title: Survival outcome after stereotactic body radiation therapy and surgery for stage I non-small cell lung cancer: a meta-analysis.
abstract: OBJECTIVE
  This study compared treatment outcomes of stereotactic body radiation therapy (SBRT) with those of surgery in stage I non-small cell lung cancer (NSCLC).
  
  
  METHODS
  Eligible studies of SBRT and surgery were retrieved through extensive searches of the PubMed, Medline, Embase, and Cochrane library databases from 2000 to 2012. Original English publications of stage I NSCLC with adequate sample sizes and adequate SBRT doses were included. A multivariate random effects model was used to perform a meta-analysis to compare survival between treatments while adjusting for differences in patient characteristics.
  
  
  RESULTS
  Forty SBRT studies (4850 patients) and 23 surgery studies (7071 patients) published in the same period were eligible. The median age and follow-up duration were 74 years and 28.0 months for SBRT patients and 66 years and 37 months for surgery patients, respectively. The mean unadjusted overall survival rates at 1, 3, and 5 years with SBRT were 83.4%, 56.6%, and 41.2% compared to 92.5%, 77.9%, and 66.1% with lobectomy and 93.2%, 80.7%, and 71.7% with limited lung resections. In SBRT studies, overall survival improved with increasing proportion of operable patients. After we adjusted for proportion of operable patients and age, SBRT and surgery had similar estimated overall and disease-free survival.
  
  
  CONCLUSIONS
  Patients treated with SBRT differ substantially from patients treated with surgery in age and operability. After adjustment for these differences, OS and DFS do not differ significantly between SBRT and surgery in patients with operable stage I NSCLC. A randomized prospective trial is warranted to compare the efficacy of SBRT and surgery.
authors: Department of Radiation Oncology, Huadong Hospital, Fudan University, Shanghai, China.
authors: Xiangpeng
authors: X
authors: Zheng
authors: Department of Radiation Oncology, the University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, the University of Michigan, Ann Arbor, Michigan.
authors: Matthew
authors: M
authors: Schipper
authors: Department of Biostatistics, the University of Michigan, Ann Arbor, Michigan.
authors: Kelley
authors: K
authors: Kidwell
authors: Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan.
authors: Jules
authors: J
authors: Lin
authors: Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan.
authors: Rishindra
authors: R
authors: Reddy
authors: Department of Radiation Oncology, Huadong Hospital, Fudan University, Shanghai, China.
authors: Yanping
authors: Y
authors: Ren
authors: Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan.
authors: Andrew
authors: A
authors: Chang
authors: Department of Thoracic Surgery, Huadong Hospital, Fudan University, Shanghai, China.
authors: Fanzhen
authors: F
authors: Lv
authors: Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan.
authors: Mark
authors: M
authors: Orringer
authors: Department of Radiation Oncology, the University of Michigan, Ann Arbor, Michigan. Electronic address: Fkong@gru.edu.
authors: Feng-Ming
authors: FM
authors: Spring Kong
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011013:Pneumonectomy / Q000401:mortality; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate