Nazmus Sakib1, Na Li1, Xiaoxia Zhu1, Dianhe Li1, Yiyi Li1, Haofei Wang2. 1. Departments of Radiation Oncology. 2. Department of Cardiothoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
Abstract
BACKGROUND: In a previous meta-analysis-based modeling study, it was hypothesized that modern postoperative radiotherapy (PORT) may improve both local recurrence and overall survival (OS) in stage IIIA-N2 non-small-cell lung cancer (NSCLC). There were only four single-arm trials with a total of 357 patients. As other trials have provided new and controversial data, we performed this updated meta-analysis to test the hypothesis. PATIENTS AND METHODS: Systematic reviews in Medline, Cochrane, and Science Direct up to December 2015 identified publications exploring the efficacy of PORT in resectable stage IIIA-N2 NSCLC. RESULTS: Overall, 16 trials comprising 3278 patients were included. There was a significant benefit in favor of PORT regarding OS [hazard ratio (HR): 0.73, 95% confidence interval (CI): 0.58-0.92, P=0.008; absolute benefit at 5 years=8%], disease-free survival (HR: 0.70, 95% CI: 0.60-0.83, P<0.0001), and locoregional recurrence-free survival (HR: 0.37, 95% CI: 0.24-0.58, P<0.0001). Restriction of the analysis to trials with induction and/or adjuvant chemotherapy led to similar results. PORT significantly decreased the risk of local recurrence (risk ratio: 0.64, 95% CI: 0.50-0.82, P=0.0006) and DM (risk ratio: 0.74, 95% CI: 0.62-0.88, P=0.0005), and the absolute risk differences were 13 and 14%, respectively. CONCLUSION: The addition of PORT, with or without chemotherapy, significantly improves local control and survival in patients with resectable stage IIIA-N2 NSCLC.
BACKGROUND: In a previous meta-analysis-based modeling study, it was hypothesized that modern postoperative radiotherapy (PORT) may improve both local recurrence and overall survival (OS) in stage IIIA-N2 non-small-cell lung cancer (NSCLC). There were only four single-arm trials with a total of 357 patients. As other trials have provided new and controversial data, we performed this updated meta-analysis to test the hypothesis. PATIENTS AND METHODS: Systematic reviews in Medline, Cochrane, and Science Direct up to December 2015 identified publications exploring the efficacy of PORT in resectable stage IIIA-N2 NSCLC. RESULTS: Overall, 16 trials comprising 3278 patients were included. There was a significant benefit in favor of PORT regarding OS [hazard ratio (HR): 0.73, 95% confidence interval (CI): 0.58-0.92, P=0.008; absolute benefit at 5 years=8%], disease-free survival (HR: 0.70, 95% CI: 0.60-0.83, P<0.0001), and locoregional recurrence-free survival (HR: 0.37, 95% CI: 0.24-0.58, P<0.0001). Restriction of the analysis to trials with induction and/or adjuvant chemotherapy led to similar results. PORT significantly decreased the risk of local recurrence (risk ratio: 0.64, 95% CI: 0.50-0.82, P=0.0006) and DM (risk ratio: 0.74, 95% CI: 0.62-0.88, P=0.0005), and the absolute risk differences were 13 and 14%, respectively. CONCLUSION: The addition of PORT, with or without chemotherapy, significantly improves local control and survival in patients with resectable stage IIIA-N2 NSCLC.
Authors: Mark R Waddle; Stephen Ko; Margaret M Johnson; Yanyan Lou; Robert C Miller; Anna C Harrell; Daniel M Trifiletti Journal: Transl Lung Cancer Res Date: 2018-04