Surgery or stereotactic body radiotherapy for elderly stage I lung cancer? A propensity score matching analysis

Miyazaki, Takuro; Yamazaki, Takuya; Nakamura, Daisuke; Sato, Shuntaro; Yamasaki, Naoya; Tsuchiya, Tomoshi; Matsumoto, Keitaro; Kamohara, Ryotaro; Hatachi, Go; Nagayasu, Takeshi

doi:10.1007/s00595-017-1536-4

Cited by 21 publications

(19 citation statements)

References 29 publications

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“…Histopathological confirmation of NSCLC in the SBRT arm varied widely, between 30% and 100%, with five studies reporting <75% of patients with a confirmed histopathological diagnosis. 7, 36, 37, 39, 42 It should be noted that two of these studies were the only publications that showed a trend of longer disease-free survival for SBRT than surgery. 7, 37…”

Section: Discussionmentioning

confidence: 99%

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

Cao

Wang

Chung

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

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

Cao

Wang

Chung

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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“…The result of the same OS between surgery and SBRT for matched patients with early-stage NSCLC is consistent with the previous studies(18, 47) which suggests that the health patients may get the same survival bene t from the two treatments. What's more, we should note that a large number of studies did not completely get the histology proof of malignance (11,20,27,28,31,32,35,37,38,45,47). In our study, the pooled results showed SBRT had more balanced OS with surgery for the patients with histopathological con rmed NSCLC than those with clinical NSCLC irrespective of matching.…”

Section: Discussionmentioning

confidence: 55%

Stereotactic body radiation therapy versus surgery for patients with early-stage non–small cell lung cancer( ≤ 5cm): A systematic review and meta-analysis

Zhou

Wen

et al. 2021

Preprint

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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.

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“…For patients 75 years or older, the 3-year OS was 78.0% (95% CI 62.0-88.0%) with a median age of 82 years in the present study. Miyazaki et al recently reported that SBRT treatment and surgery exhibit similar results for patients 80 years or older with Stage I NSCLC using propensity score matching [22]. Taremi et al reported results using SBRT for medically inoperable lung cancer regardless of pathological confirmation [23] and observed no significant differences in OS among patients with pathologically confirmed cancer.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy to treat small lung lesions clinically diagnosed as primary lung cancer by radiological examination: A prospective observational study

et al. 2018

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Surgery or stereotactic body radiotherapy for elderly stage I lung cancer? A propensity score matching analysis

Abstract: The outcomes of surgery and SBRT for elderly patients with the early stage NSCLC were roughly the same.

Cited by 21 publications

References 29 publications

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

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

Stereotactic body radiation therapy versus surgery for patients with early-stage non–small cell lung cancer( ≤ 5cm): A systematic review and meta-analysis

Stereotactic body radiotherapy to treat small lung lesions clinically diagnosed as primary lung cancer by radiological examination: A prospective observational study

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