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P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Presentations: 2
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
P1.16-22 - Meta-Analysis of Stereotactic Ablative Radiotherapy Versus Surgery for Early Stage Lung Cancer. (ID 12031)
16:45 - 18:00 | Author(s): Mariusz Kowalewski
The standard of care for operable, stage I, non-small-cell lung cancer (NSCLC) is lobectomy with mediastinal lymph node dissection or sampling. Stereotactic ablative radiotherapy (SABR) for inoperable stage I NSCLC has shown promising results, but two independent, randomised, phase 3 randomized controlled trials (RCTs) included few patients and closed early due to slow accrual. We aimed to assess overall survival with SABR versus surgery by pooling data from RCTs and adjusted observational studies.a9ded1e5ce5d75814730bb4caaf49419 Method
We performed a systematic review and meta-anaysis according to PRISMA (Preferred Items Reporting for Systematic Reviews and Meta Analyses) guidelines. The search process covered a period untill 28th of February 2018. Search terms were: SABR, stereotactic body radiation therapy, radiotherapy, lung-, pulmonary- cancer. Studies comparing SABR vs surgery for NSCLC were ellegible if reported adjusted survival data. Approaches including propensity scoring, inverse probability weighting and multivariate regressions were only considered. Survival was calculated by pooling available Hazard Ratios (HRs) in random-effects model. Studies were then stratified based on their design (RCT[s] vs Adjusted nRCT[s]). HRs were digitized from the available Kaplan-Meier curves.4c3880bb027f159e801041b1021e88e8 Result
Nineteen studies were retrieved that enrolled 23,534 patients. Among them two RCTs (N=58 pts). In overall analysis SABR was associated with significantly worsened survival as compared to surgery group: HR (95%CIs): 1.64 (1.38-1.94); p<0.001; when analyzed separately, adjusted nRCT[s] favored surgery: HR for comparison SABR vs surgery: 1.66 (1.40-1.97); p<0.001; among RCTs only, SABR was associated with a statistical trend for improved survival: HR (95%CIs): 0.14 (0.02-1.17); p=0.07. There were significant statistical differences between RCTs and adjusted nRCTs Pinteraction=0.02.
SABR could be an option for treating early stage NSCLC but there was significant discrepancy between RCTs and non-RCTs regarding survival after SABR as compared to surgery; more adequately powered randomized studies are needed before conclusions on efficacy of SABR can be drawn.6f8b794f3246b0c1e1780bb4d4d5dc53
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P1.16-38 - Meta-Analysis of Unplanned Readmissions Following Thoracoscopic Versus Open Lung Cancer Resection (ID 12028)
16:45 - 18:00 | Author(s): Mariusz Kowalewski
Approximately 7.4% of patients experience unplanned readmission within 30 days following pulmonary resection. Although video-assisted thoracic surgery (VATS) is able to improve short-term outcomes in both cancer patients and noncancer patients, surprisingly, several recent big registry studies showed significantly increased readmission rates.a9ded1e5ce5d75814730bb4caaf49419 Method
We performed a systematic review and meta-anaysis according to PRISMA (Preferred Items Reporting for Systematic Reviews and Meta-Analyses) guidelines. The search process covered a period untill 31st of March 2018. Search keywords were: VATS, lobectomy, segmentectomy, open, thoracotomy, readmission*, readmit*. Studies were to compare VATS vs open thoracotomy and reporting 30-90 days readmission rates. Only reports in English were included and retrieved as full-txts. Data were pooled in DerSimmonian and Laird Inverse Variance random effects model and reported as Risk Ratios (RR) with corresponding 95% Confidence Intervals (CIs).4c3880bb027f159e801041b1021e88e8 Result
A systematic search yielded 16 potentially elegible reports, of which 5 were further excluded because they did not report crude readmission rates across VATS vs open thoracotomy. Eleven studies remained enrolling 60,146 patients undergoing VATS (39.3%) and open thoracotomy (60.7%). Unplanned readmissions followed in 7.8% (1,843/23,632) and 8.1% (2,944/36,514) of patienst undergoing VATS and open thoracotomy respectively; there was no statistical differences between two appraoches: RR (95%CIs): 0.94 (0.75-1.19); p=0.63. Substantial heterogeneity was present (p<0.001, I2=87%) in the analysis though. No single study influenced direction nor magnitude of the estimates in number of sensitivity analyses. In meta-regression analyses we demonstrated that patients' age, disease's local advancement and centre volume did not influence the results (p>0.05). On the other hand number of complications across single study pooled n. of patients was negatively correlated with readmissions.
There was no apparent difference between VATS and open thoracotomy with regard to number of unplanned readmissions. Future studies should focus on reducing complication rates in the open thoacotomy group rather than reducing readmission rates after VATS.6f8b794f3246b0c1e1780bb4d4d5dc53