A systematic review and meta-analysis of stereotactic body radiation therapy versus surgery for patients with non–small cell lung cancer

Abstract

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.

A systematic review and meta-analysis of surgery delays and survival in breast, lung and colon cancers: Implication for surgical triage during the COVID-19 pandemic

“…5 , 7 However, curative surgery is often the single treatment for early-stage lung cancer 53 and the efficacy of alternative treatments has been shown to be inconsistent. 55 , 56 , 57 Our results suggest if delaying surgery for stages I/II lung cancers becomes necessary during future waves of COVID-19 it should be done with caution and rescheduled for the earliest possible date.…”

Stereotactic radiotherapy for early stage non-small cell lung cancer: current standards and ongoing research

“…A metaanalysis of 4850 patients within 40 SBRT studies and 7,071 patients within 23 surgical studies in ES NSCLC reported no significant difference in OS or disease-free survival (DFS) when adjusting for age and comorbidities (37). Another metaanalysis of 23 studies reported improved outcome in terms of overall-and cancer-free-survival after surgery compared to SBRT in both the matched and unmatched group (38). All retrospective and cross-study comparisons suffer from insufficient matching of surgical and SBRT patient cohorts because relevant prognostic factors are frequently unavailable for the matching process.…”

Population-based analysis of curative therapies in stage II non-small cell lung cancer: the role of radiotherapy in medically inoperable patients

“…Our findings of improved outcomes with surgery in stage II NSCLC mirror other retrospective studies in stage I disease comparing stereotactic body radiation therapy (SBRT) versus surgical resection. In a metaanalysis of over 150, 000 unmatched SBRT and surgical patients and over 17,000 matched patients, the survival was superior with surgery in both unmatched and matched populations albeit with a smaller benefit in the matched group [31]. This finding suggests that the improved outcomes must be, in part, related to differences in baseline patient and disease characteristics.…”