Stereotactic ablative radiotherapy versus lobectomy for stage I non‐small cell lung cancer: A systematic review

BACKGROUND: There is debate regarding the use of stereotactic ablative radiotherapy (SABR) or surgery for patients with early stage non‐small cell lung cancer (NSCLC). This meta‐analysis compared the clinical efficacy of SABR and lobectomy in stage I NSCLC patients. METHODS: An online search identified eight eligible articles (including 2 trials and 7 cohort studies) for inclusion. The odds ratio (OR) was used as a summary statistic. Overall survival (OS), cause‐specific survival (CSS), and recurrence‐free survival (RFS) were selected to calculate ORs with 95% confidence intervals (CI). Fixed‐effects or random‐effects models were conducted according to study heterogeneity. RESULTS: There were no significant differences between SABR and lobectomy in terms of one‐year OS or CSS. Significant benefits of surgery were observed in three‐year OS (OR 2.11, 95% CI 1.55–2.86), three‐year CSS (OR 1.94, 95% CI 1.05–3.57), three‐year RFS (OR 1.63, 95% CI 1.12–2.36), and five‐year OS (OR 2.40, 95% CI 1.71–3.36). In addition, lobectomy demonstrated a beneficial trend in one‐year RFS, five‐year RFS, and CSS. CONCLUSION: Meta‐analyses of current evidence suggested that lobectomy provides better long‐term survival outcomes for stage I NSCLC patients.