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Table 1. Summay of comparative studies between SLR and SABR in high-risk or inoperable NSCLC
Author, year, country Groups Results Comments
study type (level evidence)
Yendamuri et al. [36] (2007) 160 stage I NSCLC Univariate analysis: In high-risk patients with NSCLC,
(USA) (contraindication for lobectomy) - Better OS (P = 0.010) and limited resection has
Retrospective observational - 68 wedge resection RFS (P = 0.000) with wedge a tendency towards improved
study (level 3) - 92 3D conformal radiation resection outcome.
therapy Multivariate analysis: Propensity
- Better RFS (P = 0.002) matched analysis did not show a
Propensity score matching clear benefit for a wedge
- No differences (OS P =
0.609; RFS P = 0.701)
Forquer et al. [39] (2007) 38 stage I NSCLC: 3-year survival: SLR and SBRT have similar survival
(USA) - 19 SLR - SLR results, although a trend towards
Retrospective analysis - 19 SBRT - SBRT (P = NS) better median survival in SLR
Median survival:
- SLR 55 months
- SBRT 37 months (P = NS)
Cancer-specific deaths:
- SLR 2/10
- SBRT 2/9
Grills et al. [38] (2010) (USA) 124 T1-2N0 NSCLC: Local recurrence (LR): SBRT and wedge
Retrospective observational - 69 wedge resection - wedge 20% resection are reasonable treatment
study (level 3) - 58 SBRT - SBRT 4% (P = 0.07) options for Stage I NSCLC patients
Overall survival: who are not
- Wedge 87% suitable for lobectomy.
- SBRT 72% (P = 0.01) Wedge resection has higher LR but
Cancer specific survival (CSS): higher OS.
- Wedge 94% SBRT and surgery have comparable
- SBRT 93% (P = 0.53) CSS
Puri et al. [37] (2012) (USA) 114 stage I NSCLC: Median survival: SLR is more cost-effective due to
Retrospective observational - 57 SLR - SLR: 4.1 years longer OS
study (level 3) - 57 SBRT - SBRT: 2.9 years
4-year survival:
- SLR: 51.4%
- SBRT: 30.1%
Cost
-SLR $17 629
-SBRT $14 153
Varlotto et al. [16] (2013) 317 NSCLC: 5-year OS: Better OS in wedge resection, but
(USA) - 48 wedge - SLR 86.3% not significant in the multivariate
Retrospective study - 132 lobectomy - SBRT 31.7% (P = 0.003) analysis
(databases) - 137 SBRT
Matsuo et al. [40] (2014) 180 stage I NSCLC (high-risk for 5-year OS SBRT can be an alternative
(Japan) lobectomy): - SLR 55.6% treatment option to SLR in high-
Retrospective observational - 65 SLR - SBRT 40.4% (P = 0.124) risk patients who cannot tolerate
study (level 3) - 115 SBRT lobectomy because of medical
comorbidities
[9]
Ackerson et al. (2018) 221 stage I NSCLC: 3-year OS SBRT and sublobar resection
(USA) - 151 SLR (105 wedge and 46 - SLR 63% provide similar rates of local
Retrospective observational segmentectomies) - SBRT 35% (P < 0.001) tumor control and overall clinical
study (level 3) - 70 SBRT 3-year DFS outcomes in stage I NSCLC
- SLR 42%
- SBRT 29%) (P = 0.004)
Cancer-specific DFS
- SLR 60%
- SBRT 65%
(P = 0.84).
3-year freedom from LR:
- SLR 90%
- SBRT 85%
(P = 0.71).
Complications/side effects:
- SLR 23%
- SABR 17%