Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials

Burdett, Sarah; Parmar, Mkb; Stewart, Lesley; Souhami, R. L.; Arriagada, R.; Girling, D J; Pignon, Jean-Pierre; Torri, Valter; Brichet, AH; Lafitte, J.J.; Dautzenberg, Bertrand; Debevec, M; Kovac,; Stephens, R.; Gregor, Anne; Piantadosi, Steven; Rocmans, Pierre Arthur; Houtte, Paul Van; Wang, M

doi:10.1016/s0140-6736(98)06341-7

Cited by 726 publications

(31 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Studies on patients with stage I, stage II, or stage IIIA NSCLC have been performed to test this hypothesis [3–6]. These studies consistently showed detrimental effects of PORT on the survival of early-stage (stages I and II) patients [4, 6–9]. In contrast, the results for stage III patients with N2 NSCLC were conflicting.…”

Section: Introductionmentioning

confidence: 99%

Propensity score-matching analysis of postoperative radiotherapy for stage IIIA-N2 non-small cell lung cancer using the Surveillance, Epidemiology, and End Results database

et al. 2017

View full text Add to dashboard Cite

BackgroundTo investigate the effects of postoperative radiotherapy (PORT) on the survival of patients with resected stage IIIA-N2 non-small cell lung cancer (NSCLC).MethodsA total of 3,334 patients with resected stage IIIA-N2 NSCLC in 2004 to 2013 were identified in the Surveillance, Epidemiology, and End Results database and stratified according to use of PORT. Propensity score-matching (PSM) methods were used to balance the baseline characteristics of patients who did (n = 744) or did not (n = 744) undergo PORT. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared between these two patient groups.ResultsAfter PSM, PORT increased OS (hazard ratio, 0.793; p = 0.001) and LCSS (hazard ratio, 0.837; p = 0.022) compared with no PORT. The OS benefit for PORT was mainly seen in patients aged <60 years (5-year OS, 35.4% versus 28.9% for PORT versus no PORT, respectively; p = 0.026) and in those who underwent lobectomy (5-year OS, 43.5% versus 34.5% for PORT versus no PORT, respectively; p = 0.001). The LCSS benefit for PORT was significant in patients undergoing lobectomy (5-year LCSS, 48.3% versus 42.3% for PORT versus no PORT, respectively; p = 0.036).ConclusionsThe survival benefits of PORT were primarily observed in patients with resected stage IIIA-N2 NSCLC who were <60 years of age or had undergone lobectomy.

show abstract

Section: Introductionmentioning

confidence: 99%

Propensity score-matching analysis of postoperative radiotherapy for stage IIIA-N2 non-small cell lung cancer using the Surveillance, Epidemiology, and End Results database

et al. 2017

View full text Add to dashboard Cite

show abstract

“…An earlier meta-analysis using older radiotherapy techniques failed to show a survival benefit for this patient group [64]. More recent population studies have suggested a survival benefit with PORT for pN2 disease [65, 66].…”

Section: Introductionmentioning

confidence: 99%

A critical review of recent developments in radiotherapy for non-small cell lung cancer

Baker¹,

et al. 2016

View full text Add to dashboard Cite

Lung cancer is the leading cause of cancer mortality, and radiotherapy plays a key role in both curative and palliative treatments for this disease. Recent advances include stereotactic ablative radiotherapy (SABR), which is now established as a curative-intent treatment option for patients with peripheral early-stage NSCLC who are medically inoperable, or at high risk for surgical complications. Improved delivery techniques have facilitated studies evaluating the role of SABR in oligometastatic NSCLC, and encouraged the use of high-technology radiotherapy in some palliative settings. Although outcomes in locally advanced NSCLC remain disappointing for many patients, future progress may come about from an improved understanding of disease biology and the development of radiotherapy approaches that further reduce normal tissue irradiation. At the moment, the benefits, if any, of radiotherapy technologies such as proton beam therapy remain unproven. This paper provides a critical review of selected aspects of modern radiotherapy for lung cancer, highlights the current limitations in our understanding and treatment approaches, and discuss future treatment strategies for NSCLC.

show abstract

“…The role of postoperative radiotherapy (PORT) has been investigated in a number of studies and the results were summarized in two meta-analyses [3, 4]. These studies are extremely heterogeneous in terms of radiation dose, fractionation schedules and the quality of the irradiation technique.…”

Section: Introductionmentioning

confidence: 99%

“…It appears clear that patients after complete surgical resection (R0) and with limited lymph node involvement (N0 or N1) do not benefit from postoperative radiation [2–4]. In contrast, there is evidence for improved local tumor control and possibly improved overall survival of patients with regionally advanced tumors (pN2) after PORT [3, 5–8]. Therefore, PORT is offered by many centers in this situation.…”

Section: Introductionmentioning

confidence: 99%

PORTAF – postoperative radiotherapy of non-small cell lung cancer: accelerated versus conventional fractionation – study protocol for a randomized controlled trial

Bütof

Simon

Löck

et al. 2017

Trials

View full text Add to dashboard Cite

BackgroundIn early-stage non-small cell lung cancer (NSCLC) without affected lymph nodes detected at staging, surgical resection is still the mainstay of treatment. However, in patients with metastatic mediastinal lymph nodes (pN2) or non-radically resected primary tumors (R1/R2), postoperative radiotherapy (possibly combined with chemotherapy) is indicated. So far, investigations about time factors affecting postoperative radiotherapy have only examined the waiting time defined as interval between surgery and start of radiotherapy, but not the overall treatment time (OTT) itself. Conversely, results from trials on primary radio(chemo)therapy in NSCLC show that longer OTT correlates with significantly worse local tumor control and overall survival rates. This time factor of primary radio(chemo)therapy is thought to mainly be based on repopulation of surviving tumor cells between irradiation fractions. It remains to be elucidated if such an effect also occurs when patients with NSCLC are treated with postoperative radiotherapy after surgery (and chemotherapy). Our own retrospective data suggest an advantage of shorter OTT also for postoperative radiotherapy in this patient group.Methods/designThis is a multicenter, prospective randomized trial investigating whether an accelerated course of postoperative radiotherapy with photons or protons (7 fractions per week, 2 Gy fractions) improves locoregional tumor control in NSCLC patients in comparison to conventional fractionation (5 fractions per week, 2 Gy fractions). Target volumes and total radiation doses will be stratified in both treatment arms based on individual risk factors.DiscussionFor the primary endpoint of the study we postulate an increase in local tumor control from 70% to 85% after 36 months. Secondary endpoints are overall survival of patients; local recurrence-free and distant metastases-free survival after 36 months; acute and late toxicity and quality of life for both treatment methods.Trial registrationClinicalTrials.gov, NCT02189967. Registered on 22 May 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2346-0) contains supplementary material, which is available to authorized users.

show abstract

Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials

Cited by 726 publications

References 14 publications

Propensity score-matching analysis of postoperative radiotherapy for stage IIIA-N2 non-small cell lung cancer using the Surveillance, Epidemiology, and End Results database

Propensity score-matching analysis of postoperative radiotherapy for stage IIIA-N2 non-small cell lung cancer using the Surveillance, Epidemiology, and End Results database

A critical review of recent developments in radiotherapy for non-small cell lung cancer

PORTAF – postoperative radiotherapy of non-small cell lung cancer: accelerated versus conventional fractionation – study protocol for a randomized controlled trial

Contact Info

Product

Resources

About