Reviewer: Christopher Dolinsky, MD
University of Pennsylvania School of Medicine
Last Modified: October 21, 2005
Presenter: J. E. Bekelman, MD
Presenter's Affiliation: Memorial Sloan Kettering Cancer Center, NY, NY
Type of Session: Scientific
Materials and Methods
This is an interesting piece of research from the group at Memorial Sloan Kettering Cancer Center . The PORT meta-analysis, while on its surface eliminating the rationale for PORT, was not a perfect paper. There are a number of criticisms to the PORT meta-analysis, and data from that paper can be used to support the use of PORT in selected patients (especially N2 patients). It is not a safe conclusion to state that all physicians should have stopped using PORT since the publication of the meta-analysis. It is unclear from this research whether or not PORT was used appropriately, and it is probably too difficult to use the SEER database to determine this question. The operative findings, margin status, and histologic features may all have influenced the decision to recommend PORT after surgery. This research does show what it set out to though; that the use of PORT has decreased following the publication of the meta-analysis. It is interesting to learn about how physicians change their practice patterns based on the published literature. Many different variables will likely influence how physicians use the literature including: where something is published, how dutifully and intelligently physicians read the literature, and the perceived value of the research published. In the case of the PORT meta-analysis, the perceived value of the research may not be as high as the authors of this abstract think it should be, and this may have influenced the patterns of care in the since its publication.