Stereotactic body radiation therapy and thermal ablation for treatment of NSCLC: A systematic literature review and meta-analysis.

Rationale: Stereotactic body radiation therapy (SBRT) is the standard of care for inoperable early stage non-small cell lung cancer (NSCLC). Use of image guided thermal ablation (IGTA; including microwave ablation [MWA] and radiofrequency ablation [RFA]) has increased in NSCLC, however there are no studies comparing all three.
Objective: To compare the efficacy of IGTA (including MWA and RFA) and SBRT for the treatment of NSCLC.
Methods: Published literature databases were systematically searched for studies assessing MWA, RFA, or SBRT. Local tumor progression (LTP), disease-free survival (DFS), and overall survival (OS) were assessed with single-arm pooled analyses and meta-regressions in NSCLC patients and a stage IA subgroup. Study quality was assessed with a modified methodological index for non-randomized studies (MINORS) tool.
Results: Forty IGTA study-arms (2,691 patients) and 215 SBRT study-arms (54,789 patients) were identified. LTP was lowest after SBRT at one and two years in single-arm pooled analyses (4% and 9% vs. 11% and 18%) and at one year in meta-regressions when compared to IGTA (OR = 0.2, 95%CI = 0.07-0.63). MWA patients had the highest DFS of all treatments in single-arm pooled analyses. In meta-regressions at two and three-years, DFS was significantly lower for RFA compared to MWA (OR = 0.26, 95%CI = 0.12-0.58; OR = 0.33, 95%CI = 0.16-0.66, respectively). OS was similar across modalities, timepoints, and analyses. Older age, male patients, larger tumors, retrospective studies, and non-Asian study region were also predictors of worse clinical outcomes. In high-quality studies (MINORS score ≥ 7), MWA patients had better clinical outcomes than the overall analysis. Stage IA MWA patients had lower LTP, higher OS, and generally lower DFS, compared to the main analysis of all NSCLC patients.
Conclusions: NSCLC patients had comparable outcomes after SBRT and MWA, which were better than those with RFA.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: NF, AN, GW, YZ, and AL are employees of CRG-EVERSANA Canada, which was contracted by Johnson and Johnson Inc. to perform the SLR and analyses. IK, BL, SG, MZ, and PS are employees of Johnson and Johnson Inc. IK, BL, SG, and MZ hold stock in Johnson and Johnson Inc. PL, CN and MP are consultants for Johnson and Johnson Inc. PL is a consultant for HistoSonics. PL is a consultant for Elucent Medical. CN and MP are consultants for Medtronic. MP is a consultant for Intuitive. MP is a consultant for Bodyvision. MP is a consultant for Biodesix. MP is a consultant for Philips. MP is a consultant for Noah Medical. MP is a consultant for AstraZeneca. PL received a research grant from HistoSonics. PL received a research grant from Siemens Medical. CN and MP received research grants from Johnson and Johnson Inc. CN and MP received research grants from Medtronic. CN received a research grant from Siemens Healthineer. MP received a research grant from Intuitive. MP received a research grant from Bodyvision. MP received a research grant from Biodesix. MP received a research grant from Philips. CN and MP have been a speaker for Johnson and Johnson Inc. CN has been a speaker for Medtronic. CN has been a speaker for Siemens Healthineer. MP has been a speaker for Intuitive. MP has been a speaker for Bodyvision. MP has been a speaker for Biodesix. MP has been a speaker for AstraZeneca. PL and CN are advisory committee members for Johnson and Johnson Inc. MP is an advisory committee member for AstraZeneca. MP is an advisory committee member for Pfizer. PL holds stock in McGinley Orthopedic Innovations. PL holds stock in HistoSonics. PL holds stock in Elucent Medical.
(Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)