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

BACKGROUND

The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT).

METHODS

A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates.

RESULTS

A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses.

CONCLUSION

Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.

Significance of R1-resection at the bronchial margin after surgery for non-small-cell lung cancer

OBJECTIVES

We aimed to evaluate the significance of microscopic residual disease at the bronchial resection margin (R1-BRM) after curative surgery for non-small cell lung cancer (NSCLC).

METHODS

Retrospective review was performed on 1800 patients from 1994 to 2012. We compared recurrence and survival between 1740 patients with R0-resection at the BRM (R0-BRM) and 60 patients with R1-resection at the BRM (R1-BRM), comprising 18 cases of mucosal carcinoma in situ (R1-CIS) and 42 cases of extramucosal residual disease (R1-EMD).

RESULTS

Stump recurrence occurred in 43 patients. The 5-year cumulative incidence of stump recurrence in group R0, R1-CIS and R1-EMD was 3.1, 5.6 and 12.2%, respectively. Significant differences of stump recurrence were observed between the groups (R0 versus R1-CIS, P = 0.008; R0 versus R1-EMD, P = 0.007). In Stage IB or II disease, the overall survival rate for R1-EMD was significantly lower than that for R0-BRM (P = 0.014), whereas the difference in overall survival rate between the R1-CIS group and the R0-BRM was not significant (P = 0.37). In Stage IIIA disease, the overall survival rates for R1-CIS (P = 0.87) and R1-EMD (P = 0.45) were not significantly different from that for R0-BRM.

CONCLUSIONS

R1-BRM comprises a higher rate of stump recurrence, compared with that of R0-BRM. Herein, R1-EMD was associated with poor overall survival in Stage IB/II disease. In Stage IIIA disease, R1-BRM showed similar overall survival rate to that for R0-BRM, although the number of patients was too small to draw definitive conclusions thereon.