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Postoperative radiotherapy for non-small cell lung cancer

Burdett, S., Rydzewska, L., Tierney, J., (...), Trodella, L., Wang, M.

Cochrane Database Syst Rev. 2016 Oct 11;10:CD002142

Commentary by Tom Stinchcombe

The use of post-operative radiotherapy (PORT) in resected NSCLC remains one of the more debated topics in the treatment of NSCLC with strong opinions supporting or opposing the use of PORT. The Cochrane database of systemic reviews recently reviewed the available evidence for randomized controlled trials using individual patient data. Individual patient data on 2,343 patients were available. PORT was associated with an adverse impact on survival (hazard ration of 1.18, 95% CI, 1.07 to 1.31; P=0.001), and absolute detriment of 5% (95% CI 2 to 9%) at 2 years. There was no evidence that PORT was more effective by stage, but there was a suggestion that PORT was more detrimental in earlier stage patients. When local recurrence-free survival was analyzed it favored surgery alone (HR of 1.12, 95% CI, 1.10 to 1.24; P=0.03). Patients were enrolled over an extended period of time on these trials and the staging tests (e.g. the adoption of PET scan staging), and radiation techniques are different than current standards. This analysis investigated trials comparing surgery alone versus surgery and PORT, and many patients currently receive adjuvant chemotherapy which may impact the value of PORT. An ongoing European trial is investigating PORT in patients with resected N2 disease, and will provide important information on this subgroup of patients.  Outside the context of a clinical trial the use of PORT should be considered cautiously and only in selected patients.

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