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Online Clinical Calculator |
The efficacy of surgery for
loco-regional NSCLC
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Clinical Question:
Does surgery is considered the treatment of choice for patients with
resectable stage I and II (and some patients with stage IIIA) non-small cell
lung cancer?
Bottom Line:
The efficacy of surgery for loco-regional NSCLC are limited by the small
number of participants studied and methodological weaknesses of trials.
However current evidence suggests that complete mediastinal lymph node
dissection is associated with improved survival compared with node sampling
in patients with stage I to IIIA NSCLC undergoing resection.
Reference:
Surgery for non-small cell lung cancer: systematic review and meta-analysis
of randomised controlled trials.Wright G, Manser RL, Byrnes G, Hart D,
Campbell DA. Thorax. 2006 Jan 31
Study Design:
Systematic review and Meta-analysis of Randomised-controlled trials
Synopsis:
Surgery is considered the treatment of choice for patients with resectable
stage I and II (and some patients with stage IIIA) non-small cell lung
cancer (NSCLC) but there are no previous published systematic reviews. A
systematic review and meta-analysis of randomised-controlled trials was
conducted to determine whether surgical resection of NSCLC improves
disease-specific mortality in patients with stages I to IIIA, compared with
non-surgical therapy and to compare the efficacy of different surgical
approaches. Eleven trials were included. No studies had untreated control
groups. In pooled analysis of three trials, 4-year survival was superior in
patients undergoing resection with stage I to IIIA NSCLC who had complete
mediastinal lymph node dissection compared with lymph node sampling; the
hazard ratio estimated at 0.78 (95% CI: 0.65-0.93). Another trial reported
an increased rate of local recurrence in patients with stage I NSCLC treated
with limited resection compared with lobectomy. One small study reported a
survival advantage among patients with stage IIIA NSCLC treated with
chemotherapy then surgery compared with those treated with chemotherapy then
radiotherapy. No other trials reported significant improvements in survival
after surgery compared with non-surgical therapy. |
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