local failure compared to other NSCLC histologies. It is unknown if higher BED leads to improved outcomes in this patient population. We evaluated the effect of “high” BED versus “low” BED SBRT on overall survival (OS) in SCC and non-SCC NSCLC patients. The National Cancer Database was used to identify patients with cT1-2N0M0 NSCLC diagnosed between 2006–2016 treated with 3–5 fraction SBRT. Patients were grouped by BEDhigh (>150 Gy) and BEDlow (≤132 Gy). Univariate and multivariable analysis using Kaplan-Meier and Cox proportional hazards regression modeling were performed. Propensity-score matched analysis with inverse probability of treatment (IPTW) weighting was used to account for selection bias. We identified 4,717 eligible SCC patients and 8,807 eligible non-SCC NSCLC patients. In SCC patients, BEDhigh was associated with improved OS in both univariate and multivariate analysis (MVA HR 0.84 95% CI 0.76–0.92, p 150 Gy may confer a survival benefit in patients with SCC histology. Histology-based dose modification should be considered, and prospective validation may be warranted.