This study from Japan reported clinical outcomes of 43 patient with operable stage IA or IB NSCLC treated with a dose of 66 GyRBE in 10 fractions for peripheral lesions, or 72.6 GyRBE in 22 fractions for central lesions. At 3-year, the rate of OS, LC and PFS were 95%, 95% and 86%; and 83%, 95% and 77% at 7-year. 2% (one patient) grade 3 and 9% (four patients) grade 2 radiation pneumonitis occurred. The authors concluded that proton therapy with image guidance provided effective disease control and survival in operable stage I NSCLC, particularly for peripheral lesions, with minimal toxicity and favorable patient-reported QoL.