Critical appraisal:Burdett SS, Stewart LA, Rydzewska L 2007 4
- Burdett SS, Stewart LA, Rydzewska L. Chemotherapy and surgery versus surgery alone in non-small cell lung cancer. Cochrane Database Syst Rev 2007 Jul 18;(3):CD006157 Available from: http://www.ncbi.nlm.nih.gov/pubmed/17636828.
- Assigned to
- Topic area
- Guidelines:Guidelines:Lung cancer/Treatment/Non-small-cell stage III operable
- Clinical question
Section below only relevant for Cancer Council Project Officer
Burdett SS, Stewart LA, Rydzewska L. Chemotherapy and surgery versus surgery alone in non-small cell lung cancer. Cochrane Database Syst Rev 2007 Jul 18;(3):CD006157 Available from: http://www.ncbi.nlm.nih.gov/pubmed/17636828.
- What is the clinical benefit of neoadjuvant chemotherapy for patients with stage III operable NSCLC?
systematic review — This is a systematic review and quantitative meta-analysis based on aggregate data extracted from trial publications. It evaluated evidence only from randomised controlled trials, and aimed to evaluate the effect of pre-operative chemotherapy on survival in NSCLC patients. If adequate data were available, then the aim was also to investigate whether or not pre-defined patient subgroups, such as disease stage, benefit more or less from pre-operative chemotherapy.
|Moderate risk of bias||Comments: The systematic review asked a clear question: "To evaluate the effect of pre-operative chemotherapy on survival in patients with non-small cell lung cancer". An appropriate search strategy and inclusion criteria were used.
Included in the analysis was 988 patients who represented 75% of the randomised evidence. The 7 randomised controlled trials (RCTs) included were assessed as having fairly good methodological quality. All of the RCTs appeared to be randomised but none gave full details; 6 of the RCTs did not reach their accrual targets; and only 2 of the RCTs reported patient exclusions.
No statistical heterogeneity was found between the studies indicating that were similar enough to be combined.
Since a literature-based systematic review and meta-analysis rather than an individual patient data (IPD)-based meta-analysis (although this project is ongoing) was done, a less reliable estimate of the treatment effect is given and the subgroup analyses conducted to address whether pre-operative chemotherapy is more or less effective in certain disease stages is not reliable.
|2||Reason for decision: Although this systematic review was described by the authors as limited, it represented a comprehensive and up to date systematic review of published data. It suggested a significant survival benefit for NSCLC patients with stage 1-3 disease who had received pre-operative chemotherapy versus those who did not. All but one hazard ratio estimate was in favour of pre-operative chemotherapy although the confidence intervals for individual trial results were wide and the results of all trials were inconclusive.|
|1||Additional comments: The results of this systematic review suggested that there may be a survival benefit from pre-operative chemotherapy in all NSCLC patients with stage 1-3 disease although the extent of that benefit in stage 3 patients was less clearly defined.|