Radiology, University of Wisconsin, Madison, WI, United States.
Department of Surgery, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
Lung Cancer. 2023 Aug;182:107259. doi: 10.1016/j.lungcan.2023.107259. Epub 2023 Jun 2.
Stereotactic body radiation therapy (SBRT) is the standard of care for inoperable early stage non-small cell lung cancer (NSCLC). Use of image guided thermal ablation (IGTA; including microwave ablation [MWA] and radiofrequency ablation [RFA]) has increased in NSCLC, however there are no studies comparing all three.
To compare the efficacy of IGTA (including MWA and RFA) and SBRT for the treatment of NSCLC.
Published literature databases were systematically searched for studies assessing MWA, RFA, or SBRT. Local tumor progression (LTP), disease-free survival (DFS), and overall survival (OS) were assessed with single-arm pooled analyses and meta-regressions in NSCLC patients and a stage IA subgroup. Study quality was assessed with a modified methodological index for non-randomized studies (MINORS) tool.
Forty IGTA study-arms (2,691 patients) and 215 SBRT study-arms (54,789 patients) were identified. LTP was lowest after SBRT at one and two years in single-arm pooled analyses (4% and 9% vs. 11% and 18%) and at one year in meta-regressions when compared to IGTA (OR = 0.2, 95%CI = 0.07-0.63). MWA patients had the highest DFS of all treatments in single-arm pooled analyses. In meta-regressions at two and three-years, DFS was significantly lower for RFA compared to MWA (OR = 0.26, 95%CI = 0.12-0.58; OR = 0.33, 95%CI = 0.16-0.66, respectively). OS was similar across modalities, timepoints, and analyses. Older age, male patients, larger tumors, retrospective studies, and non-Asian study region were also predictors of worse clinical outcomes. In high-quality studies (MINORS score ≥ 7), MWA patients had better clinical outcomes than the overall analysis. Stage IA MWA patients had lower LTP, higher OS, and generally lower DFS, compared to the main analysis of all NSCLC patients.
NSCLC patients had comparable outcomes after SBRT and MWA, which were better than those with RFA.
立体定向体部放射治疗（SBRT）是不可手术的早期非小细胞肺癌（NSCLC）的标准治疗方法。影像引导热消融（IGTA；包括微波消融[MWA]和射频消融[RFA]）在 NSCLC 中的应用越来越多，但尚无比较这三种方法的研究。
比较 IGTA（包括 MWA 和 RFA）与 SBRT 治疗 NSCLC 的疗效。
系统检索了评估 MWA、RFA 或 SBRT 的已发表文献数据库。采用单臂汇总分析和 NSCLC 患者及 IA 期亚组的荟萃回归分析评估局部肿瘤进展（LTP）、无疾病生存（DFS）和总生存（OS）。采用改良的非随机研究方法学指数（MINORS）工具评估研究质量。
共纳入 40 个 IGTA 研究臂（2691 例患者）和 215 个 SBRT 研究臂（54789 例患者）。单臂汇总分析显示，SBRT 在 1 年和 2 年时 LTP 最低（分别为 4%和 9%，而 IGTA 为 11%和 18%），与 IGTA 相比，荟萃回归在 1 年时 LTP 也最低（OR=0.2，95%CI=0.07-0.63）。在单臂汇总分析中，MWA 患者的 DFS 最高。荟萃回归分析显示，在 2 年和 3 年时，RFA 的 DFS 明显低于 MWA（OR=0.26，95%CI=0.12-0.58；OR=0.33，95%CI=0.16-0.66）。各治疗方法在不同时间点和分析中的 OS 相似。年龄较大、男性患者、肿瘤较大、回顾性研究和非亚洲研究区域也是临床结局较差的预测因素。在高质量研究（MINORS 评分≥7）中，MWA 患者的临床结局优于总体分析。与所有 NSCLC 患者的主要分析相比，IA 期 MWA 患者的 LTP 更低、OS 更高、DFS 通常更低。
SBRT 和 MWA 治疗 NSCLC 患者的临床结局相似，优于 RFA。
