Critical appraisal:Fayter D, Corbett M, Heirs M, Fox D, Eastwood A 2010 3

From Cancer Guidelines Wiki

Critical Appraisal

Article being appraised

Fayter D, Corbett M, Heirs M, Fox D, Eastwood A. A systematic review of photodynamic therapy in the treatment of pre-cancerous skin conditions, Barrett's oesophagus and cancers of the biliary tract, brain, head and neck, lung, oesophagus and skin. Health Technol Assess 2010 Jul;14(37):1-288 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20663420.


Applicable clinical question

Key Facts

Study Design

systematic review — In the section looking at PDT and Barrett's oesophagus there were 11 RCT's included. The majority of studies were small and likely to be underpowered. One large study was performed at 30 centre in 4 countries raising the possibility of institutional differences and protocol deviations. The included studies often reported their methods poorly and randomisation techniques were usually suboptimal. Some included studies were only published in abstract form making assessment of the validity of the data difficult.

Number of Patients:

594


Includes an economic evaluation

no

Evidence ratings

Level of evidence

I

Risk of bias
Low risk of bias Comments: The review was largely descriptive and summarised various studies with comparable study design. Well constructed and useful summaries included.

Risk of bias assessment: systematic review

Studies included in the review
Was an adequate search strategy used?
Very thorough – included appropriate search terms and databases
Were the inclusion criteria appropriate and applied in an unbiased way?
Yes – pre-specified inclusion criteria applied independently by two people
Were the studies assessed for quality (relating to the minimisation of biases)?
Yes – appropriate quality issues were assessed independently by two people
Were the characteristics and results of individual studies appropriately summarised?
Yes – summary descriptive tables of subjects, interventions, outcomes etc are provided and estimates of treatment effect displayed
The following questions are only relevant for systematic reviews that pooled data
Were the methods used for pooling the data appropriate?
No response
If there was heterogeneity, were sources of heterogeneity explored?
No response
Size of effect
2 Reason for decision: The studies all looked at PDT using various protocols, photosensitiser drugs and times of drug administration. All do show that PDT is able to ablate Barrett's mucosa.
Relevance of evidence
2 Additional comments: Studies were conducted in various patient groups making interpretation difficult. The majority had non-dysplastic Barrett's mucosa and it is unlikely that this will ultimately be the treatment group in which ablation therapy will be offered.
Result of appraisal

Jutta's tick icon.png Included




Completed by

Dr Mark Schoeman MBBS, PhD, FRACP, AGAF


Jutta's tick icon.png This appraisal has been completed.


Article
Fayter D, Corbett M, Heirs M, Fox D, Eastwood A. A systematic review of photodynamic therapy in the treatment of pre-cancerous skin conditions, Barrett's oesophagus and cancers of the biliary tract, brain, head and neck, lung, oesophagus and skin. Health Technol Assess 2010 Jul;14(37):1-288 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20663420.
Assigned to
User:Mark.schoeman
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


Section below only relevant for Cancer Council Project Officer

Edit appraisal assignment