Postoperative radiotherapy in stage II or IIIA completely resected non-small cell lung cancer: a systematic review and practice guideline.
The Lung Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-based Care conducted a systematic review of literature published between 1985 and July 2003 and developed an evidence-based clinical practice guideline on postoperative radiotherapy in patients with completely resected pathologic stage II or IIIA non-small cell lung cancer (NSCLC). Forty-four Ontario clinicians reviewed the draft guideline. Evidence included one meta-analysis of individual patient data (from nine randomized controlled trials) and three randomized controlled trials (two including data reported in the meta-analysis) that compared surgery with or without postoperative radiotherapy. The meta-analysis and one trial detected a significant detriment to survival with postoperative radiotherapy. Two trials detected no survival difference. The meta-analysis detected a significant advantage in local recurrence-free survival (time to local recurrence or death) with surgery alone, although two trials detected a significant advantage in rate of local recurrence with postoperative radiotherapy. Subset analyses from the meta-analysis and one trial suggested that postoperative radiotherapy was detrimental to survival mainly in stage II disease; no benefit or detriment was evident for stage III disease.


CONCLUSIONS
Postoperative radiation therapy following complete resection of stage II non-small cell lung cancer is not recommended. No definitive recommendation can be made for stage IIIA disease.
Okawara
Gordon
G
Hamilton Regional Cancer Centre, 699 Concession Street, Hamilton, Ont, Canada L8V 5C2.
Ung
Yee Chung
YC
Markman
Barbara R
BR
Mackay
Jean A
JA
Evans
William K
WK
D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D015201:Meta-Analysis as Topic; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic