Background: In a previous meta-analysis-based modeling study, it was hypothesized that modern postoperative radiotherapy (PORT) may improve both local recurrence and overall survival (OS) in stage IIIA-N2 non-small-cell lung cancer (NSCLC). There were only four single-arm trials with a total of 357 patients. As other trials have provided new and controversial data, we performed this updated meta-analysis to test the hypothesis.
Patients And Methods: Systematic reviews in Medline, Cochrane, and Science Direct up to December 2015 identified publications exploring the efficacy of PORT in resectable stage IIIA-N2 NSCLC.
Results: Overall, 16 trials comprising 3278 patients were included. There was a significant benefit in favor of PORT regarding OS [hazard ratio (HR): 0.73, 95% confidence interval (CI): 0.58-0.92, P=0.008; absolute benefit at 5 years=8%], disease-free survival (HR: 0.70, 95% CI: 0.60-0.83, P<0.0001), and locoregional recurrence-free survival (HR: 0.37, 95% CI: 0.24-0.58, P<0.0001). Restriction of the analysis to trials with induction and/or adjuvant chemotherapy led to similar results. PORT significantly decreased the risk of local recurrence (risk ratio: 0.64, 95% CI: 0.50-0.82, P=0.0006) and DM (risk ratio: 0.74, 95% CI: 0.62-0.88, P=0.0005), and the absolute risk differences were 13 and 14%, respectively.
Conclusion: The addition of PORT, with or without chemotherapy, significantly improves local control and survival in patients with resectable stage IIIA-N2 NSCLC.
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View Article and Find Full Text PDFEndobronchial ultrasound-guided transbronchial needle aspiration validated with video-assisted mediastinoscopic lymphadenectomy in the mediastinal restaging of patients with stage IIIA non-small cell lung cancer after induction therapy.
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Pulmonology Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Plaça Dr Robert 5, Terrassa, Barcelona 08221, Spain.
Article Synopsis
- This study examines the use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for restaging non-small cell lung cancer (NSCLC) after initial treatment, validated by a separate procedure called video-assisted mediastinoscopic lymphadenectomy (VAMLA).* -
- A retrospective analysis of patients showed that EBUS-TBNA has a moderate sensitivity (63.1%) but excellent specificity (100%) for identifying mediastinal disease, while VAMLA confirmed a 100% accuracy when follow-up was needed after a negative EBUS-TBNA result.* -
- The findings suggest EBUS-TBNA should be the first choice for invasive rest
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