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Galvez et al. Mini-invasive Surg 2020;4:86 I http://dx.doi.org/10.20517/2574-1225.2020.86 Page 9 of 12

Table 2. Summay of comparative studies between SLR and SABR including operable NSCLC
Author, year, country Groups Results Comments
Study type (level evidence)
Deng et al. [47] (2017) 13.598 stage I NSCLC three 3 year survival rate: SABR shows a local control rate
(China) strategies (SBRT, SLR, lobectomy) - SABR worse than SLR (RR = comparable to that of lobectomy
Meta-analysis (level 12 cohort studies (4 studies 0.78; P = 0.001) and sublobar resection
evidence 1) comparative with SLR) OS: In patients not amenable to
No randomized trial - SABR worse than SLR (HR = lobectomy, SABR is an alternative
1.60; P < 0.001) treatment comparable to sublobar
Subgroup analysis (4 of resection
12 studies), there were no
significant differences in terms
of 3-year survival, OS and 3-year
locorregional control
Chen et al. [48] (2018) 19.882 patients OS: Better OS with SLR but the meta-
(Canada) 16 propensity score studies - SABR worse than SLR (HR = analysis included studies of
Meta-analysis (level No randomized trial 1.28; 95%CI: 1.06-1.56) patients at risk for surgery.
evidence 1) Lung cancer specific survival: No distinction between wedge and
- No differences (HR = 1.22; segmentectomy
95%CI: 0.95-1.57)
Iguchi et al. [49] (2020) 289 patients stage I NSCLC: 5 year overall survival (OS): SLR shows a trend towards longer
(Japan) - 38 RF ablation - 58.9% RF ablation survival, but SBRT can be an
Retrospective observational - 58 SBRT - 42% SBRT alternative in stage I NSCLC
study (level 3) - 193 SLR - 85.5% SLR
5 year progression free survival
(PFS):
- 39.9% RF ablation
- 34.9% SBRT
- 75.9% SLR
After propensity score:
5 year overall survival (OS):
- 59.7% RF ablation
- 63.7% SBRT
- 71% SLR
5 year progression free survival
(PFS):
- 35.9% RF ablation
- 55.7% SBRT
- 61.9% SLR
Bryant et al. [50] (2018) 1,083 early stage NSCLC: Cancer-specific survival (CSS): Lobectomy improves survival
(USA) - 634 SLR - No differences (HR = 1.25; comparing to SBRT in early
Retrospective observational - 449 SBRT 95%CI: 0.93-1.68; P = 0.15) stage NSCLC, while there are no
study (level 3) Overall survival (OS): differences between SLR and SBRT
- No differences (HR 1.17;
95%CI: 0.90-1.53; P = 0.85)
[51]
Wu et al. (2020) (China) 19.934 NSCLC: Overall survival (OS): SLR may be associated
Retrospective study - 9.967 SLR - SLR 60.4 months with increased survival in patients
(databases) - 9.967 SBRT - SBRT 40.5 months (HR = with stage I NSCLC
1.559; 95%CI: 1.497-1.623; P compared with SBRT
< 0.001) Other variables
Median survival: such as cardiopulmonary function
- Segmentectomy 71.4 months probably play a role in treatment
- Wedge 58.0 months (P < selection and may affect survival
0.001)
Tumors ≤ 2 cm:
- SBRT median 45.0 months
- SLR 67.5 months (HR = 1.626;
95%CI: 1.538-1.720; P < 0.001)
[7]
Cao et al. (2019) (USA) 23 studies in NSCLC Overall survival: Surgery might be superior to SBRT
Meta-analysis (level - higher in SLR than SABR in in terms of mid- and long-term
evidence 1) unmatched patients from 6 clinical outcomes
studies (OR = 1.54; 95%CI: SBRT is associated with lower
1.36-1.75; P < 0.00001) perioperative mortality
Improved outcomes after surgery,
may be attributable at least in
part to an imbalance of baseline
characteristics

NSCLC: non-small cell lung cancer; OS: overall survival; RFS: recurrence-free survival; SLR: sublobar resection; SABR: stereotactic
ablative radiotherapy; SBRT: stereotactic body radiation therapy; DSS: disease-specific survival; CSS: cancer-specific survival