Background: Stereotactic body radiation therapy (SBRT) is considered as the preferred treatment method for inoperable early-stage non-small cell lung cancer (NSCLC). However, there is still a debate on the efficacy of SBRT and surgery. This meta-analysis aimed to compare survival outcomes of SBRT and surgery for early-stage NSCLC (≤5cm).Methods: A systematic review and meta-analysis were performed to compare survival outcomes of surgery and SBRT. And the pooled analysis was conducted with STATA 14.0 software. Results: Thirty-nine comparative studies were included for systematic review and twenty-eight of which for quantitative analysis. Compared with SBRT, overall survival (OS) was superior after surgical resection, included lobectomy, sublobar resection, video-assisted thoracoscopic surgery, and thoracotomy, for patients with early-stage NSCLC (≤5cm). And the results of subgroup analysis remained the support of surgery except for the OS of operable matched cohorts and the one matched cohort of age ≥75. However, the HR of OS showed a reduction from patients with unspecific age, ≥65 to ≥75 years old and histopathologically confirmed NSCLC to clinical NSCLC. Although cancer-specific survival and local control was superior after surgery, the recurrence rate of tumors, locoregional control, distant control, and regional control of matched patients demonstrated no significantly different outcomes between SBRT and surgery for early-stage NSCLC.Conclusions: Results show that surgery has superior OS, CSS and local control compared to SBRT for early-stage NSCLC. There is still necessary to explore the survival difference between SBRT and surgery for patients with different characteristics by large-sample, long-term follow-up randomized clinical studies.
Purpose: The treatments for advanced or metastatic BRAF mutant melanoma are flourish, but the most effective treatment is unclear. Here, we conducted a network meta-analysis (NMA) in unresectable stage III or advanced (or metastatic) stage IV BRAF mutant melanoma patients to estimate the efficacy of various first line treatments.Methods: A comprehensive search for RCTs in PubMed and EMBASE was conducted to January 2021. Randomized control trials of unresectable stage III or advanced stage IV BRAF mutant melanoma were eligible if not receive previously treatment. By a Bayesian network meta-analysis, the effectiveness of each treatment was estimated and ranked based on the odds ratio (OR) for Object response rate (ORR) and hazard ratio (HR) for Overall survival (OS).Results: Eight trials enrolling 3272 patients were included. Combination dabrafenib and trametinib with pembrolizumab (HR: 0.37; 95% confidence interval [CI]: 0.21-0.66; compared with dacarbazine) ranked as the best effective treatment for OS.Conclusion: Combination pembrolizumab with trametinib and dabrafenib and combination atezolizumab with trametinib and dabrafenib appear more effective as first line treatments for unresectable stage III or advanced (or metastatic) stage IV BRAF mutant melanoma patients. Whereas, further RCTs are needed to complete the network.
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