Stereotactic body radiotherapy versus surgery for resectable stage I non-small cell lung cancer: a systematic evaluation

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. Key words: Carcinoma, non-small cell lung/stereotactic body radiotherapy; Carcinoma, non-small cell lung/surgery; Systematic review