Critical appraisal:De Ruysscher D, Pijls-Johannesma M, Bentzen SM, Minken A, Wanders R, Lutgens L, et al 2006 3

Critical Appraisal

Article being appraised

De Ruysscher D, Pijls-Johannesma M, Bentzen SM, Minken A, Wanders R, Lutgens L, et al. Time between the first day of chemotherapy and the last day of chest radiation is the most important predictor of survival in limited-disease small-cell lung cancer. J Clin Oncol 2006 Mar 1;24(7):1057-63 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16505424.

Applicable clinical question

What is the optimal dose and fractionation schedule of thoracic radiotherapy in adult patients with limited stage SCLC?

Key Facts

Study Design

systematic review

Number of Patients:

1056

Includes an economic evaluation

no

Evidence ratings

Level of evidence

I

Risk of bias

Moderate risk of bias

Comments: Didnt use individual pt data. Because differnt RT schedules were used in different studies, EQD2 was calculated based on assumptions which may be faulty (they are admittedly unknown for SCLC). Where the start of radiotherapy was not required at a specific day, authors took the mean between the permitted time limits in the study protocol.

Size of effect

1	Reason for decision: The time from first chemo to last RT fraction is significant for OS. Early vs Late RT significant for OS.

Relevance of evidence

1	Additional comments: shows the importance of starting radiotherapy as soon after (or concurrent with) the first chemo cycle as possible. Effect on OS. Also importance of Finishing RT as close as possible to the start of treatment for SCLC-LD

Result of appraisal

Included