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Evidence summaries

Treatment of Lung Cancer

Combination of radiotherapy and chemotherapy is effective in limited stage small cell lung cancer (SCLC). In stage I and II non-small cell lung cancer (NSCLC), post-operative radiotherapy is not shown to extend survival. In stage III NSCLC, radiotherapy may improve short-term survival. Prophylactic brain irradiation reduces the risk of brain metastases from SCLC. Level of evidence: "A"

A systematic review 1 of 80 studies covering a total of 28,172 patients was abstracted in DARE. The review included two meta-analyses (4,014 patients), 29 randomised studies (6,947 patients), 19 prospective studies (1,144 patients) and 21 retrospective studies (16,067 patients). The results were as follows:

  • SCLC limited stage disease: combination of radiotherapy and chemotherapy reduces the number of local recurrences and improves overall survival.
  • SCLC extensive stage disease: adding radiotherapy does not improve survival.
  • NSCLC stages I and II: surgery is accepted as the primary treatment strategy. No evidence that post-operative radiotherapy extends survival.
  • NSCLC stage III: Radiotherapy improves short-term (2-3 years) survival in this group but gains in 5-year survival are in doubt.
  • Prophylactic cranial irradiation for brain metastases appears to substantially reduce the risk of symptomatic brain metastases from SCLC but not from NSCLC.
  • Palliative treatment of associated symptoms: radiotherapy is highly effective in easing symptoms (severe cough, severe bleeding, pain, pulmonary obstruction and vena cava superior syndrome).

According to a Cochrane review 2 (abstract , review [Abstract]) [withdrawn from publication] the relative risk of death in the treatment group compared to control group was 0.84 (95% CI 0.73 to 0.97), corresponding to a 5.4% increase in the 3-year survival rate, from 15.3% in the control group to 20.7% in the treatment group (NNT = 19). Prophylactic irradiation also increased disease-free survival (RR 0.75, 95% CI 0.65 to 0.86).

    References

    • Frödin JE. Lung cancer. Acta Oncol 1996;35 Suppl 7:46-53. [PubMed] [DARE]
    • Prophylactic Cranial Irradiation Overview Collaborative Group. WITHDRAWN: Cranial irradiation for preventing brain metastases of small cell lung cancer in patients in complete remission. Cochrane Database Syst Rev 2018;(2):CD002805. [PubMed].

Primary/Secondary Keywords