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Cochrane Database of Systematic Reviews

Radioterapia posoperatoria para el cáncer de pulmón de células no pequeñas

Información

DOI:
https://doi.org/10.1002/14651858.CD002142.pub4Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 11 octubre 2016see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Cáncer de pulmón

Copyright:
  1. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Sarah Burdett

    Correspondencia a: Meta‐analysis Group, MRC Clinical Trials Unit at UCL, London, UK

    [email protected]

  • Larysa Rydzewska

    Meta‐analysis Group, MRC Clinical Trials Unit at UCL, London, UK

  • Jayne Tierney

    Meta‐analysis Group, MRC Clinical Trials Unit at UCL, London, UK

  • David Fisher

    MRC Clinical Trials Unit at UCL, London, UK

  • Mahesh KB Parmar

    MRC Clinical Trials Unit at UCL, London, UK

  • Rodrigo Arriagada

    Karolinska Institutet, Stockholm, Sweden

  • Jean Pierre Pignon

    Plateforme LNCC de Méta‐analyse en Oncologie et Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France

  • Cecile Le Pechoux

    Département de Radiothérapie, Gustave Roussy Cancer Campus, Villejuif, France

  • on behalf of the PORT Meta‐analysis Trialists Group

    Meta‐analysis Group, MRC Clinical Trials Unit at UCL, London, UK

Contributions of authors

The writing group for the current version of this review consisted of S Burdett, LHM Rydzewska, JF Tierney, MKB Parmar, D Fisher, R Arriagada, JP Pignon and C Le Pechoux, on behalf of the PORT Meta‐analysis Trialists Group.

Sources of support

Internal sources

  • Medical Research Council, UK.

External sources

  • NHS R&D programme project grant NCP/U03, UK.

Declarations of interest

None known.

Acknowledgements

The following investigators, groups and project management team* form the original PORT Meta‐analysis Group and participated in this meta‐analysis.

R Arriagada, Institut Gustave‐Roussy, Villejuif, France; AH Brichet, JJ Lafitte, Hôpital Calmette, CHRU, Lille, France; S Burdett*, D Fisher, DJ Girling, MKB Parmar*, LHM Rydzewska*, RJ Stephens, LA Stewart*, JF Tierney, MRC Clinical Trials Unit at UCL, UK; B Dautzenberg, Groupe d'Etude et de Traitement des Cancers Bronchiques (GETCB); M Debevec, V Kovac, Institute of Oncology, Zaloska 2 , Ljublijana, Slovenia; A Gregor, European Organization for Research and Treatment of Cancer, Brussels, Belgium; JH Park, Korea Cancer Center, Seoul, Korea; S Piantadosi, Lung Cancer Study Group, USA; JP Pignon, Institut Gustave‐Roussy, Villejuif, France; P Rocmans, Dept of Thoracic Surgery, Hôpitaux St Pierre et Erasme, Brussels, Belgium; R Souhami*, University College London, Medical School, UK; V Torri, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy; P Van Houtte, Dept of Radiotherapy, Institut Jules Bordet, Brussels, Belgium; L Trodella, Department of Radiation Oncology, Università Cattolica del S. Cuore, Rome; M Wang, Dept of Radiation Oncology and Surgery, Chinese Academy of Medical Sciences, Beijing, China.

The authors thank the European Organization for Research and Treatment of Cancer for permission to the the data from EORTC 08861 for this research. The contents of this publication and methods used are solely the responsibility of the authors and do not necessarily represent the official views of the EORTC.

Co‐ordination of the meta‐analysis and the collaborators' meeting was funded by the UK National Health Service Research and Development Cancer Programme (project grant NCP/U03). We would like to thank all those patients who took part in the trials and contributed to this research. The meta‐analysis would not have been possible without their help or without the collaborating institutions, which kindly supplied their trial data.

We are particularly grateful to Desmond Curran, Stanley Dische and Michele Saunders for helpful comments on the 1998 manuscript.

Version history

Published

Title

Stage

Authors

Version

2016 Oct 11

Postoperative radiotherapy for non‐small cell lung cancer

Review

Sarah Burdett, Larysa Rydzewska, Jayne Tierney, David Fisher, Mahesh KB Parmar, Rodrigo Arriagada, Jean Pierre Pignon, Cecile Le Pechoux, on behalf of the PORT Meta‐analysis Trialists Group

https://doi.org/10.1002/14651858.CD002142.pub4

2016 Sep 29

Postoperative radiotherapy for non‐small cell lung cancer

Review

Sarah Burdett, Larysa Rydzewska, Jayne Tierney, David Fisher, Mahesh KB Parmar, Rodrigo Arriagada, Jean Pierre Pignon, Cecile Le Pechoux, on behalf of the PORT Meta‐analysis Trialists Group

https://doi.org/10.1002/14651858.CD002142.pub3

2005 Apr 20

Postoperative radiotherapy for non‐small cell lung cancer

Review

PORT Meta‐analysis Trialists Group

https://doi.org/10.1002/14651858.CD002142.pub2

2003 Jan 20

Postoperative radiotherapy for non‐small cell lung cancer

Review

G roup PORT Meta‐analysis Trialists, Lesley A Stewart, Sarah S Burdett

https://doi.org/10.1002/14651858.CD002142

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figuras y tablas -
Figure 1

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Figuras y tablas -
Figure 2

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Overall survival.
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Figure 3

Overall survival.

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PORT effect on overall survival by trial according to stage.
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Figure 4

PORT effect on overall survival by trial according to stage.

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Hazard ratio (HR) for the interaction between the effect of PORT on survival and (a) stage or (b) nodal status.
Figuras y tablas -
Figure 5

Hazard ratio (HR) for the interaction between the effect of PORT on survival and (a) stage or (b) nodal status.

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Sensitivity analysis 1: only trials with all stage subgroups included.
Figuras y tablas -
Figure 6

Sensitivity analysis 1: only trials with all stage subgroups included.

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Sensitivity analysis (2): only trials with stage II and III subgroups represented.
Figuras y tablas -
Figure 7

Sensitivity analysis (2): only trials with stage II and III subgroups represented.

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PORT effect on overall survival by trial according to nodal status.
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Figure 8

PORT effect on overall survival by trial according to nodal status.

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Comparison 1 Surgery + PORT versus surgery alone, Outcome 1 Survival.
Figuras y tablas -
Analysis 1.1

Comparison 1 Surgery + PORT versus surgery alone, Outcome 1 Survival.

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Comparison 1 Surgery + PORT versus surgery alone, Outcome 2 Local recurrence‐free survival.
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Analysis 1.2

Comparison 1 Surgery + PORT versus surgery alone, Outcome 2 Local recurrence‐free survival.

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Comparison 1 Surgery + PORT versus surgery alone, Outcome 3 Distant recurrence‐free survival.
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Analysis 1.3

Comparison 1 Surgery + PORT versus surgery alone, Outcome 3 Distant recurrence‐free survival.

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Comparison 1 Surgery + PORT versus surgery alone, Outcome 4 Recurrence‐free survival.
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Analysis 1.4

Comparison 1 Surgery + PORT versus surgery alone, Outcome 4 Recurrence‐free survival.

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Comparison 1 Surgery + PORT versus surgery alone, Outcome 5 RT delivery method.
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Analysis 1.5

Comparison 1 Surgery + PORT versus surgery alone, Outcome 5 RT delivery method.

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Comparison 1 Surgery + PORT versus surgery alone, Outcome 6 RT dose.
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Analysis 1.6

Comparison 1 Surgery + PORT versus surgery alone, Outcome 6 RT dose.

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Table 1. Common meta‐analysis stage scale (original analyses ‐ based on TNM 4th edition)

T stage

N stage

M stage

Meta‐analysis stage

AJCC stage

0, 1, 2, X, iS

0

0

I

I

0, 1, 2, X, iS

1

0

II

II

Any

2, 3

0

III

III non‐metastatic

3, 4

Any

0

III

III non‐metastatic

Any

Any

1

IV

Any metastatic

AJCC = American Joint Committee on Cancer.
Figuras y tablas -
Table 1. Common meta‐analysis stage scale (original analyses ‐ based on TNM 4th edition)
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Table 2. Common meta‐analysis stage scale (current analysis ‐ based on TNM 6th edition)

T stage

N stage

M stage

Meta‐analysis stage

1, 2

0

0

I

1, 2

1

0

II

3

0

0

II

1, 2

2

0

III

3

1, 2

0

III

Any

Any

1

IV
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Table 2. Common meta‐analysis stage scale (current analysis ‐ based on TNM 6th edition)
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Table 3. Characteristics of participants in PORT meta‐analysis

Characteristic

Postoperative RT

Surgery only

Total

AGE (data from 11 trials)

< 54 years

294

327

621

55 to 59 years

267

261

528

60 to 64 years

290

276

566

> 65 years

312

315

627

Unknown

0

1

1

SEX (data from 11 trials)

Male

988

992

1980

Female

175

187

362

Not recorded

0

1

1

HISTOLOGY (data from 9 trials)

Adenocarcinoma

195

218

413

Squamous

522

545

1067

Other

66

54

120

Unknown

380

363

743

META‐ANALYSIS STAGE (data from 11 trials)

I

328

338

666

II

353

366

719

III

463

455

918

IV

1

0

1

Unknown

18

21

39

WHO PERFORMANCE STATUS (data from 4 trials; not used)

Good (0, 1)

195

196

391

Poor (2, 3, 4)

77

83

160

Unknown

22

21

43
Figuras y tablas -
Table 3. Characteristics of participants in PORT meta‐analysis
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Table 4. Changes in results over time

Trend or interaction

1998

Trend or interaction

2005

Trend or interaction

2010 'old' methods

Trend or interaction

2010 'new' methods

and TNM changes

Age

P = 0.34

P = 0.44

P = 0.32

P = 0.20

Sex

P = 0.94

P = 0.92

P = 0.84

P = 0.49

Histology

P = 0.75

P = 0.61

P = 0.42

P = 0.38

Stage

P = 0.0003

P = 0.003

P = 0.003

P = 0.12

Nodal status

P = 0.016

P = 0.02

P = 0.03

P = 0.39
Figuras y tablas -
Table 4. Changes in results over time
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Comparison 1. Surgery + PORT versus surgery alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Survival Show forest plot

11

2343

Hazard Ratio (95% CI)

1.18 [1.07, 1.31]

2 Local recurrence‐free survival Show forest plot

11

2343

Hazard Ratio (95% CI)

1.12 [1.01, 1.23]

3 Distant recurrence‐free survival Show forest plot

11

2343

Hazard Ratio (95% CI)

1.13 [1.02, 1.24]

4 Recurrence‐free survival Show forest plot

11

2343

Hazard Ratio (95% CI)

1.10 [0.99, 1.21]

5 RT delivery method Show forest plot

11

2343

Hazard Ratio (95% CI)

1.18 [1.07, 1.31]

5.1 Cobalt‐60 only

1

202

Hazard Ratio (95% CI)

1.48 [1.09, 2.02]

5.2 Cobalt‐60 and linac

6

1746

Hazard Ratio (95% CI)

1.18 [1.05, 1.33]

5.3 Linac only

4

395

Hazard Ratio (95% CI)

1.02 [0.80, 1.31]

6 RT dose Show forest plot

11

2343

Peto Odds Ratio (95% CI)

1.18 [1.07, 1.31]

6.1 < 45 Gy

2

382

Peto Odds Ratio (95% CI)

0.93 [0.75, 1.17]

6.2 ≥ 45 Gy

9

1961

Peto Odds Ratio (95% CI)

1.25 [1.12, 1.40]
Figuras y tablas -
Comparison 1. Surgery + PORT versus surgery alone
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