Stereotactic body radiotherapy versus surgery for early-stage non-small cell lung cancer: an updated meta-analysis involving 29,511 patients included in comparative studies / Radioterapia estereotáxica corporal vs. cirurgia para câncer de pulmão de células não pequenas em estágio inicial: meta-análise atualizada envolvendo 29.511 pacientes incluídos em estudos comparativos

ABSTRACT Objective: To evaluate the efficacy of stereotactic body radiotherapy (SBRT) versus surgery for early-stage non-small cell lung cancer (NSCLC) by means of a meta-analysis of comparative studies. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines, searches were performed on PubMed, MEDLINE, Embase, and Cochrane Library for eligible studies. The meta-analysis compared the hazard ratios (HR) for overall survival (OS), cancer-specific survival (CSS), and local control (LC). Subgroup and meta-regression analyses evaluated the association of extent of surgical resection, study publication year, tumor staging, propensity score matching, proportion of chemotherapy use, and proportion of pathological lymph node involvement with CSS and OS. Results: Thirty studies involving 29,511 patients were included (surgery group: 17,146 patients and SBRT group: 12,365 patients). There was a significant difference in favor of surgery vs. SBRT in the 3-year OS (HR = 1.35; 95% CI: 1.22-1.44; I2 = 66%) and 3-year CSS (HR = 1.23; 95% CI: 1.09-1.37; I2 = 17%), but not in the 3-year LC (HR = 0.97; 95% CI: 0.93-1.08; I2 = 19%). In the subgroup analysis for OS, no significant difference between surgery and SBRT groups was observed in the T1N0M0 subgroup (HR = 1.26; 95% CI: 0.95-1.68; I2 = 0%). In subgroup analysis for CSS, no significant difference was detected between the sublobar resection subgroup and the SBRT group (HR = 1.21; 95% CI: 0.96-1.53; I2 = 16%). Conclusions: Surgery generally resulted in better 3-year OS and CSS than did SBRT; however, publication bias and heterogeneity may have influenced these findings. In contrast, SBRT produced LC results similar to those of surgery regardless of the extent of surgical resection. These findings may have important clinical implications for patients with comorbidities, advanced age, poor pulmonary reserve, and other factors that may contraindicate surgery.

RESUMO Objetivo: Avaliar a eficácia da stereotactic body radiotherapy (SBRT, radioterapia estereotáxica corporal) vs. cirurgia para câncer de pulmão de células não pequenas em estágio inicial por meio de uma meta-análise de estudos comparativos. Métodos: Seguindo as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses e Meta-analysis of Observational Studies in Epidemiology, foram realizadas buscas no PubMed, MEDLINE, Embase e Cochrane Library por estudos elegíveis. A meta-análise comparou as razões de risco (RR) para sobrevida global (SG), sobrevida específica para câncer (SEC) e controle local (CL). As análises de subgrupo e metarregressão avaliaram a associação de extensão da ressecção cirúrgica, ano de publicação do estudo, estadiamento do tumor, correspondência de escore de propensão, porcentagem de quimioterapia e porcentagem de acometimento linfonodal com SEC e SG. Resultados: Trinta estudos envolvendo 29.511 pacientes foram incluídos (grupo cirurgia: 17.146 pacientes e grupo SBRT: 12.365 pacientes). Houve diferença significativa a favor da cirurgia vs. SBRT na SG em 3 anos (RR = 1,35; IC95%: 1,22-1,44; I2 = 66%) e na SEC em 3 anos (RR = 1,23; IC95%: 1,09-1,37; I2 = 17%), mas não no CL em 3 anos (RR = 0,97; IC95%: 0,93-1,08; I2 = 19%). Na análise de subgrupo para SG, nenhuma diferença significativa entre os grupos cirurgia e SBRT foi observada no subgrupo T1N0M0 (RR = 1,26; IC95%: 0,95-1,68; I2 = 0%). Na análise de subgrupo para SEC, nenhuma diferença significativa foi detectada entre o subgrupo ressecção sublobar e o grupo SBRT (RR = 1,21; IC95%: 0,96-1,53; I2 = 16%). Conclusões: A cirurgia geralmente resultou em melhor SG e SEC em 3 anos do que a SBRT; no entanto, viés de publicação e heterogeneidade podem ter influenciado esses achados. Já a SBRT produziu resultados de CL semelhantes aos da cirurgia, independentemente da extensão da ressecção cirúrgica. Esses achados podem ter implicações clínicas importantes para pacientes com comorbidades, idade avançada, baixa reserva pulmonar e outros fatores que possam contraindicar a cirurgia.

Sublobar resection in the treatment of elderly patients with early-stage non-small cell lung cancer / Ressecção sublobar no tratamento de pacientes idosos com câncer de pulmão não pequenas células em estágio inicial

ABSTRACT Surgical resection is the primary treatment option for early-stage non-small cell lung cancer, lobectomy being considered the standard of care. In elderly patients, physiological characteristics can limit the suitability for surgery and the extent of resection. Sublobar resection (SLR) can be offered as an alternative. The aim of this real-world analysis was to compare lobectomy and SLR in terms of recurrence and survival rates in patients over 70 years of age.

RESUMO A ressecção cirúrgica é a principal opção de tratamento para o câncer de pulmão não pequenas células em estágio inicial, sendo a lobectomia considerada o tratamento padrão. Em pacientes idosos, as características fisiológicas podem limitar a adequabilidade da cirurgia e a extensão da ressecção. A ressecção sublobar (RSL) pode ser oferecida como alternativa. O objetivo deste estudo de mundo real foi comparar a lobectomia e a RSL em termos de taxas de recidiva e de sobrevida em pacientes acima de 70 anos de idade.

Controversies over the treatment for stage Ⅲ A-N2 non-small cell lung cancer and related advances / 中华放射肿瘤学杂志

Stage Ⅲ A non-small cell lung cancer (NSCLC) has high heterogeneity and there are some controversies over the treatment of this disease,especially for patients with stage ⅢA-N2 NSCLC.This article investigates whether preoperative or postoperative radiotherapy can improve the survival of patients with stage ⅢA-N2 NSCLC and evaluates the effect of surgical treatment.

An analysis of prognostic factors for stage ⅢA (N2) non-small cell lung cancer after complete resection / 中华放射肿瘤学杂志

Objective To investigate the factors associated with postoperative metastasis, recurrence, and survival in patients with stage ⅢA ( N2 ) non?small cell lung cancer ( NSCLC ) , and to provide an objective basis for postoperative radiotherapy in patients. Methods Clinical data were collected from 199 patients who underwent complete resection and were diagnosed with stage ⅢA ( N2 ) NSCLC after surgery in our hospital from 2009 to 2013. The Cox regression model was used for the multivariate analyses of metastasis and recurrence. The survival rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. Results In the 199 patients, 173 had complete follow?up data. The 1?and 2?year metastasis, recurrence, and survival rates were 38?7%/52?6%, 27?8%/39?1%, and 92?5%/51?4%, respectively. The multivariate analysis showed that pathological type and two positive indices among preoperative CEA/CY211/SCC were two risk factors for metastasis ( P=0?013,0?014) . Positive lymph node number, metastatic lymph node number, lymph node metastasis rate, and two positive indices among preoperative CEA/CY211/SCC were risk factors for recurrence ( P=0?046,0?004,0?028,0?001) . All the above indices were risk factors for low survival rates ( P= 0?013 , 0?011 , 0?002,0?026 ) . Conclusions Patients with stage ⅢA ( N2 ) NSCLC who have positive lymph nodes, lymph node metastases, and two positive indices among preoperative CEA/CY211/SCC may benefit from postoperative radiotherapy.

Stereotactic body radiotherapy versus surgery for resectable stage Ⅰ non-small cell lung cancer: a systematic evaluation / 中华放射肿瘤学杂志

Objective To systematically evaluate the efficacy and safety of stereotactic body radiotherapy (SBRT) for resectable stage Ⅰ non-small cell lung cancer (NSCLC).Methods Clinical trials of SBRT or surgery for resectable stage Ⅰ NSCLC were collected by computerized search of Cochrane Library,MEDLINE,EMbase,CBM,CNKI,and VIP.Literature selection,quality evaluation,and data extraction were performed by two inspectors based on the inclusion and exclusion criteria.A meta-analysis was performed on the enrolled studies using RevMan 5.3 software.Results A total of four clinical trials involving 410 patients were included.The results of meta-analysis showed that there was no significant difference in 3-year overall survival rate between SBRT and surgery (RR=1.13,95％ CI=0.66-1.94,P=0.66);there was no significant difference in local control rate between SBRT and surgery (RR=0.71,95％ CI=0.26-1.93,P=0.50);patients treated with SBRT had significantly lower incidence rates of grade 3-4 adverse reactions than those treated with surgery (RR=0.29,95％ CI=0.16-0.53,P=0.000).Conclusions SBRT shows equivalent efficacy to surgery in the treatment of resectable stage Ⅰ NSCLC.However,due to the limitations in this systematic evaluation,the conclusion needs to be further confirmed by large randomized controlled trials.

Surgery for stage Ⅳ non-small cell lung cancer / 中国癌症杂志

Stage Ⅳ non-small cell lung cancer should be restaged according different prognosis. Some patients with advanced NSCLC who received operative resection may be cured. Based on completely resection of primary lung cancer that no mediastinal lymphnode metastasis solitary brain metastasis or adrenal metastasis or ipsilateral lung metastasis should be considered for resection. Palliative surgery should be a part of multidisciplinary therapy for selective patients with advanced NSCLC.