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Review
. 2016 Sep 29;9(9):CD002142.
doi: 10.1002/14651858.CD002142.pub3.

Postoperative radiotherapy for non-small cell lung cancer

Sarah Burdett  1 , Larysa Rydzewska, Jayne Tierney, David Fisher, Mahesh Kb Parmar, Rodrigo Arriagada, Jean Pierre Pignon, Cecile Le Pechoux; PORT Meta‐analysis Trialists Group
Affiliations
Review

Postoperative radiotherapy for non-small cell lung cancer

Sarah Burdett et al. Cochrane Database Syst Rev. .

Update in

  • Postoperative radiotherapy for non-small cell lung cancer.
    Burdett S, Rydzewska L, Tierney J, Fisher D, Parmar MK, Arriagada R, Pignon JP, Le Pechoux C; PORT Meta‐analysis Trialists Group. Burdett S, et al. Cochrane Database Syst Rev. 2016 Oct 11;10(10):CD002142. doi: 10.1002/14651858.CD002142.pub4. Cochrane Database Syst Rev. 2016. PMID: 27727451 Free PMC article. Review.

Abstract

Background: The role of postoperative radiotherapy (PORT) in the treatment of patients with completely resected non-small cell lung cancer (NSCLC) was not clear. A systematic review and individual participant data meta-analysis was undertaken to evaluate available evidence from randomised controlled trials (RCTs). These results were first published in Lung Cancer in 2013.

Objectives: To evaluate the effects of PORT on survival and recurrence in patients with completely resected NSCLC. To investigate whether predefined patient subgroups benefit more or less from PORT.

Search methods: We supplemented MEDLINE and CANCERLIT searches (1965 to 8 July 2016) with information from trial registers, handsearching of relevant meeting proceedings and discussion with trialists and organisations.

Selection criteria: We included trials of surgery versus surgery plus radiotherapy, provided they randomised participants with NSCLC using a method that precluded prior knowledge of treatment assignment.

Data collection and analysis: We carried out a quantitative meta-analysis using updated information from individual participants from all randomised trials. We sought data on all participants from those responsible for the trial. We obtained updated individual participant data (IPD) on survival and date of last follow-up, as well as details on treatment allocation, date of randomisation, age, sex, histological cell type, stage, nodal status and performance status. To avoid potential bias, we requested information on all randomised participants, including those excluded from investigators' original analyses. We conducted all analyses on intention-to-treat on the endpoint of survival.

Main results: We identified 14 trials evaluating surgery versus surgery plus radiotherapy. Individual participant data were available for 11 of these trials, and our analyses are based on 2343 participants (1511 deaths). Results show a significant adverse effect of PORT on survival, with a hazard ratio of 1.18, or an 18% relative increase in risk of death. This is equivalent to an absolute detriment of 5% at two years (95% confidence interval (CI) 2% to 9%), reducing overall survival from 58% to 53%. Subgroup analyses showed no differences in effects of PORT by any participant subgroup covariate.We did not undertake analysis of the effects of PORT on quality of life and adverse events. Investigators did not routinely collect quality of life information during these trials, and it was unlikely that any benefit of PORT would offset the observed survival disadvantage. We considered risk of bias in the included trials to be low.

Authors' conclusions: Results from 11 trials and 2343 participants show that PORT is detrimental to those with completely resected non-small cell lung cancer and should not be used in the routine treatment of such patients. Results of ongoing RCTs will clarify the effects of modern radiotherapy in patients with N2 tumours.

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Conflict of interest statement

None known.

Figures

Figure 1
Figure 1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figure 2
Figure 2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Figure 3
Figure 3
Overall survival.
Figure 4
Figure 4
PORT effect on overall survival by trial according to stage.
Figure 5
Figure 5
Hazard ratio (HR) for the interaction between the effect of PORT on survival and (a) stage or (b) nodal status.
Figure 6
Figure 6
Sensitivity analysis 1: only trials with all stage subgroups included.
Figure 7
Figure 7
Sensitivity analysis (2): only trials with stage II and III subgroups represented.
Figure 8
Figure 8
PORT effect on overall survival by trial according to nodal status.
Analysis 1.1
Analysis 1.1
Comparison 1 Surgery + PORT versus surgery alone, Outcome 1 Survival.
Analysis 1.2
Analysis 1.2
Comparison 1 Surgery + PORT versus surgery alone, Outcome 2 Local recurrence‐free survival.
Analysis 1.3
Analysis 1.3
Comparison 1 Surgery + PORT versus surgery alone, Outcome 3 Distant recurrence‐free survival.
Analysis 1.4
Analysis 1.4
Comparison 1 Surgery + PORT versus surgery alone, Outcome 4 Recurrence‐free survival.
Analysis 1.5
Analysis 1.5
Comparison 1 Surgery + PORT versus surgery alone, Outcome 5 RT delivery method.
Analysis 1.6
Analysis 1.6
Comparison 1 Surgery + PORT versus surgery alone, Outcome 6 RT dose.
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References

References to studies included in this review

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References to studies excluded from this review

    1. Mayer R, Smolle‐Juettner F‐M, Szolar D, Stuecklschweiger GF, Quehenberger F, Friehs G, et al. Postoperative radiotherapy in radically resected non‐small cell lung cancer. Chest 1997;112:954‐9. - PubMed
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References to ongoing studies

    1. LUNG ART‐IGR 2006/1202 (ongoing). Phase III study comparing post‐operative conformal radiotherapy to no post‐operative radiotherapy in patients with completely resected non‐small cell lung cancer and mediastinal N2 involvement. NCT00410683.

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References to other published versions of this review

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