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Meta-Analysis
. 2010 Jun 16;2010(6):CD002140.
doi: 10.1002/14651858.CD002140.pub3.

Concurrent chemoradiotherapy in non-small cell lung cancer

Noelle O'Rourke  1 , Marta Roqué I Figuls, Nuria Farré Bernadó, Fergus Macbeth
Affiliations
Meta-Analysis

Concurrent chemoradiotherapy in non-small cell lung cancer

Noelle O'Rourke et al. Cochrane Database Syst Rev. .

Abstract

Background: This is an updated version of the original review published in Issue 4, 2004. The use of concurrent chemotherapy and radiotherapy in non-small cell lung cancer (NSCLC) might be seen as a way of increasing the effectiveness of radical radiotherapy at the same time as reducing the risks of metastatic disease.

Objectives: To determine the effectiveness of concurrent chemoradiotherapy as compared to radiotherapy alone with regard to overall survival, tumour control and treatment-related morbidity. To determine the effectiveness of concurrent versus sequential chemoradiotherapy.

Search strategy: For this update we ran a new search in October 2009, using a search strategy adapted from the design in the original review. We searched: CENTRAL (accessed through The Cochrane Library, 2009, Issue 4), MEDLINE (accessed through PubMed), and EMBASE (accessed through Ovid).

Selection criteria: Randomised trials of patients with stage I-III NSCLC undergoing radical radiotherapy and randomised to receive concurrent chemoradiotherapy versus radiotherapy alone, or concurrent versus sequential chemoradiotherapy.

Data collection and analysis: Study selection, data extraction and assessment of risk of bias was performed independently by two authors. Pooled hazard ratios and relative risks were calculated according to a random-effects model.

Main results: Nineteen randomised studies (2728 participants) of concurrent chemoradiotherapy versus radiotherapy alone were included. Chemoradiotherapy significantly reduced overall risk of death (HR 0.71, 95% CI 0.64 to 0.80; I(2) 0%; 1607 participants) and overall progression-free survival at any site (HR 0.69, 95% CI 0.58 to 0.81; I(2) 45%; 1145 participants). Incidence of acute oesophagitis, neutropenia and anaemia were significantly increased with concurrent chemoradiation. Six trials (1024 patients) of concurrent versus sequential chemoradiation were included. A significant benefit of concurrent treatment was shown in overall survival (HR 0.74, 95% CI 0.62 to 0.89; I(2) 0%; 702 participants). This represented a 10% absolute survival benefit at 2 years. More treatment-related deaths (4% vs 2%) were reported in the concurrent arm without statistical significance (RR 2.02, 95% CI 0.90 to 4.52; I(2) 0%; 950 participants). There was increased severe oesophagitis with concurrent treatment (RR 4.96, 95%CI 2.17 to 11.37; I(2) 66%; 947 participants).

Authors' conclusions: This update of the review published in 2004 incorporates additional trials and more mature data. It demonstrates the benefit of concurrent chemoradiation over radiotherapy alone or sequential chemoradiotherapy. Patient selection is an important consideration in view of the added toxicity of concurrent treatment. Uncertainty remains as to how far this is purely due to a radiosensitising effect and whether similar benefits could be achieved by using modern radiotherapy techniques and more dose intensive accelerated and/ or hyperfractionated radiotherapy regimens.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Concurrent chemoradiotherapy vs Radiotherapy alone, Outcome 1 Overall survival.
1.2
1.2. Analysis
Comparison 1 Concurrent chemoradiotherapy vs Radiotherapy alone, Outcome 2 Overall survival 2‐years.
1.3
1.3. Analysis
Comparison 1 Concurrent chemoradiotherapy vs Radiotherapy alone, Outcome 3 Progression‐free survival.
1.4
1.4. Analysis
Comparison 1 Concurrent chemoradiotherapy vs Radiotherapy alone, Outcome 4 Progression‐free survival 2‐years.
1.5
1.5. Analysis
Comparison 1 Concurrent chemoradiotherapy vs Radiotherapy alone, Outcome 5 Locoregional progression‐free survival.
1.6
1.6. Analysis
Comparison 1 Concurrent chemoradiotherapy vs Radiotherapy alone, Outcome 6 Locoregional progression‐free survival 2‐years.
1.7
1.7. Analysis
Comparison 1 Concurrent chemoradiotherapy vs Radiotherapy alone, Outcome 7 Toxicity.
2.1
2.1. Analysis
Comparison 2 Concurrent vs Sequential chemoradiotherapy, Outcome 1 Overall survival.
2.2
2.2. Analysis
Comparison 2 Concurrent vs Sequential chemoradiotherapy, Outcome 2 Overall survival 2‐years.
2.3
2.3. Analysis
Comparison 2 Concurrent vs Sequential chemoradiotherapy, Outcome 3 Progression‐free survival.
2.4
2.4. Analysis
Comparison 2 Concurrent vs Sequential chemoradiotherapy, Outcome 4 Progression‐free survival 2‐years.
2.5
2.5. Analysis
Comparison 2 Concurrent vs Sequential chemoradiotherapy, Outcome 5 Locoregional PFS 2‐years.
2.6
2.6. Analysis
Comparison 2 Concurrent vs Sequential chemoradiotherapy, Outcome 6 Toxicity.
3.1
3.1. Analysis
Comparison 3 Subgroup analysis Chemoradiotherapy vs Radiotherapy, Outcome 1 Chemotherapy regime.
3.2
3.2. Analysis
Comparison 3 Subgroup analysis Chemoradiotherapy vs Radiotherapy, Outcome 2 Frequency of chemotherapy administration.
3.3
3.3. Analysis
Comparison 3 Subgroup analysis Chemoradiotherapy vs Radiotherapy, Outcome 3 Platinum dose.
3.4
3.4. Analysis
Comparison 3 Subgroup analysis Chemoradiotherapy vs Radiotherapy, Outcome 4 Radiotherapy fractionation.
3.5
3.5. Analysis
Comparison 3 Subgroup analysis Chemoradiotherapy vs Radiotherapy, Outcome 5 Dose of radiotherapy.
3.6
3.6. Analysis
Comparison 3 Subgroup analysis Chemoradiotherapy vs Radiotherapy, Outcome 6 Duration of follow‐up.
4.1
4.1. Analysis
Comparison 4 Subgroup analysis Concurrent vs Sequential, Outcome 1 Dose of radiotherapy.
4.2
4.2. Analysis
Comparison 4 Subgroup analysis Concurrent vs Sequential, Outcome 2 Duration of follow‐up.
5.1
5.1. Analysis
Comparison 5 More frequent versus less frequent chemotherapy, Outcome 1 Frequency of chemotherapy.
6.1
6.1. Analysis
Comparison 6 Sensitivity fixed: Concurrent vs Radiotherapy, Outcome 1 Overall survival.
6.2
6.2. Analysis
Comparison 6 Sensitivity fixed: Concurrent vs Radiotherapy, Outcome 2 Overall survival 2‐years.
6.3
6.3. Analysis
Comparison 6 Sensitivity fixed: Concurrent vs Radiotherapy, Outcome 3 Progression‐free survival.
6.4
6.4. Analysis
Comparison 6 Sensitivity fixed: Concurrent vs Radiotherapy, Outcome 4 Progression‐free survival 2‐years.
6.5
6.5. Analysis
Comparison 6 Sensitivity fixed: Concurrent vs Radiotherapy, Outcome 5 Locoregional progression‐free survival.
6.6
6.6. Analysis
Comparison 6 Sensitivity fixed: Concurrent vs Radiotherapy, Outcome 6 Locoregional progression‐free survival 2‐years.
6.7
6.7. Analysis
Comparison 6 Sensitivity fixed: Concurrent vs Radiotherapy, Outcome 7 Toxicity.
7.1
7.1. Analysis
Comparison 7 Sensitivity fixed: Concurrent vs Sequential, Outcome 1 Overall survival.
7.2
7.2. Analysis
Comparison 7 Sensitivity fixed: Concurrent vs Sequential, Outcome 2 Overall survival 2‐years.
7.3
7.3. Analysis
Comparison 7 Sensitivity fixed: Concurrent vs Sequential, Outcome 3 Progression‐free survival.
7.4
7.4. Analysis
Comparison 7 Sensitivity fixed: Concurrent vs Sequential, Outcome 4 Progression‐free survival 2‐years.
7.5
7.5. Analysis
Comparison 7 Sensitivity fixed: Concurrent vs Sequential, Outcome 5 Locoregional progression‐free survival 2‐years.
7.6
7.6. Analysis
Comparison 7 Sensitivity fixed: Concurrent vs Sequential, Outcome 6 Toxicity.
8.1
8.1. Analysis
Comparison 8 Sensitivity ITT: Concurrent vs Radiotherapy, Outcome 1 Overall survival 2‐years.
8.2
8.2. Analysis
Comparison 8 Sensitivity ITT: Concurrent vs Radiotherapy, Outcome 2 Progression‐free survival 2‐years.
8.3
8.3. Analysis
Comparison 8 Sensitivity ITT: Concurrent vs Radiotherapy, Outcome 3 Locoregional progression‐free survival 2‐years.
9.1
9.1. Analysis
Comparison 9 Sensitivity ITT: Concurrent vs Sequential, Outcome 1 Overall survival 2‐years.
9.2
9.2. Analysis
Comparison 9 Sensitivity ITT: Concurrent vs Sequential, Outcome 2 Progression‐free survival 2‐years.
10.1
10.1. Analysis
Comparison 10 Sensitivity fully published: Concurrent vs Sequential, Outcome 1 Overall survival.
10.2
10.2. Analysis
Comparison 10 Sensitivity fully published: Concurrent vs Sequential, Outcome 2 Overall survival 2‐years.
10.3
10.3. Analysis
Comparison 10 Sensitivity fully published: Concurrent vs Sequential, Outcome 3 Toxicity.
See this image and copyright information in PMC

Update of

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