Lung cancer: chemotherapy, surgery, radiotherapy, two systematic reviews and IPD meta-analyses

What was this study about?

Non-small cell lung cancer is the most common type of lung cancer. If the tumour is not too big and has not spread to other parts of the body, doctors usually operate to remove it. At the same time, they will also remove a bit of the lung, or the entire lung that has the tumour. They may also give radiotherapy (treatment with x-rays) after the operation. Adding chemotherapy (drug treatment) to surgery (with or without radiotherapy) may be better. This treatment is sometimes called adjuvant chemotherapy.

In 1995, we did a systematic review and meta analysis of individual patient data looking at adjuvant chemotherapy and surgery (with or without radiotherapy). It brought information from all patients who took part in similar trials. These trials compared what happened to people with non-small cell lung cancer who were given adjuvant chemotherapy and surgery (with or without radiotherapy) with those who had surgery (with or without radiotherapy). We found that it was not clear whether adjuvant chemotherapy helped patients with non-small cell lung cancer live longer.

Since this study was completed, many new trials have been done. Therefore, we carried out a new systematic review and meta-analysis of individual patient data that included all trials, old and new. This study aimed to find out if giving adjuvant chemotherapy as well as and surgery (with or without radiotherapy) can:

• Help patients live longer
• Stop the cancer coming back (recurrence)
• Stop the cancer spreading to other parts of the body (metastases)

What difference did this study make?

These studies found that people with non-small cell lung cancer that had chemotherapy and surgery (with or without radiotherapy) lived longer than those who had surgery alone (with or without radiotherapy).

After 5 years, 64 out of every 100 who were given chemotherapy and surgery were alive compared to 60 out of every 100 who just had surgery. For those who also received radiotherapy, after 5 years 33 out of every 100 patients who received chemotherapy, surgery and radiotherapy were alive compared to 29 out of every 100 patients who received surgery and radiotherapy.

In both studies, there was little variation in the effect of chemotherapy according to the type of chemotherapy given, other trial characteristics or by the type of patient.

NSCLC Meta-analyses Collaborative Group. Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small cell lung cancer: two meta-analyses of individual patient data. Lancet. 2010;375(9722):1267-77

Type of study

Meta-analyses

Contact details

MRCCTU.Meta-Analysis@ucl.ac.uk

Who funded the study?

The Medical Research Council, UK and Institut Gustave-Roussy, France.