Critical appraisal:PORT Meta-analysis Trialists Group 2005 3

Critical Appraisal

Article being appraised

PORT Meta-analysis Trialists Group. Postoperative radiotherapy for non-small cell lung cancer. Cochrane Database Syst Rev 2005 Apr 18;(2):CD002142 Available from: http://www.ncbi.nlm.nih.gov/pubmed/15846628.

Applicable clinical question

What is the role of postoperative radiotherapy (PORT) in resected stage III NSCLC?

Key Facts

Study Design

systematic review — randomised trials only

Number of Patients:

2343

Includes an economic evaluation

no

Evidence ratings

Level of evidence

I

Risk of bias

Low risk of bias

Comments: Please replace this text and briefly describe the reasons for your rating

Size of effect

4

Reason for decision: When looking at overall effect of PORT on survival (all stages): HR 1.18(1.07-1.31, p=0.001)

On subset analysis, there was no clear evidence of a detriment for stage III patients. Hazard ratio for N2 disease 0.97 but with wide confidence intervals - therefore no clear evidence of detrimental or beneficial effect
NB. Largest trial contributing to systematic review shows worst effect of PORT due to deaths from intercurrent disease
Also detrimental effect of older RT techniques

Relevance of evidence