Evidence Supporting Contemporary Post-operative Radiation Therapy (PORT) Using Linear Accelerators in N2 Lung Cancer
A partir d'une revue de la littérature (11 études incluant au total 2 728 patients traités entre 1982 et 2005), cette étude évalue le bénéfice, en termes de survie sans récidive locorégionale et de survie globale, d'une radiothérapie post-opératoire utilisant un accélérateur linéaire chez les patients atteints d'un cancer du poumon de stade III-N2
Purpose : Post-operative radiotherapy (PORT) treatment for lung cancer declined since a meta-analysis showed no benefit in patients with N2 disease. Because several included studies employed outmoded radiation planning and delivery techniques, we sought to determine whether PORT with modern technology benefits patients with N2 disease. Methods : We conducted searches of the published literature. For inclusion, studies must have included patients with stage III-N2 lung cancer treated with PORT using only linear accelerators, used a control group that did not receive PORT, and reported outcome data for overall survival (OS). Prospective and retrospective analyses were included. Exclusion criteria were the use of cobalt devices or orthovoltage radiation. Results : Data were evaluated with random-effects models. Three prospective and eight retrospective studies were included. The PORT and no-PORT groups included 1,368 and 1,360 patients, respectively. The PORT group had significantly improved OS over the no-PORT group (hazard ratio [HR] = 0.77, 95% confidence interval [CI] 0.62 to 0.96, P=.020). Locoregional recurrence-free survival (LRFS) in ten studies for which data was available was also improved in the PORT group (HR = 0.51, CI 0.41 to 0.65, P<.001). Conclusions : PORT was associated with significantly lower risk of death and locoregional recurrence in patients with N2 lung cancer. Our study was limited by lack of access to individual patient data, which would have enabled more detailed analyses. Regardless, data thus far suggest PORT may be associated with a survival benefit. Given a lack of large-scale prospective data, clinical trials evaluating PORT with modern technology are warranted.