Radiotherapy, lobectomy or sublobar resection? A meta-analysis of the choices for treating stage I non-small-cell lung cancer

Deng, Han‐Yu; Wang, Yun-Cang; Ni, Peng-Zhi; Li, Gang; Yang, Xiaoyan; Lin, Yi‐Dan; Liu, Lunxu

doi:10.1093/ejcts/ezw272

Cited by 38 publications

(47 citation statements)

References 36 publications

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“…This has been previously shown in a metaanalysis, which identified similar survival rates between patients who received SBRT and those who received surgery only after adjusting for age and %Op [102]. This finding has been corroborated in a pooled analysis of 2 RCTs, while unadjusted data still favored surgery [12,101,105]. The current study is limited by considerable selection bias due to that most studies included in the analysis were single- institutional, single-arm, observational studies from various continents of the world with great heterogeneity, including variation in quality.…”

Section: Discussionsupporting

confidence: 62%

Comparison of particle beam therapy and stereotactic body radiotherapy for early stage non-small cell lung cancer: A systematic review and hypothesis-generating meta-analysis

Chi¹,

Chen

Wen

et al. 2017

Radiotherapy and Oncology

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Purpose To assess hypo-fractionated particle beam therapy (PBT)'s efficacy relative to that of photon stereotactic body radiotherapy (SBRT) for early stage (ES) non-small cell lung cancer (NSCLC). Methods Eligible studies were identified through extensive searches of the PubMed, Medline, Google-scholar, and Cochrane library databases from 2000 to 2016. Original English publications of ES NSCLC were included. A meta-analysis was performed to compare the survival outcome, toxicity profile, and patterns of failure following each treatment. Results 72 SBRT studies and 9 hypo-fractionated PBT studies (mostly single-arm) were included. PBT was associated with improved overall survival (OS; p = 0.005) and progression-free survival (PFS; p = 0.01) in the univariate meta-analysis. The OS benefit did not reach its statistical significance after inclusion of operability into the final multivariate meta-analysis (p = 0.11); while the 3-year local control (LC) still favored PBT (p = 0.03). Conclusion Although hypo-fractionated PBT may lead to additional clinical benefit when compared with photon SBRT, no statistically significant survival benefit from PBT over SBRT was observed in the treatment of ES NSCLC in this hypothesis-generating meta-analysis after adjusting for potential confounding variables.

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Section: Discussionsupporting

confidence: 62%

Comparison of particle beam therapy and stereotactic body radiotherapy for early stage non-small cell lung cancer: A systematic review and hypothesis-generating meta-analysis

Chi¹,

Chen

Wen

et al. 2017

Radiotherapy and Oncology

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“…Until recently, segmentectomy and wedge resection have been used when pulmonary function or other comorbidities pose a high operative risk. However, the use of segmentectomy has recently been recommended for small peripheral stage I NSCLCs instead of lobectomy [10,11], as outcomes are comparable to those after lobectomy. On the other hand, pneumonectomy is still reserved for more extensive disease, as the surgical morbidity and mortality are higher than for lobectomy or sublobar resections [7].…”

Section: Introductionmentioning

confidence: 99%

Lobectomy for non-small cell lung carcinoma: a nationwide study of short- and long-term survival

et al. 2017

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Introduction: Lobectomy is the standard curative treatment for non-small cell carcinoma (NSCLC) of the lung. Most studies on lobectomy have focused on short-term outcome and 30-day mortality. The aim of this study was to determine both short-term and long-term surgical outcome in all patients who underwent lobectomy for NSCLC in Iceland over a 24-year period. Material and methods: The study involved 489 consecutive patients with NSCLC who underwent lobectomy with curative intent in Iceland, 1991Iceland, -2014. Patient demographics, pTNM stage, rate of perioperative complications, and 30-day mortality were registered. Overall survival was analyzed with the Kaplan-Meier method. The Cox proportional hazards model was used to evaluate factors that were prognostic of overall mortality. To study trends in survival, the study period was divided into six 4-year periods. The median follow-up time was 42 months and no patients were lost to follow-up. Results: The average age of the patients was 67 years and 53.8% were female. The pTNM disease stage was IA in 148 patients (30.0%), IB in 125 patients (25.4%), IIA in 96 patients (19.5%), and IIB in 50 patients (10.1%), but 74 (15.0%) were found to be stage IIIA, most often diagnosed perioperatively. The total rate of major complications was 4.7%. Thirty-day mortality was 0.6% (three patients). One-and 5-year overall survival was 85.0% and 49.2%, respectively, with 3-year survival improving from 48.3% to 72.8% between the periods 1991-1994 and 2011-2014 (p ¼ .0004). Advanced TNM stage and age were independent negative prognostic factors for all-cause mortality, and later calendar year and free surgical margins were independent predictors of improved survival. Conclusions: The short-term outcome of lobectomy for NSCLC in this population-based study was excellent, as reflected in the low 30-day mortality and low rate of major complications. The long-term survival was acceptable and the overall 3-year survival had improved significantly during the study period.

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“…Inoperable SABR patients had poorer conditions (older, higher comorbidities scores, and poorer respiratory tests results) than surgical patients, leading to decreased OS. Surgical and SABR technical procedures varied broadly and/or were not reported (12,18,19). In conclusion, existing retrospective data, including meta-analysis on the literature, should be interpreted with extreme caution (11)(12)(13)(14).…”

mentioning

confidence: 98%

“…This is not surprising given that non-comparable patients have been included. SABR patients were generally inoperable, with higher comorbidities scores (11)(12)(13)(14). Death, in the SABR population, is mostly due to intercurrent causes, and OS may then not be considered as a valid comparison endpoint (15).…”

mentioning

confidence: 99%

Stereotactic ablative body radiation therapy or surgery for operable early non-small cell lung cancer patients: bound hand and foot to evidence

2017

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Radiotherapy, lobectomy or sublobar resection? A meta-analysis of the choices for treating stage I non-small-cell lung cancer

Cited by 38 publications

References 36 publications

Comparison of particle beam therapy and stereotactic body radiotherapy for early stage non-small cell lung cancer: A systematic review and hypothesis-generating meta-analysis

Comparison of particle beam therapy and stereotactic body radiotherapy for early stage non-small cell lung cancer: A systematic review and hypothesis-generating meta-analysis

Lobectomy for non-small cell lung carcinoma: a nationwide study of short- and long-term survival

Stereotactic ablative body radiation therapy or surgery for operable early non-small cell lung cancer patients: bound hand and foot to evidence

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