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

Abstract

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.

Causation between Pathway Completion and Reduced Hospital Stay in Patients with Lung Cancer: a Retrospective Cohort Study Using Propensity Score Matching

“…Historically, there have been three main methods for the treatment of cancer: operation, chemotherapy, and radiotherapy. In addition, various meta-analysis studies have evaluated the combination of these methods for typical types of lung cancer (e.g., second malignancies after radiotherapy for prostate cancer [18], chemotherapy in non-small cell lung cancer [19], radiotherapy plus epidermal growth factor receptor tyrosine kinase inhibitors [20], and other treatments [21][22][23][24][25][26]).…”

Stereotactic Radiotherapy for Ultra-Central Lung Oligometastases in Non-Small-Cell Lung Cancer

“…Among future strategies, expanding use of proton therapy and hadrons (for example, carbon ion) may allow potential dosimetric advantage over photon-based SBRT in reducing dose exposure of critical structures while maintaining target tumor dose coverage. In a recent meta-analysis by Chi et al, a lower incidence of grade ≥3 toxicity was associated with the use of particle therapy (0.9% vs. 3.4%, p = 0.001) [29].…”

Proton Beam Therapy for Histologically or Clinically Diagnosed Stage I Non-Small Cell Lung Cancer (NSCLC): The First Nationwide Retrospective Study in Japan

“…In the pooled analysis, the rate of grade !3 RP was significantly lower for PBT than for SBRT (0.9% [95% CI, 1.1%-3.3%] vs 3.4% [95% CI, 2.9%-4.0%], P < .001), even though tumors that were more advanced in size and T-stage were treated with PBT. 26 A second advantage is that PBT can be used to treat centrally located tumors. Timmerman et al 10 reported that patients with centrally located tumors had a higher rate of grade !3 toxicities and a lower 2-year rate of freedom from severe toxicity (54%), compared with 83% for patients with peripheral tumors.…”

“…However, their meta-analysis included only preliminary PBT results and had a small sample size. [23][24][25] In a more recent meta-analysis, Chi et al 26 reported that PBT did not improve OS and PFS in comparison with SBRT (P Z .11) based on multivariate analysis, and PBT yielded a better 3year LC (P Z .03); the rate of grade !3 toxicity was lower (4.8% vs 6.9%, P Z .05) based on pooled analysis. Thus, studies with a larger sample size with longer follow-up are required to accurately evaluate PBT in this patient population.…”