Chen Enli, Wang Juan, Jia Chenfei, Min Xueya, Zhang Hongtao
Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China.
Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China.
Interact Cardiovasc Thorac Surg. 2021 Aug 18;33(3):377-384. doi: 10.1093/icvts/ivab097.
The purpose of this study was to compare the clinical outcomes for sublobar resection (SR) or SR plus intraoperative brachytherapy (SRB) for clinical stage I non-small-cell lung cancer.
A systematic search was performed in the EMBASE, PubMed and Cochrane Library databases to identify related studies comparing SR to SRB. Data were collected on local recurrence (LR) as a primary outcome and regional or distant recurrence, overall survival and disease-free survival (DFS) as secondary outcomes. Meta-analysis was carried out using Stata 12.0.
A total of 476 patients received SRB, and 617 received SR across 5 studies. Meta-analysis of LR, regional or distant recurrence, overall survival and disease-free survival rates showed no significant difference between SRB and SR groups. However, when biologically effective dose (BED) was >100 Gy, LR rate was lower in the SRB group than in the SR group (Relative risk [RR] = 0.143, 95% confidence interval [CI]: 0.051-0.397) (p < 0.001). When BED was <100 Gy, no significant difference was found in LR rate between SRB and SR groups (SRB versus SR: RR = 1.132, 95%CI: 0.704-1.821) (p = 0.608).
Intraoperative brachytherapy was not associated with reduced risk of regional or distant metastasis or improved outcomes for patients with clinical stage I non-small-cell lung cancer; however, it might reduce the LR rate when BED was >100 Gy.
本研究旨在比较亚肺叶切除（SR）或亚肺叶切除联合术中近距离放疗（SRB）治疗临床Ⅰ期非小细胞肺癌的临床疗效。
在EMBASE、PubMed和Cochrane图书馆数据库中进行系统检索，以确定比较SR与SRB的相关研究。收集局部复发（LR）作为主要结局，区域或远处复发、总生存和无病生存（DFS）作为次要结局的数据。使用Stata 12.0进行荟萃分析。
5项研究中，共有476例患者接受了SRB，617例接受了SR。对LR、区域或远处复发、总生存和无病生存率的荟萃分析显示，SRB组和SR组之间无显著差异。然而，当生物等效剂量（BED）>100 Gy时，SRB组的LR率低于SR组（相对危险度[RR]=0.143，95%置信区间[CI]：0.051-0.397）（p<0.001）。当BED<100 Gy时，SRB组和SR组的LR率无显著差异（SRB与SR：RR=1.132，95%CI：0.704-1.821）（p=0.608）。
术中近距离放疗与临床Ⅰ期非小细胞肺癌患者区域或远处转移风险降低或预后改善无关；然而，当BED>100 Gy时，它可能会降低LR率。
