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  • br Methods A systematic review


    Methods: A systematic review of relevant studies was performed through online databases using predefined criteria. The most updated studies were selected for meta-analysis according to unmatched and matched patient cohorts.
    Results: Thirty-two studies were identified in the systematic review, and 23 were selected for quantitative analysis. Surgery was associated with superior overall survival in both unmatched (odds ratio, 2.49; 95% confidence interval, 2.10-2.94; P <.00001) and matched (odds ratio, 1.71; 95% confidence interval,
    1.52-1.93; P<.00001) cohorts. Subgroup analysis demonstrated superior overall survival for lobectomy and sublobar resection compared with stereotactic body AMG-176 therapy. In unmatched and matched cohorts, cancer-specific survival, disease-free survival, and freedom from locoregional recurrence were superior after surgery. However, stereotactic body radiation therapy was associated with fewer perioperative deaths.
    Conclusions: The current evidence suggests surgery is superior to stereotactic body radiation therapy in terms of mid- and long-term clinical outcomes; stereotactic body radiation therapy is associated with lower perioperative mortality. However, the improved outcomes after surgery may be due at least in part to an imbalance of baseline characteristics. Future studies should aim to provide histopathologic confirmation of malignancy and compare stereotactic body radiation therapy with minimally invasive anatomical resections. (J Thorac Cardiovasc Surg 2019;157:362-73) 
    survival 50%
    Overall 25%
    Years after procedure
    Kaplan–Meier graph of overall survival using data from matched patients with NSCLC.
    Central Message
    In matched patients with early-stage NSCLC, surgery was superior to SBRT in overall survival, cancer-specific survival, disease-free survival, and freedom from disease recurrence.
    With a paucity of randomized data, observa-tional studies have used propensity score matching to minimize the risk of selection bias to compare surgery versus SBRT in patients with NSCLC. This systematic review and meta-analysis identified superior mid- and long-term clinical outcomes for surgery in both matched and unmatched patient cohorts. However, periprocedural mortality was lower for SBRT.
    See Editorial Commentary page 374.
    From the aThoracic Surgery Service and dDepartment of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; bCollaborative Research Group, Macquarie University, Sydney, Australia; and cDepartment of Medicine, Cornell University, New York, NY.
    This work was supported, in part, by National Institutes of Health Cancer Center Support Grant P30 CA008748.
    Address for reprints: David R. Jones, MD, Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 7, New York, NY 10065 (E-mail: [email protected]).
    Stereotactic body radiation therapy (SBRT) is the preferred treatment modality for patients with medically inoperable early-stage non–small cell lung cancer (NSCLC).1,2 Compared with conventional radiotherapy, SBRT delivers
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    362 The Journal of Thoracic and Cardiovascular Surgery c January 2019
    Cao et al Thoracic: Lung Cancer: Review
    Abbreviations and Acronyms CI ¼ confidence interval NSCLC ¼ non–small cell lung cancer OR ¼ odds ratio
    SBRT ¼ stereotactic body radiation therapy VATS ¼ video-assisted thoracoscopic surgery
    fewer fractions of high-dose radiation per fraction with increased precision, sparing the surrounding normal tissue to maximize the biologically effective dose while minimizing toxicity, resulting in improved local control and overall survival.3,4 The accumulating clinical experience with SBRT in prospective trials has led to heightened interest among the oncology community about the comparative outcomes of SBRT versus surgical resection for early-stage NSCLC in operable patients.5,6