Oncologic Outcomes of Surgery Versus SBRT for Non–Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis

Ijsseldijk, Michiel A.; Shoni, Melina; Siegert, Charles; Wiering, Bastiaan; Engelenburg, Anton K.C. van; Tsai, Thomas C.; Broek, Richard P. G. ten; Lebenthal, Abraham

doi:10.1016/j.cllc.2020.04.017

Cited by 28 publications

(17 citation statements)

References 737 publications

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“…In terms of surgical treatment, Jensik et al [26] were the first to propose segmentectomy as an appropriate alternative to lobectomy for small-sized lung cancers. Since then, the debate has continued with findings for and against this in randomized trials, large database studies, and meta-analysis reviews, with lobectomy continuing as the standard of care with allowances for sublobar resection of high-risk cases [3,7,27,28] . Relatively few studies have focused on direct comparisons of surgical options in high-risk patients.…”

Section: Therapeutic Choice For Optimal Long-term Outcomes Of High-risk Patientsmentioning

confidence: 99%

“…Relatively few studies have focused on direct comparisons of surgical options in high-risk patients. Ijsseldijk et al [28] recently published a comprehensive systematic review and meta-analysis of 100 studies comparing SBRT, sublobar resection, and lobectomy. In this work, they found that lobar resection had a 5-year OS of 74% [0.69, 0.78], sublobar resection had a 70% OS [0.64, 0.77], and SBRT had a 46% OS [0.35, 0.57], with both surgical survivals statistically better compared to SBRT, both P < 0.01.…”

Section: Therapeutic Choice For Optimal Long-term Outcomes Of High-risk Patientsmentioning

confidence: 99%

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Sublobar resection in high-risk patients for lobectomy: current and future strategy

Dolan¹,

Swanson²

2021

Mini-invasive Surg

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Surgical resection by lobectomy is the gold standard of therapy for early stage non-small cell lung cancer. However, not all patients are medically fit to undergo surgery. In patients considered high-risk for lobectomy, alternative strategies have been developed including radiofrequency ablation, cryoablation, microwave ablation, stereotactic radiation therapy, wedge resection, and segmentectomy. This work reviews the definition of high-risk, and the outcomes that have been associated with each treatment technique. Some technical points regarding wedge resection versus segmentectomy are noted. Future directions are discussed in the context of treatment for patients considered at high-risk for lobectomy.

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Section: Therapeutic Choice For Optimal Long-term Outcomes Of High-risk Patientsmentioning

confidence: 99%

Section: Therapeutic Choice For Optimal Long-term Outcomes Of High-risk Patientsmentioning

confidence: 99%

Sublobar resection in high-risk patients for lobectomy: current and future strategy

Dolan¹,

Swanson²

2021

Mini-invasive Surg

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“…For early-stage NSCLC, stereotactic ablative radiotherapy (SBRT) does not achieve surgically equivalent oncological outcomes ( 6 ) and is recommended for patients who are medically inappropriate for surgery ( 7 ). Surgery is still regarded to be the mainstay treatment for patients with early-stage NSCLCs ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

Selection of the surgical approach for patients with cStage IA lung squamous cell carcinoma: A population-based propensity score matching analysis

et al. 2022

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BackgroundThis study aimed to conduct a comparative analysis of the survival rates after segmentectomy, wedge resection, or lobectomy in patients with cStage IA lung squamous cell carcinoma (SCC).MethodsWe enrolled 4,316 patients who had cStage IA lung SCC from the Surveillance, Epidemiology, and End Results (SEER) database. The Cox proportional hazards model was conducted to recognize the potential risk factors for overall survival (OS) and lung cancer-specific survival (LCSS). To eliminate potential biases of included patients, the propensity score matching (PSM) method was used. OS and LCSS rates were compared among three groups stratified according to tumor size.ResultsKaplan–Meier analyses revealed no statistical differences in the rates of OS and LCSS between wedge resection (WR) and segmentectomy (SG) groups for patients who had cStage IA cancers. In patients with tumors ≤ 1 cm, LCSS favored lobectomy (Lob) compared to segmentectomy (SG), but a similar survival rate was obtained for wedge resection (WR) and lobectomy (Lob). For patients with tumors sized 1.1 to 2 cm, lobectomy had improved OS and LCSS rates compared to the segmentectomy or wedge resection groups, with the exception of a similar OS rate for lobectomy and segmentectomy. For tumors sized 2.1 to 3 cm, lobectomy had a higher rate of OS or LCSS than wedge resection or segmentectomy, except that lobectomy conferred a similar LCSS rate compared to segmentectomy. Multivariable analyses showed that patients aged ≥75 and tumor sizes of >2 to ≤3 cm were potential risk factors for OS and LCSS, while lobectomy and first malignant primary indicator were considered protective factors. The Cox proportional analysis also confirmed that male patients aged ≥65 to <75 were independent prognostic factors that are indicative of a worse OS rate.ConclusionsThe tumor size can influence the surgical procedure recommended for individuals with cStage IA lung SCC. For patients with tumors ≤1 cm, lobectomy is the recommended approach, and wedge resection or segmentectomy might be an alternative for those who cannot tolerate lobectomy if adequate surgical margin is achievable and enough nodes are sampled. For tumors >1 to ≤3 cm, lobectomy showed better survival outcomes than sublobar resection. Our findings require further validation by randomized controlled trial (RCT) or other evidence.

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“…Conventional fractionated radiotherapy usually delivers in small fractions (1.8–2.0Gy per fraction) over a number of weeks, while hypofractionated radiotherapy delivers higher dose (3–20Gy) in fewer fractions ( 2 , 3 ). Emerging evidence suggests that hypofractionated radiotherapy—clinically called stereotactic body radiotherapy (SBRT) or radiosurgery (SRS)—may elicit a pronounced anti-tumor effect ( 4 , 5 ). In addition to directly killing tumor cells, hypofractionated irradiation can induce tumor cells death via antitumor immunity ( 6 ) and vascular damage ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Advances in Hypofractionated Irradiation-Induced Immunosuppression of Tumor Microenvironment

Wang

2021

Front. Immunol.

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Hypofractionated radiotherapy is external beam irradiation delivered at higher doses in fewer fractions than conventional standard radiotherapy, which can stimulate innate and adaptive immunity to enhance the body’s immune response against cancer. The enhancement effect of hypofractionated irradiation to immune response has been widely investigated, which is considered an approach to expand the benefit of immunotherapy. Meanwhile, increasing evidence suggests that hypofractionated irradiation may induce or enhance the suppression of immune microenvironments. However, the suppressive effects of hypofractionated irradiation on immunomicroenvironment and the molecular mechanisms involved in these conditions are largely unknown. In this context, we summarized the immune mechanisms associated with hypofractionated irradiation, highlighted the advances in its immunosuppressive effect, and further discussed the potential mechanism behind this effect. In our opinion, besides its immunogenic activity, hypofractionated irradiation also triggers homeostatic immunosuppressive mechanisms that may counterbalance antitumor effects. And this may suggest that a combination with immunotherapy could possibly improve the curative potential of hypofractionated radiotherapy.

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Oncologic Outcomes of Surgery Versus SBRT for Non–Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis

Cited by 28 publications

References 737 publications

Sublobar resection in high-risk patients for lobectomy: current and future strategy

Sublobar resection in high-risk patients for lobectomy: current and future strategy

Selection of the surgical approach for patients with cStage IA lung squamous cell carcinoma: A population-based propensity score matching analysis

Advances in Hypofractionated Irradiation-Induced Immunosuppression of Tumor Microenvironment

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