Systematic review
Comparison of particle beam therapy and stereotactic body radiotherapy for early stage non-small cell lung cancer: A systematic review and hypothesis-generating meta-analysis

https://doi.org/10.1016/j.radonc.2017.05.007Get rights and content

Abstract

Purpose

To assess hypo-fractionated particle beam therapy (PBT)’s efficacy relative to that of photon stereotactic body radiotherapy (SBRT) for early stage (ES) non-small cell lung cancer (NSCLC).

Methods

Eligible studies were identified through extensive searches of the PubMed, Medline, Google-scholar, and Cochrane library databases from 2000 to 2016. Original English publications of ES NSCLC were included. A meta-analysis was performed to compare the survival outcome, toxicity profile, and patterns of failure following each treatment.

Results

72 SBRT studies and 9 hypo-fractionated PBT studies (mostly single-arm) were included. PBT was associated with improved overall survival (OS; p = 0.005) and progression-free survival (PFS; p = 0.01) in the univariate meta-analysis. The OS benefit did not reach its statistical significance after inclusion of operability into the final multivariate meta-analysis (p = 0.11); while the 3-year local control (LC) still favored PBT (p = 0.03).

Conclusion

Although hypo-fractionated PBT may lead to additional clinical benefit when compared with photon SBRT, no statistically significant survival benefit from PBT over SBRT was observed in the treatment of ES NSCLC in this hypothesis-generating meta-analysis after adjusting for potential confounding variables.

Section snippets

Search strategy and selection criteria

A systematic search was conducted in PubMed, Medline, Google-scholar, and the Cochrane library for studies published between January 2000, and June 2016. The subject heading “non-small cell lung cancer/ carcinoma” was combined with the following terms: “early stage”, “stage I”, “T1”, “T2”, “stereotactic body radiation therapy”, “stereotactic body radiotherapy”, “stereotactic ablative radiotherapy”, “SBRT”, “SABR”, “hypo-fractionated radiotherapy”, “particle beam therapy”, “proton therapy”,

Study selection and characteristics

The study selection process is shown in Suppl. Fig. 1. Among 501 relevant publications on SBRT and 113 relevant publications on PBT, 205 full text articles for SBRT and 19 full text articles for hypo-fractionated PBT (proton and carbon ion therapy) were assessed for eligibility. Of these, 72 studies on photon SBRT and 9 studies on PBT for ES NSCLC were selected [10], [12], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40]

Discussion

Through a systematic review of the literature, data extracted from 72 studies on SBRT and 9 studies on hypo-fractionated PBT for ES NSCLC from North America, Europe and Asia were analyzed in a meta-analysis, which represents the most comprehensive review of the subject matter to date. Even with relatively more advanced tumors in size and T stage, patients treated with PBT were found to have significantly better OS and PFS than those treated with photon SBRT in the weighted multivariate analysis

Conclusion

Although hypo-fractionated PBT may lead to additional clinical benefit when compared with photon SBRT, no statistically significant survival benefit from PBT over SBRT was observed in the treatment of ES NSCLC in this hypothesis-generating meta-analysis after adjusting for potential confounding variables.

Conflict of interest

None

Funding source

None

Acknowledgement

We would like to thank Ms. Jin H. Jiao for her significant contribution to the conduct of the systematic literature search.

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