Archives

  • 2019-10
  • 2019-11
  • 2020-03
  • 2020-07
  • 2020-08
  • 2021-03
  • A 61603 NR NR NR br Miyazaki NR NR NR

    2020-03-17

    NR NR NR
    Miyazaki42 NR NR NR NR
    NR NR NR NR
    NR NR NR NR
    SBRT, Stereotactic body radiation therapy; A, adenocarcinoma; S, squamous cell carcinoma; O, other type of non–small cell lung cancer; U, undefined; NR, not reported.
    arrhythmia, and myocardial infarction. Summaries of the reported periprocedural mortality and morbidity outcomes for matched and unmatched patients are presented in Tables E3 and E4, respectively.
    DISCUSSION
    Encouraging outcomes of SBRT compared with conventional radiotherapy has led to a paradigm shift in the management of patients with early-stage NSCLC who are considered inoperable surgical candidates.3,48,49 Although there is currently no class I evidence to compare SBRT with surgical resection, recent guidelines from the American Society of Radiation Oncology, endorsed by the American Society of Clinical Oncology, recommend that
    SBRT should be considered for all patients with stage I NSCLC who are considered high risk for surgery.50,51 With
    the increasing prevalence of lung cancer screening programs and an aging A 61603 with increased comorbidities, there is a growing number of high-risk pa-tients diagnosed with resectable NSCLC.52 There is an ur-gent need to clearly delineate the periprocedural and long-term clinical outcomes of these 2 modalities to help refine the treatment selection process for this group of patients.
    The present systematic review identified 32 comparative studies with overall survival outcomes for SBRT versus surgical resection, and patients from the most updated and complete studies were divided into unmatched and matched cohorts for meta-analysis. Key findings included 
    statistically superior outcomes for surgery for overall survival, cancer-specific survival, disease-free survival, and freedom from locoregional disease recurrence in both unmatched and matched cohorts. There was a trend favor-ing surgery for freedom from distant disease recurrence, but this finding was not statistically significant. After matching was performed, ORs were reduced relative to the unmatched comparisons but remained in favor of surgery. This reduction in the magnitude of benefits after matching suggests that some of the long-term clinical outcomes favoring surgery may result from an imbalance in baseline patient characteristics, preoperative comorbidities, or tumor characteristics, rather than treatment efficacy. Nonetheless, it should be noted that the present study identified the most comparable cohorts in the current literature and demonstrated that surgery remained superior to SBRT for mid- and long-term outcomes when analysis was limited to only matched patients. Subgroup analysis of lobectomy versus SBRT demonstrated superior overall survival outcomes for lobectomy for both unmatched and matched cohorts. Sublobar resection was also superior to SBRT for overall survival, although there was a limited number of studies with matched data. Reporting of perioperative mortality and morbidity outcomes varied widely across studies, with slightly higher perioperative mortality for surgery than for SBRT in both the matched and unmatched cohorts. This is consistent with recent findings of higher mortality at
    368 The Journal of Thoracic and Cardiovascular Surgery c January 2019
    Cao et al
    Thoracic: Lung Cancer: Review
    Odds Ratio
    Odds Ratio
    Study or Subgroup log [Odds Ratio] SE Weight IV, Random, 95% CI
    Favours
    Favours
    A
    [surgery]
    Odds Ratio
    Odds Ratio
    Study or Subgroup log [Odds Ratio] SE Weight IV, Random, 95% CI
    Favours
    Favours