Stereotactic Body Radiotherapy for Centrally Located Primary Non-Small-Cell Lung Cancer: A Meta-Analysis

Tosol Yu; In-Soo Shin; Won Sup Yoon; Chai Hong Rim

doi:10.1016/j.cllc.2019.02.023

Stereotactic Body Radiotherapy for Centrally Located Primary Non-Small-Cell Lung Cancer: A Meta-Analysis

Clin Lung Cancer. 2019 Jul;20(4):e452-e462. doi: 10.1016/j.cllc.2019.02.023. Epub 2019 Mar 19.

Authors

Tosol Yu¹, In-Soo Shin², Won Sup Yoon³, Chai Hong Rim⁴

Affiliations

¹ Department of Radiation Oncology, Dongnam Institute of Radiological & Medical Sciences, Busan, Republic of Korea; Health Policy Division, Gangneung Public Health Center, Gangneung, Republic of Korea.
² Department of Education, College of Education, Jeonju University, Jeonju, Republic of Korea.
³ Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Republic of Korea.
⁴ Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Republic of Korea. Electronic address: crusion3@naver.com.

PMID: 31029573
DOI: 10.1016/j.cllc.2019.02.023

Abstract

Background: The purpose of the study was to evaluate the efficacy and safety of stereotactic body radiotherapy (SBRT) for centrally located, primary non-small-cell lung cancer (NSCLC).

Materials and methods: Systematic search of 4 databases (PubMed, MEDLINE, EMBASE, and Cochrane Library) was performed for literature published until May 9, 2018. Primary (overall survival [OS] and local control [LC] rates) and secondary (Grade ≥3 toxicity) endpoints were reported.

Results: Thirteen studies encompassing 599 patients with central NSCLCs were included. Median values of T1 tumor proportion, tumor size, and median survival were 55.3% (range, 0%-75%), 3.3 (range, 2.1-4.1) cm, and 26 (range, 14-68.9) months, respectively. Pooled rates of 1-, 2-, and 3-year OS rates were 84.3% (95% confidence interval [CI], 75.7-90.3), 64.0% (95% CI, 52.9-72.2), and 50.5% (95% CI, 39.4-61.5), respectively. Pooled rates of 1-, 2-, and 3-year LC rates were 89.4% (95% CI, 80.8-94.4), 82.2% (95% CI, 71.7-89.4), and 72.2% (95% CI, 55.0-84.7), respectively. Pooled rate of Grade ≥3 complication was 12.0% (95% CI, 7.3-19.0). Meta-regression analyses showed significant positive relationships between biologically equivalent dose using an α/β of 10 Gy in the linear quadratic model (BED_10Gy) and 1- and 2-year LC rates (P < .001 and P < .001), and 1- and 2-year OS rates (P = .0178 and P = .032), and Grade ≥3 complication rate (P = .0029). In subgroup comparisons between BED_10Gy <100 Gy versus ≥100 Gy, 1- and 2-year LC rates were significantly different but not for OS and Grade ≥3 complication rates.

Conclusion: Our results suggests that SBRT is potent for tumor control in central NSCLC, although complications should be further minimized through optimization of dose-fractionation scheme and accurate planning. Using BED_10Gy ≥100 Gy yielded higher LC rates, and dose escalation was related to OS, LC, and complications.

Keywords: Dose fractionation; Network meta-analysis; Non–small-cell lung carcinoma; Radiosurgery; Survival rate.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Non-Small-Cell Lung / mortality
Carcinoma, Non-Small-Cell Lung / radiotherapy*
Dose Fractionation, Radiation
Humans
Lung Neoplasms / mortality
Lung Neoplasms / radiotherapy*
Radiosurgery / methods*
Survival Analysis