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.

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.

Published by Lung cancer (Amsterdam, Netherlands), 2004. The guideline itself is at the source linked here.

doi.org/10.1016/j.lungcan.2003.09.020