Surgical Resection, Radiotherapy, And Percutaneous Thermal Ablation for Treatment of Stage 1 Non-Small Cell Lung Cancer: A Systematic Review and Network Meta-Analysis

Abstract

Introduction: Non-small cell lung cancer (NSCLC) makes up the majority of lung cancer cases. Currently surgical resection of the affected lung parenchyma is the gold standard of treatment. However, as patients are becoming medically more complex and presenting with more advanced disease, minimally invasive image guided percutaneous ablations are gaining popularity. Therefore, comparison of surgical, ablative, and second-line external beam therapies will help clinicians, as management of NSCLC changes. We will conduct a meta-analysis, reviewing literature investigating these therapies in adult patients diagnosed with Stage I NSCLC (tumor ranging from 0-5 cm, with no hilar nor mediastinal nodal involvement, confirmed either through cytology or histology regardless of type). Methods and Analysis: We will search electronic databases from their inception to January 2021 to identify randomized controlled trials (RCTs), cluster-RCTs, and cohort studies comparing the survival and clinical outcomes between any two interventions (lobectomy, wedge resection, radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation and consolidated radiation therapies (EBRT, SBRT and 3D-CRT). The primary outcomes will include: cancer-specific survival (CSS), lung disease free survival, locoregional recurrence, death, toxicity, and non-target organ injury. In addition to the electronic databases, we will search for published and unpublished studies in trial registries and will review the references of included studies for possible inclusion in this review. Risk of bias will be assess using tools developed by the Cochrane collaboration. Two reviewers will independently assess the eligibility of studies and conduct the corresponding risk-of-bias assessments. For each outcome, given a sufficient number of studies, we will conduct a network meta-analysis. Finally, we will use the Confidence in Network meta-analysis (CINeMA) tool to assess the quality of the evidence for each of the primary outcomes. Ethics and Dissemination: We aim to share our findings through high-impact peer review. As interventional techniques become more popular, it will be important for all providers in multi-disciplinary teams focused on care of these patients to receive continuing medical education on related to these interventions. Data synthesized in this study will be made available to readers.