Intervention Review

Postoperative radiotherapy for non-small cell lung cancer

  1. PORT Meta-analysis Trialists Group

Editorial Group: Cochrane Lung Cancer Group

Published Online: 20 APR 2005

Assessed as up-to-date: 18 JAN 2009

DOI: 10.1002/14651858.CD002142.pub2

How to Cite

PORT Meta-analysis Trialists Group. Postoperative radiotherapy for non-small cell lung cancer. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD002142. DOI: 10.1002/14651858.CD002142.pub2.

Author Information

  1. MRC Clinical Trials Unit, London, UK

*Larysa Rydzewska, Meta-analysis Group, MRC Clinical Trials Unit, 222 Euston Road, London, NW1 2DA, UK. lhr@ctu.mrc.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 APR 2005

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The role of postoperative radiotherapy (PORT) in the treatment of patients with completely resected non-small cell lung cancer was not clear. A systematic review and quantitative meta-analysis were therefore undertaken to evaluate the available evidence from randomised trials.

Objectives

To evaluate the effect of postoperative radiotherapy on survival and recurrence in patients with completely resected non-small cell lung cancer. To investigate whether or not pre-defined patient subgroups benefit more or less from PORT.

Search methods

We supplemented MEDLINE and CANCERLIT searches with information from trial registers, by handsearching relevant meeting proceedings and by discussion with relevant trialists and organisations.

Selection criteria

Both published and unpublished trials were eligible for inclusion provided the patients had undergone a complete resection; had been randomised between radiotherapy and no immediate further treatment; that the method of randomisation precluded prior knowledge of the treatment to be assigned; and that recruitment was after 1965.

Data collection and analysis

We carried out a quantitative meta-analysis using updated information from individual patients from all available randomised trials. We sought data from all patients randomised in all eligible trials directly from those responsible. We obtained updated information on survival, recurrence and date of last follow up. To avoid potential bias, we requested information for all randomised patients including those who had been excluded from the investigators' original analyses.

Main results

We included 2343 patients from 11 trials (median follow up of 4.4 years). The results showed a significant adverse effect of PORT on survival with a hazard ratio of 1.18 or an 18% relative increase in the risk of death. This is equivalent to an absolute detriment of 5% at two years (95% CI 2% to 9%), reducing overall survival from 58% to 53%. Exploratory subgroup analyses suggested that this detrimental effect was most pronounced for patients with stage I/II, N0-N1 disease, whereas for stage III, N2 patients there was no clear evidence of an adverse effect.

Authors' conclusions

PORT is detrimental to patients with early stage completely resected non-small cell lung cancer and should not be used in the routine treatment of such patients. The role of PORT in the treatment of N2 tumours is not clear and may justify further research.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Postoperative radiotherapy for non-small cell lung cancer

Non-small cell lung cancer is the most common type of lung cancer. If this type of lung cancer has not spread, standard treatment is an operation to remove the tumour. Trials of a treatment called Post-Operative Radiotherapy Treatment (PORT), which involves giving x-ray treatment after the operation, have been carried out. These trials have been combined in this review, which found that giving PORT did not help people live longer. Fewer people given PORT treatment lived for two years after the operation (53%) than those who were not given PORT (58%). The treatment seemed to be harmful to patients in the early stages of the disease whose cancer had not spread. For those with more advanced disease, the evidence is less clear. However, even for these patients there is no indication that PORT is beneficial. Radiotherapy given after successful removal of tumour at operation is not beneficial for patients with non-small cell lung cancer and should not be used as routine treatment. Further research with new types of radiotherapy may be justified.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

非小細胞肺癌之手術後放射治療

手術後的放射治療在非小細胞肺癌患者接受根除性腫瘤切除術後的治療角色仍不明確,因此根據隨機試驗所得到的證據來做系統的回顧以及定量性的統合分析

目標

依病人的存活率和復發率,來評估非小細胞肺癌病人接受根除性手術後,繼續接受術後放射治療的效果。並研究預先分組的不同類型病人,是否能從手術後放射治療獲得益處。

搜尋策略

以MEDLINE和CANCERLIT搜查的資料為主,並使用來自試驗註冊者的資料、人工搜尋相關的會議記錄並且與相關的試驗執行者及組織討論後,來補充MEDLINE和CANCERLIT搜查的資料。

選擇標準

收集1965年之後登錄之研究,包含已發表及未發表的臨床試驗,只要符合曾接受過根除性手術治療,並且被隨機分配為接受術後放射治療,或者是沒有立即接受進一步治療的病人均可被收錄。隨機分配的方法是排除掉已接受過治療的病人。

資料收集與分析

從所有可用的隨機試驗的病人的最新資料來進行定量性的統合分析。合格的臨床試驗的病人資料是直接從試驗負責人處取得,包括了存活率、復發率和最後一次追蹤日期的最新資料。為了避免潛在的偏見,所有接受隨機分配的病人資料,包括了被研究人員排除在原始分析之外的病人資料也都要蒐集。

主要結論

共蒐集了10個試驗,有2232個病人,追蹤時間的中位數是4.25年。結果顯示,手術後放射線治療造成重大不良反應的危險比(hazard ratio)為1.18或相對地增加了18 %的死亡危險。二年整體存活率從58 %減少到52 % 。相當於減少了絕對值6 % 的存活率(95 % CI為2 %至9 %)。次群體分析顯示,這種不利的影響在第一期或第二期肺癌,即淋巴轉移N0N1的病人最顯著,在第三期,即淋巴轉移為N2的病人沒有明確的證據顯示會造成不良的影響。

作者結論

手術後放射治療用在接受根除性手術之早期非小細胞肺癌的病人身上是不利的,並且不應該常規地使用在此類病人身上。但手術後放射治療在治療N2腫瘤的角色未明,需要更多的研究來評估。

翻譯人

本摘要由臺北榮民總醫院羅永鴻翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

手術後給予放射治療會增加接受根除性手術之早期非小細胞肺癌病人的死亡風險。 非小細胞肺癌是最常見的肺癌癌型,如果這種肺癌沒有轉移,標準的治療是手術切除整個腫瘤。許多試驗研究手術後給予放射治療是否能使病人存活更久,這篇回顧發現手術後放射治療是有傷害性的,接受手術後放射治療的組別有較低的兩年存活率(52%),然而沒有接受手術後放射治療的組別則有較高的兩年存活率(58%)。這種治療對於尚未擴散的早期腫瘤的病人的傷害較大。在較晚期的病人則是證據不明,但也沒有證據顯示手術後放射線治療對於較晚期的病人是有幫助的。手術後放射治療對於已成功切除腫瘤的病人是有害的,不能夠當成例行的治療。至於新型的放射線治療則需要更多試驗來評估。