Authors' objectives: Evaluate the efficacy, safety and efficiency of radiosurgery and stereotactic body radiotherapy in stage I non small cell lung cancer (NSCLC) patients and in the treatment of pulmonary oligometastases.

Authors' recommendations: SBRT to treat Stage I NSCLC patients No randomised controlled trials that assess SBRT compared to other therapeutic alternatives (surgery, conventional or particle radiotherapy) have been found. The levels of evidence for studies of treatment with SBRT are low although the scientific production is high. The studies that were found are non randomised controlled studies and observational studies. Studies show high heterogeinity. There is variability in the fractionation schemes, patients treated and consequently in the efficacy and safety results. Main serious adverse events described are pneumonitis, dyspnea, chest pain and rib fracture episodes. There has been estimated an improvement in overall survival in inoperable patients treated with SBRT vs. conventional radiotherapy (outcomes assessed in case control studies and comparative metanalysis). No differences have been estimated in overall survival between patients treated with SBRT and surgery, and patients treated with SBRT and particle therapy. No solid conclusions of the efficacy and safety of SBRT can be drawn owed to low level of evidence of the comparative studies found. High methodological quality studies are needed to asses directly stage I NSCLC patients treated with SBRT vs. other therapeutic alternatives. There are four randomised controlled trials ongoing. These studies will asses properly SBRT vs. surgery (ROSEL study, STAR study and other phase III study) and SBRT vs. conventional radiotherapy (CHISEL study). The bibliography about efficiency results for stage I NSCLC patients is scarce and the comparative studies are low level evidenced. It can be concluded that results point out that SBRT treatment is efficient compared to radiofrequency ablation, conventional radiotherapy and protons radiotherapy in terms of cost utility (two studies) and that SBRT is efficiente compared to conventional radiotherapy in terms of cost (one study). On the other hand, in the cost effectiveness analysis surgery appears to meet the standards for cost effectiveness compared to SBRT, under many methodology considerations (this results should be confirmed in a randomized controlled trial). SBRT to treat pulmonary oligometastasis No randomised controlled trials that assess SBRT compared to other therapeutic strategies (surgery or conventional radiotherapy) have been found. The levels of evidence for studies of treatment with SBRT are low. The studies that were found are observational studies without control group. Studies show high heterogeinity. There is variability in the fractionation schemes, patients treated and consequently in the efficacy and safety results. Main serious adverse events described are pneumonitis episodes. No solid conclusions of the efficacy and safety of SBRT can be drawn owed to low level of evidence of the studies found. High methodological quality studies are needed to asses directly pulmonary oligometastases treated with SBRT vs. other therapeutic alternatives. No efficiency studies that assess SBRT compared to other therapeutic alternatives in patients with pulmonary metastases have been found.

Project Status: Completed

URL for project: https://www.aetsa.org/publicacion/radiocirugia-y-radioterapia-estereotaxica-corporal-eficacia-seguridad-y-eficiencia-en-cancer-de-pulmon-primario-y-oligometastasis-pulmonares/

Year Published: 2012

URL for published report: https://www.aetsa.org/download/publicaciones/antiguas/AETSA_2011_6_SBRT.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Andalusian Health Technology Assessment Area

Contact Address: Area de Evaluacion de Tecnologias Sanitarias Sanitarias de Andalucia (AETSA) Avda. Innovación, s/n Edificio Arena 1. Sevilla (Spain) Tel. +34 955 006 309

Contact Name: aetsa.csalud@juntadeandalucia.es

Contact Email: aetsa.csalud@juntadeandalucia.es

Copyright: Andalusian Agency for Health Technology Assessment (AETSA)