Terapie tradizionali: non sempre utili, qualche volta dannose!…
Abstract n. 1: Cancer. 2012 Feb 13. doi: 10.1002/cncr.26585. [Epub ahead of print]
Postoperative radiotherapy (PORT) for elderly patients (pazienti anziani) with stage III lung cancer (cancro del polmone in stadio III).
Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York; Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, New York, New York. firstname.lastname@example.org.
The potential role of postoperative radiation therapy (PORT) for patients who have completely resected, stage III nonsmall cell lung cancer (NSCLC) with N2 disease remains controversial (la PORT rimane un trattamento controverso nei pazienti con cancro del polmone non a piccole cellule -NSCLC localmente avanzato). By using population-based data, the authors of this report compared the survival of a concurrent cohort of elderly patients who had N2 disease treated with and without PORT.(Gli autori di questo studio hanno, perciò, inteso esplorare il valore della PORT in una popolazione anziana con linfonodi mediastinici metastatici -N2- utilizzando dati che provenivano da un grande registro tumorale americano, conosciuto come SEER),
By using the Surveillance, Epidemiology, and End Results (SEER) registry linked to Medicare records, 1307 patients were identified who had stage III NSCLC with N2 lymph node involvement diagnosed between 1992 and 2005. Propensity scoring methods and instrumental variable analysis were used to compare the survival of patients who did and did not receive PORT after controlling for selection bias.
Overall, 710 patients (54%) received PORT. Propensity score analysis indicated that PORT was not associated with improved survival in patients with N2 disease (hazard ratio [HR], 1.11; 95% confidence interval [CI], 0.97-1.27). Analyses that were limited to patients who did or did not receive chemotherapy, who received intermediate-complexity or high-complexity radiotherapy planning, or adjusted for time trends produced similar results. The instrumental variable estimator for the absolute improvement in 1-year and 3-year survival with PORT was -0.04 (95% CI, -0.15 to 0.08) and -0.08 (95% CI, -0.24 to 0.15), respectively.
The current data suggested that PORT is not associated with improved survival for elderly patients with N2 disease (Questo studio dimostra che non vi è beneficio nel trattare con PORT i pazienti anziani con malattia N2). These findings have important clinical implications, because SEER data indicate that a large percentage of elderly patients currently receive PORT despite the lack of definitive evidence about its effectiveness (Questa scoperta ha importanti implicazioni cliniche perché il registro tumorale SEER dimostra che ancora oggi una grande percentuale di pazienti anziani con malattia localmente avanzata sono ancora trattati con la PORT nonostante manchi di una qualunque prova di efficacia). The potential effectiveness of PORT should be evaluated further in randomized controlled trials. Cancer 2011;. © 2011 American Cancer Society.
Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials. PORT Meta-analysis Trialists Group.
The role of postoperative radiotherapy in treatment of patients with completely resected non-small-cell lung cancer (NSCLC) remains unclear. We undertook a systematic review and meta-analysis of the available evidence from randomised trials.
Updated data were obtained on individual patients from all available randomised trials of postoperative radiotherapy versus surgery alone. Data on 2128 patients from nine randomised trials (published and unpublished) were analysed by intention to treat (I dati di 2128 pazienti derivanti da 9 sperimentazioni controllate furono analizzati). There were 707 deaths among 1056 patients assigned postoperative radiotherapy and 661 among 1072 assigned surgery alone. Median follow-up was 3.9 years (2.3-9.8 for individual trials) for surviving patients.
The results show a significant adverse effect of postoperative radiotherapy on survival (hazard ratio 1.21 [95% CI 1.08-1.34]) (I risultati dell’analisi dimostrarono un significativo effetto negativo della PORT sulla sopravvivenza, con un rischio di morte maggiore del 21% a seguito del suo utilizzo). This 21% relative increase in the risk of death is equivalent to an absolute detriment of 7% (3-11) at 2 years, reducing overall survival from 55% to 48%. Subgroup analyses suggest that this adverse effect was greatest for patients with stage I/II, N0-N1 disease, whereas for those with stage III, N2 disease there was no clear evidence of an adverse effect (L’analisi dei sottogruppi dimostrò che l’effetto dannoso era molto forte per i pazienti con malattia iniziale e incerto per quelli con malattia localmente avanzata).
Postoperative radiotherapy is detrimental to patients with early-stage completely resected NSCLC and should not be used routinely for such patients. The role of postoperative radiotherapy in the treatment of N2 tumours is not clear and may warrant further research.