Advances and controversies in the management of early stage non-small cell lung cancer

Table 1 Studies analyzing surgery and stereotactic body radiotherapy in non-small cell lung cancer

Ref.	Type	Surgery-RT, No.	Surgery-RT, Local failure	Surgery-RT, PFS	Surgery-RT, OS	Surgery-RT, Toxicity	LoE
Grills et al[74], 2010	R	69 wedge resection; 58 SBRT; Unfit for lobectomy	20%-4% (P = 0.07)	65% vs 77% (P = 0.37)	87% vs 72% (P = 0.01)	Readmission 10%; Pneumonitis 2%; Fracture 11%	3
Varlotto et al[75], 2013	R	48 sublobar resection +132 lobectomy; 137 SBRT	At 5 yr 18.8% lobectomy vs SBRT 12.2% (P = 0.382); Resection 7.1%	No differences (P = 0.378)	At 5 yr lobectomy vs SBRT 33.7%; Resection 86.3% (P = 0.04, P = 0.003)		3
Verstegen et al[76], 2013	R	64 VATS; 64 SBRT; 54% inoperable	At 3 yr 3.1% vs 1.6% (P = 0.04)	79.7% vs 75%	76.9% vs 90.8% (P = 0.83)	23.4% vs 6.3% G ≥ 3 (P = 0.03)	3
Matsuo et al[77], 2014	R	53 sublobar resection; 53 SBRT	At 5 yr 14.1% vs 28.3% (P = 0.059)		55.6% vs 40.4% (P = 0.124)		3
Zheng et al[78], 2014	MA	11921; 7071 surgery; 4850 SBRT	At 1 yr 93% lobectomy vs 91.5% sublobar resection vs 96.3% SBRT. At 3 yr 85% vs 78.4% vs 87.8%. At 5 yr 80% vs 63.4% vs 83.9% (P = 0.45)	At 1 yr 93.5% lobectomy vs 90.3% sublobar resection vs 87.1% SBRT. At 3 yr 82.9% vs 82.1% vs 65.8%. At 5 yr 74.8% vs 71.2% vs 65.8% (P = 0.46)	At 1 yr 92.5% lobectomy vs 93.2% sublobar resection vs 83.4% SBRT. At 3 yr 77.9% vs 80.7% vs 56.6%. At 5 yr 66.1% vs 71.7% vs 41.2% HR = 0.52, 95%CI: 0.2-1.36 for lobectomy and HR = 0.49, 95%CI: 0.19-1.3 for sublobar resection		1
Yu et al[79], 2015	R	1078; 711 surgery; 367 SBRT			At 2 yr 77.7% vs 59.9% (P = 0.01)	Acute 54.9% vs 7.9% (P < 0.001). Chronic 73.9% vs 69.7% P = 0.31)	3
Rosen et al[80], 2016	R	1781 lobectomy; 1781 SBRT			At 5 yr 59% vs 29%; 58% vs 40% for patients who refused surgery (P = 0.010)		3
Ma et al[81], 2016 (adjusted for operable patients)	MA	6969; 3436 VATS; 4433 SBRT		No differences (P = 0.378)	No differences HR = 2.02, 95%CI: 0.45-3.07 (P = 0.36)		2
Deng et al[82], 2017	MA	13598	No differences (P = 0.453)		At 3 yr 68.1% vs 47.7% (P < 0.001)		1
Grills et al[74], 2010	P. III	222 Lobectomy; 254 SBRT	At 5 yr 5% vs 8% (P = 0.388)	At 5 yr 72% vs 53% (P = 0.018)	At 5 yr 78% vs 61% (P = 0.006)		1
Ackerson et al[83], 2018	R	151 surgery; 70 SBRT	At 3 yr 10% vs 15% (P = 0.71)	42% vs 29% (P = 0.004)	At 3 yr 63% vs 35% (P < 0.001)	23%-17%	3
Tamura et al[84], 2019	R	141 surgery; 106 SBRT	Higher for SBRT (P = 0.0082)	At 5 yr 69.7%-50.2% (P = 0.036)	At 5 yr 69.7% vs 50.2% (P = 0.036)	8.6% surgery; SBRT G ≥ 2 7.5%	3

G: Grade; LoE: Level of evidence; MA: Meta-analysis; P: Phase; OS: Overall survival; RT: Radiotherapy; VATS: Video-assisted thoracoscopic surgery.