Safety and Efficacy of Tomotherapy for Lung Cancer Compared to Other Radiotherapy Techniques: A Systematic Review

Lung cancer is one of the most common cancers worldwide with high mortality and short survival rate. Radiotherapy is one of the treatment modalities in patients who are non-surgery candidates or refuse surgery.

The current study aimed at evaluating the effectiveness and safety of this technique compared to similar ones for lung cancer treatment.

In order to answer the research question and find the available evidence, after the development of the search strategy, Pubmed, Cochran, Ovid, Medline, and DARE databases were searched and related articles were selected based on the inclusion criteria. Then, we chose all studies that had the PICO acceptance criteria (Participants: adults with lung cancer; Intervention: tomotherapy; Comparisons: tomotherapy with Cyberknife; Outcomes: local tumor control (LTC), survival rate (SR), complications, and degree of toxicity). The quality assessment of the studies was conducted using the CASP (Critical Appraisal Skills Programme) checklist. Two independent search engines evaluated the articles in terms of methodology, and information was extracted from the papers.

Overall, 12 retrospective studies with 616 patients were found examining the efficacy and safety of a certain technology. According to the results of the studies, the local tumor control (LTC) index varied from 63% to 100%. The two and five-year SRs were 73% and 56%, respectively. In addition, the mortality rate of patients until the completion of the treatment course was 34%, indicating the higher efficacy of tomotherapy than the efficacy of other similar techniques. The toxicity of tomotherapy was less than that of Cyberknife, which indicates its more safety.

According to the epidemiology of cancer, especially lung cancer, and due to aging of the population in Iran, and considering the higher efficacy and safety of tomotherapy in comparison with other similar technologies, i.e., Cyberknife and Gamma Knife, tomotherapy is a superior technique in the control and treatment of lung cancer although other aspects, such as cost-efficacy, should be considered.