Chen Dongjie, Zhao Man, Xiang Xiaoyong, Liang Jun
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong 518172, China.
Chin Med J (Engl). 2022 Jul 14;135(13):1517-24. doi: 10.1097/CM9.0000000000002131.
Percutaneous local tumor ablation (LTA) and stereotactic body radiotherapy (SBRT) have been regarded as viable treatments for early-stage lung cancer patients. The purpose of this study was to compare the efficacy and safety of LTA with SBRT for early-stage non-small cell lung cancer (NSCLC).
PubMed, Embase, Cochrane library, Ovid, Google scholar, CNKI, and CBMdisc were searched to identify potential eligible studies comparing the efficacy and safety of LTA with SBRT for early-stage NSCLC published between January 1, 1991, and May 31, 2021. Hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were applied to estimate the effect size for overall survival (OS), progression-free survival (PFS), locoregional progression (LP), and adverse events.
Five studies with 22,231 patients were enrolled, including 1443 patients in the LTA group and 20,788 patients in the SBRT group. The results showed that SBRT was not superior to LTA for OS (HR = 1.03, 95% CI: 0.87-1.22, P = 0.71). Similar results were observed for PFS (HR = 1.09, 95% CI: 0.71-1.67, P = 0.71) and LP (HR = 0.66, 95% CI: 0.25-1.77, P = 0.70). Subgroup analysis showed that the pooled HR for OS favored SBRT in patients with tumors sized >2 cm (HR = 1.32, 95% CI: 1.14-1.53, P = 0.0003), whereas there was no significant difference in patients with tumors sized ≤2 cm (HR = 0.93, 95% CI: 0.64-1.35, P = 0.70). Moreover, no significant differences were observed for the incidence of severe adverse events (≥grade 3) (OR = 1.95, 95% CI: 0.63-6.07, P = 0.25) between the LTA group and SBRT group.
Compared with SBRT, LTA appears to have similar OS, PFS, and LP. However, for tumors >2 cm, SBRT is superior to LTA in OS. Prospective randomized controlled trials are required to determine such findings.
INPLASY202160099.
经皮局部肿瘤消融术（LTA）和立体定向体部放疗（SBRT）被视为早期肺癌患者的可行治疗方法。本研究的目的是比较LTA与SBRT治疗早期非小细胞肺癌（NSCLC）的疗效和安全性。
检索PubMed、Embase、Cochrane图书馆、Ovid、谷歌学术、中国知网和中国生物医学文献数据库，以确定1991年1月1日至2021年5月31日期间发表的比较LTA与SBRT治疗早期NSCLC疗效和安全性的潜在合格研究。采用风险比（HR）或比值比（OR）及95%置信区间（CI）来估计总生存期（OS）、无进展生存期（PFS）、局部区域进展（LP）和不良事件的效应大小。
纳入5项研究，共22231例患者，其中LTA组1443例，SBRT组20788例。结果显示，SBRT在OS方面并不优于LTA（HR = 1.03，95%CI：0.87 - 1.22，P = 0.71）。PFS（HR = 1.09，95%CI：0.71 - 1.67，P = 0.71）和LP（HR = 0.66，95%CI：0.25 - 1.77，P = 0.70）也观察到类似结果。亚组分析显示，肿瘤大小>2 cm的患者中，SBRT在OS方面的合并HR更有利（HR = 1.32，95%CI：1.14 - 1.53，P = 0.0003），而肿瘤大小≤2 cm的患者中无显著差异（HR = 0.93，95%CI：0.64 - 1.35，P = 0.70）。此外，LTA组和SBRT组在严重不良事件（≥3级）发生率方面未观察到显著差异（OR = 1.95，95%CI：0.63 - 6.07，P = 0.25）。
与SBRT相比，LTA似乎具有相似的OS、PFS和LP。然而，对于>2 cm的肿瘤，SBRT在OS方面优于LTA。需要进行前瞻性随机对照试验来确定这些发现。
INPLASY注册号：INPLASY202160099。
