Lung cancer: post-operative radiotherapy, a systematic review and IPD meta-analysis

Postoperative radiotherapy for non‐small cell lung cancer

Do patients with non‐small cell lung cancer live longer if they are given radiotherapy after surgery?

What was this study about?

Non‐small cell lung cancer is the most common type of lung cancer. If the tumour is early stage, is not too big and has not spread to other parts of the body, doctors usually operate to remove it. Radiotherapy (treatment with x‐rays) is sometimes given after the operation, aiming to kill any remaining cancer cells.

In 1998, we did a systematic review and meta‐analysis of individual participant data looking at trials of this treatment ‐ postoperative radiotherapy (PORT). This review brought together information from all patients who took part in similar trials. These trials compared what happened to people with non‐small cell lung cancer who were given radiotherapy after surgery and those who had surgery without radiotherapy. Results were first published in The Lancet in 1998.

Since this review was completed, many trials have been done. To ensure that available evidence is as up‐to‐date as possible, we have updated the systematic review and meta‐analysis of individual participant data to included all trials, old and new. Similar to the 1998 review, this review aimed to find out if giving radiotherapy after surgery (1) helped patients live longer, (2) stopped cancer from coming back (recurrence) and (3) stopped cancer from spreading to other parts of the body (metastases).

What difference did this study make?

Results showed that fewer people given PORT treatment lived for two years after the operation (53 out of every 100 patients) than those not given PORT after the operation (58 out of every 100 patients). Researchers reported no difference in effects of PORT by types of patients included in trials.

Researchers did not routinely collect quality of life information during the trials, and it was unlikely that any benefit of PORT would offset the observed survival disadvantage.

Radiotherapy given after successful removal of tumour at operation is not beneficial for patients with non‐small cell lung cancer and should not be used as routine treatment; however, further research into new types of radiotherapy for patients at higher risk of recurrence is ongoing.

PORT Meta-analysis Trialists Group. Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials. Lancet. 1998;352:257-63

Burdett S, Stewart L, on behalf of the PORT Meta-analysis Group. Postoperative radiotherapy in non-small cell lung cancer: update of an individual patient data meta-analysis. Lung Cancer. 2005;47(1):81-3.

Burdett S, Rydzewska L, Tierney JF, Fisher DJ. A closer look at the effects of postoperative radiotherapy by stage and nodal status: Updated results of an individual participant data meta-analysis in non-small-cell lung cancer. Lung Cancer. 2013;80:350-2

Burdett S, Rydzewska L, Tierney J, Fisher D, Parmar MK, Arriagada R, et al. Postoperative radiotherapy for non-small cell lung cancer. Cochrane Database Syst Rev. 2016;10:CD002142

Type of study

Meta-analyses

Contact details

MRCCTU.meta-analysis@ucl.ac.uk

Who funded the study?

The Medical Research Council

When did it take place?

This study was originally carried out and published in 1998, it has been updated since with most recent results published in 2016

Where did it take place?

The study was done at the MRC Clinical Trials Unit, but it brought together the results of trials from all over the world

Who was included?

Patients with non-small cell lung cancer who took part in randomised controlled trials comparing radiotherapy and surgery with surgery alone. The most recent update of the study includes 2343 patients from 11 trials.