CHISELing a path forward in the treatment of early-stage non-small-cell lung cancer
Mené sur 101 patients atteints d'un cancer du poumon non à petites cellules de stade T1–T2aN0M0, cet essai multicentrique de phase III évalue, du point de vue du délai avant échec thérapeutique, l'efficacité d'une radiothérapie stéréotaxique ablative par rapport à une radiothérapie standard
Rapid technological changes inherently conflict with the slow pace of evidence-based medicine. In technology-driven specialties such as radiation oncology, it is difficult for randomised data to keep up as treatment tools evolve. Often, new approaches are introduced into clinical practice without supporting level 1 evidence. Adoption of a useful technology into clinical practice without level 1 evidence from randomised controlled trials allows immediate access for patients, and if the technology proves beneficial, outcomes are improved. But premature adoption of a technology that is later proven to be unhelpful leads to unnecessary cost and possibly harm. Differentiating between these two scenarios in advance, before randomised controlled trials, is often impossible. Moreover, even when randomised controlled trials are launched, a large proportion of them fail, leaving us without a high level of evidence despite enormous efforts. Even successful trials can be irrelevant if a technology has drastically improved since the trial was launched.
The Lancet Oncology , commentaire, 2018