- Email: [email protected]
CHEST RADIOTHERAPY IN LIMITED SMALL CELL LUNG CANCER
226
[5]
[6] [7]
[8] [9]
[10]
[11] [12]
[13]
[14] [15]
Letters to the Editor treatment of locally advanced or metastatic non-small cell lung cancer. J Clin Oncol 1999;17:12±18. Clamon G, Herndon J, Cooper R, Chang AY, Rosenman J, Green MR. Radiosensitization with carboplatin for patients with unresectable stage III non-small cell lung cancer: a phase III trial of the Cancer and Leukaemia Group B and the Eastern Cooperative Oncology Group. J Clin Oncol 1999;17:4±11. Cochrane Collaboration Handbook. Oxford: Update Software, 2000. Crino L, Scagliotti GV, Ricci S, et al. Gemcitabine and cisplatin versus mitomycin, ifosfamide and cisplatin in advanced non-small cell lung cancer: a randomized phase III study of the Italian Lung Cancer Project. J Clin Oncol 1999;17:3522±3530. De Ruysscher R, Vansteenkiste J. Chest radiotherapy in limited stage small cell lung cancer: facts, question, prospects. Radiother Oncol 2000;55:1±9. Jeremic B, Shibamoto Y, Acimovic L, Djuric L. Randomized trial of hyperiractionated radiation therapy with or without concurrent chemotherapy for stage III non-small cell lung cancer. J Clin Oncol 1995;13:452±458. Jeremic P, Chibamoto Y, Acimovic I, Milisavljevic S. Hyperfractionated radiation therapy with or without concurrent chemotherapy for stage III non-small cell lung cancer: a randomized trial. J Clin Oncol 1996;14:1065±1070. Mulrow CW. The medical review article: state of the science. Ann Intern Med 1987;106:485±488. Non-small Cell Lung Cancer Cooperative Group. Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. Br Med J 1995;311:899±909. Soresi E, Clerici M, Grilli R, et al. A randomized clinical trial comparing radiation therapy v radiation therapy plus cis-dichlorodiammine platinum (II) in the treatment of locally advanced nonsmall cell lung cancer. Semin Oncol ;15 Suppl 1988;7:20±25. Stevens CW, Lee JS, Cox J, Komaki R. Novel approaches to locally advanced non-small cell lung cancer. Radiother. Oncol. 2000;55:11± 18. Trovo MG, Minatel E, Franchin G, et al. Radiotherapy versus radiotherapy enhanced by cisplatin in stage III non-small cell lung cancer. Int J Radiat Oncol Biol Phys 1992;24:11±15.
Sincerely, Fergus Macbeth a, Allan Price b (Received 25 September 2000; accepted 14 March 2001) a
b
Velindre Hospital, Cardiff, CFI4 2TL, UK, Department of Clinical Oncology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK 0167-8140/01/$ - see front matter q 2001 Elsevier Science Ireland Ltd. All rights reserved. PII: S01 67-8140(01)0035 5-3
CHEST RADIOTHERAPY IN LIMITED SMALL CELL LUNG CANCER To the Editor, We read with great interest the comments of Drs F. Macbeth and A. Price about our review, and we thank them for the attention they gave to our article [1]. It was our aim to perform as objective as possible a
review with the least possible bias and to clearly identify the problems we encountered to the readers. Because we wanted to rely as much as possible on randomized controlled trials that do not necessarily clearly answer the questions we ask today, no ®rm conclusions could be drawn, but merely `suggestions'. It was therefore never our intention to give some kind of `guidelines' to the readers because we think that disappointingly few hard conclusions can be drawn from the available data. However, in order to strengthen the data, we are planning to perform a meta-analysis which hopefully will allow us to give more useful information to clinicians and patients. References [1] De Ruysscher D, Van Steenkiste J. Chest radiotherapy in limited small cell lung cancer: facts, questions, prospects. Radiother Oncol 2000;55:1±9.
Sincerely, Dirk De Ruysscher (Received 20 October 2000; accepted 14 March 2001) Sint Maarten Ziekenhuis, Department of Radiotherapy and Oncology, Rooienberg 25, 2570 Duffel, Belgium 0167-8140/01/$ - see front matter q 2001 Elsevier Science Ireland Ltd. All rights reserved. PII: S0 167-8140(01 )00 354-1
RESPONSE TO MACBETH AND PRICE CONCERNING OUR PAPER ªNovel approaches to locally advanced nonsmall cell lung cancerº To the Editor, Our paper was designed to bring disparate areas of lung cancer research together, and to form a bridge between standard treatment and more novel, molecular therapies. We did not intend this to be an exhaustive, meta-analysis type review. In our opinion, such an approach would be impossible considering the scope of our review (from protons to gene therapy to immunotherapy). While metaanalyses are clearly valuable [3], they are fraught with a number of problems that have been well-described [1,2,4]. Medicine is changing rapidly, and the pace of this change is likely to accelerate. When staging, surgery, radiotherapy techniques, and chemotherapeutic agents are all in a state of ¯ux, meta-analysis has a more poorly de®ned role. Several of the studies discussed in our review do not even involve human subjects and yet hold signi®cant promise for improving the therapeutic index for our patients in the clinic. It would be unfortunate to limit discussion of promising
[5]
[6] [7]
[8] [9]
[10]
[11] [12]
[13]
[14] [15]
Letters to the Editor treatment of locally advanced or metastatic non-small cell lung cancer. J Clin Oncol 1999;17:12±18. Clamon G, Herndon J, Cooper R, Chang AY, Rosenman J, Green MR. Radiosensitization with carboplatin for patients with unresectable stage III non-small cell lung cancer: a phase III trial of the Cancer and Leukaemia Group B and the Eastern Cooperative Oncology Group. J Clin Oncol 1999;17:4±11. Cochrane Collaboration Handbook. Oxford: Update Software, 2000. Crino L, Scagliotti GV, Ricci S, et al. Gemcitabine and cisplatin versus mitomycin, ifosfamide and cisplatin in advanced non-small cell lung cancer: a randomized phase III study of the Italian Lung Cancer Project. J Clin Oncol 1999;17:3522±3530. De Ruysscher R, Vansteenkiste J. Chest radiotherapy in limited stage small cell lung cancer: facts, question, prospects. Radiother Oncol 2000;55:1±9. Jeremic B, Shibamoto Y, Acimovic L, Djuric L. Randomized trial of hyperiractionated radiation therapy with or without concurrent chemotherapy for stage III non-small cell lung cancer. J Clin Oncol 1995;13:452±458. Jeremic P, Chibamoto Y, Acimovic I, Milisavljevic S. Hyperfractionated radiation therapy with or without concurrent chemotherapy for stage III non-small cell lung cancer: a randomized trial. J Clin Oncol 1996;14:1065±1070. Mulrow CW. The medical review article: state of the science. Ann Intern Med 1987;106:485±488. Non-small Cell Lung Cancer Cooperative Group. Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. Br Med J 1995;311:899±909. Soresi E, Clerici M, Grilli R, et al. A randomized clinical trial comparing radiation therapy v radiation therapy plus cis-dichlorodiammine platinum (II) in the treatment of locally advanced nonsmall cell lung cancer. Semin Oncol ;15 Suppl 1988;7:20±25. Stevens CW, Lee JS, Cox J, Komaki R. Novel approaches to locally advanced non-small cell lung cancer. Radiother. Oncol. 2000;55:11± 18. Trovo MG, Minatel E, Franchin G, et al. Radiotherapy versus radiotherapy enhanced by cisplatin in stage III non-small cell lung cancer. Int J Radiat Oncol Biol Phys 1992;24:11±15.
Sincerely, Fergus Macbeth a, Allan Price b (Received 25 September 2000; accepted 14 March 2001) a
b
Velindre Hospital, Cardiff, CFI4 2TL, UK, Department of Clinical Oncology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK 0167-8140/01/$ - see front matter q 2001 Elsevier Science Ireland Ltd. All rights reserved. PII: S01 67-8140(01)0035 5-3
CHEST RADIOTHERAPY IN LIMITED SMALL CELL LUNG CANCER To the Editor, We read with great interest the comments of Drs F. Macbeth and A. Price about our review, and we thank them for the attention they gave to our article [1]. It was our aim to perform as objective as possible a
review with the least possible bias and to clearly identify the problems we encountered to the readers. Because we wanted to rely as much as possible on randomized controlled trials that do not necessarily clearly answer the questions we ask today, no ®rm conclusions could be drawn, but merely `suggestions'. It was therefore never our intention to give some kind of `guidelines' to the readers because we think that disappointingly few hard conclusions can be drawn from the available data. However, in order to strengthen the data, we are planning to perform a meta-analysis which hopefully will allow us to give more useful information to clinicians and patients. References [1] De Ruysscher D, Van Steenkiste J. Chest radiotherapy in limited small cell lung cancer: facts, questions, prospects. Radiother Oncol 2000;55:1±9.
Sincerely, Dirk De Ruysscher (Received 20 October 2000; accepted 14 March 2001) Sint Maarten Ziekenhuis, Department of Radiotherapy and Oncology, Rooienberg 25, 2570 Duffel, Belgium 0167-8140/01/$ - see front matter q 2001 Elsevier Science Ireland Ltd. All rights reserved. PII: S0 167-8140(01 )00 354-1
RESPONSE TO MACBETH AND PRICE CONCERNING OUR PAPER ªNovel approaches to locally advanced nonsmall cell lung cancerº To the Editor, Our paper was designed to bring disparate areas of lung cancer research together, and to form a bridge between standard treatment and more novel, molecular therapies. We did not intend this to be an exhaustive, meta-analysis type review. In our opinion, such an approach would be impossible considering the scope of our review (from protons to gene therapy to immunotherapy). While metaanalyses are clearly valuable [3], they are fraught with a number of problems that have been well-described [1,2,4]. Medicine is changing rapidly, and the pace of this change is likely to accelerate. When staging, surgery, radiotherapy techniques, and chemotherapeutic agents are all in a state of ¯ux, meta-analysis has a more poorly de®ned role. Several of the studies discussed in our review do not even involve human subjects and yet hold signi®cant promise for improving the therapeutic index for our patients in the clinic. It would be unfortunate to limit discussion of promising