Li Shuangjiang, Nie Shihong, Li Zhiping, Che Guowei
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
West China Medical Center, West China Hospital, Sichuan University, Chengdu, China.
Interact Cardiovasc Thorac Surg. 2019 Oct 1;29(4):544-550. doi: 10.1093/icvts/ivz133.
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether stereotactic body radiotherapy (SBRT) was equivalent to metastasectomy in patients with pulmonary oligometastases arising from solid tumours. Altogether, 1612 papers were found using the reported search, of which 5 cohort studies derived from 4 patient populations represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All 5 studies demonstrated no significant difference in post-treatment overall survival, disease-free survival or local control between SBRT and metastasectomy for pulmonary oligometastases. One of the 5 studies showed a significantly decreased rate of severe complications among the patients treated with SBRT. The other papers reported higher rates of complications in the SBRT groups, invariably due to radiation, but with uncertain clinical significance. The evidence strength of these findings may be largely attenuated due to the small sample size, heterogeneity of SBRT protocols and incomparable follow-up periods between the 2 treatment groups. The selection criteria for the choice of treatment were not stated. We conclude, based on limited evidence, that SBRT has equivalent outcomes to metastasectomy in the treatment of patients with pulmonary oligometastases.
根据结构化方案撰写了一篇胸外科最佳证据主题文章。所探讨的问题是，立体定向体部放疗（SBRT）在实体瘤肺寡转移患者中是否等同于肺转移瘤切除术。通过报告的检索共找到1612篇论文，其中来自4个患者群体的5项队列研究代表了回答该临床问题的最佳证据。这些论文的作者、期刊、发表日期和国家、所研究的患者组、研究类型、相关结局和结果都列成了表格。所有5项研究均表明，对于肺寡转移，SBRT与肺转移瘤切除术在治疗后总生存、无病生存或局部控制方面无显著差异。5项研究中的1项显示，接受SBRT治疗的患者中严重并发症发生率显著降低。其他论文报告SBRT组并发症发生率较高，均归因于放疗，但临床意义不确定。由于样本量小、SBRT方案的异质性以及两个治疗组之间随访期不可比，这些研究结果的证据强度可能会大幅减弱。未说明选择治疗方法的标准。基于有限的证据，我们得出结论，在治疗肺寡转移患者方面，SBRT与肺转移瘤切除术疗效相当。
