Objective:
Stereotactic body radiation therapy (SBRT) is the preferred treatment modality for patients with inoperable early-stage non-small cell lung cancer. However, comparative outcomes between SBRT and surgery for high-risk patients remain controversial. The primary aim of the present meta-analysis was to assess overall survival in matched and unmatched patient cohorts undergoing SBRT or surgery. Secondary endpoints included cancer-specific survival, diseasefree survival, disease recurrence, and perioperative outcomes.
Methods:
A systematic review of relevant studies was performed through online databases using predefined criteria. The most updated studies were selected for meta-analysis according to unmatched and matched patient cohorts.
Results:
Thirty-two studies were identified in the systematic review, and 23 were selected for quantitative analysis. Surgery was associated with superior overall survival in both unmatched (odds ratio [OR], 2.49; 95% confidence interval [CI], 2.10–2.94; p<0.00001) and matched (OR, 1.71; 95% CI, 1.52–1.93; p<0.00001) cohorts. Subgroup analysis demonstrated superior overall survival for lobectomy and sublobar resection, compared with SBRT. In unmatched and matched cohorts, cancer-specific survival, disease-free survival, and freedom from locoregional recurrence were superior after surgery. However, SBRT was associated with fewer perioperative deaths.
Conclusions:
The current evidence suggests surgery is superior to SBRT in terms of mid- and long-term clinical outcomes; SBRT is associated with lower perioperative mortality. The improved outcomes after surgery, however, may be attributable at least in part to an imbalance of baseline characteristics. Future studies should aim to provide histopathological confirmation of malignancy and compare SBRT with minimally invasive anatomical resections.