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Review
. 2017 Jun 20;8(25):41670-41678.
doi: 10.18632/oncotarget.16471.

Definitive radiochemotherapy versus surgery within multimodality treatment in stage III non-small cell lung cancer (NSCLC) - a cumulative meta-analysis of the randomized evidence

Christoph Pöttgen  1 , Wilfried Eberhardt  2 , Georgios Stamatis  3 , Martin Stuschke  1
Affiliations
Review

Definitive radiochemotherapy versus surgery within multimodality treatment in stage III non-small cell lung cancer (NSCLC) - a cumulative meta-analysis of the randomized evidence

Christoph Pöttgen et al. Oncotarget. .

Abstract

Randomized trials were analyzed comparing surgery with definitive radiotherapy as local curative treatment options within the framework of different multimodality treatments for patients with locally advanced non-small cell lung cancer (NSCLC). Endpoints for comparison of treatment results were overall survival, progression-free survival, and toxicity.Hazard ratios (HR) were taken to measure treatment effects and pooled using a random effects model.Overall survival was not significantly different between surgical and definitive radiotherapy arms (HR=0.92 [95%CI 0.82-1.04], p=0.19, χ2-test). There was heterogeneity with respect to survival at 2 years (p<0.0001, Cochran Mantel Haenszel (CMH)-test). Latter trials using concurrent radiochemotherapy (ccRT/CT) showed better survival at 2 years (risk ratio of death=0.80 [95%CI 0.73-0.88], p<0.0001, CMH-test). In the ccRT/CT trials, survival in the surgical arms tended to have an excess early mortality before 6 months of follow-up and a lesser hazard rate in comparison to definitive ccRT/CT thereafter (HR=0.78 [95%CI 0.63-0.98]). Over all trials, treatment associated mortality was higher in the surgical arms (risk ratio=3.56 [95% CI: 1.65-7.72], p=0.0005, CMH test). With respect to progression-free survival, no significant differences were found (HR=0.91 [95%CI: 0.73 - 1.13]), although the largest conducted trial found an advantage for the surgical arm (HR=0.77 [95%CI: 0.62-0.96]).Induction therapy followed by resection or definitive radiochemotherapy represent valuable curative treatment options for patients with stage III NSCLC, the individual treatment choice deserves careful interdisciplinary evaluation and counseling. Based on the broad heterogeneity of patient groups in these stages further research on predictive factors supporting individual therapy selection is necessary.

Keywords: NSCLC; meta-analysis; radiochemotherapy; trimodality.

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Conflict of interest statement

CONFLICTS OF INTEREST

Christoph Pöttgen: Honoraria: Roche.

Martin Stuschke, Georgios Stamatis: No relationship to disclose.

Wilfried Eberhardt:

Honoraria: Eli Lilly, Boehringer Ingelheim, Pfizer, Novartis, Roche, Merck, Bristol-Myers Squibb, Amgen, GlaxoSmithKline, Aestellas, Bayer, Teva, Merck Serono, Daichi Sankyo, Hexal

Consulting or Advisory Role: Eli Lilly, Boehringer Ingelheim, Novartis, Pfizer, Roche, Merck, Bristol-Myers Squibb, Aestellas, Bayer, Teva, Daichi Sankyo

Research Funding: Eli Lilly (Inst)

Figures

Figure 1
Figure 1. Forest plot: overall survival - randomized prospective studies, experimental: treatment arm with surgery
Figure 2
Figure 2. Forest plot: progression-free survival - randomized prospective studies with published progression-free survival rates, experimental: treatment arm with surgery
See this image and copyright information in PMC

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References

    1. Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE, Nicholson AG, Groome P, Mitchell A, Bolejack V. International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Boards, and Participating Institutions. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2016;11:39–51. doi: 10.1016/j.jtho.2015.09.009. - DOI - PubMed
    1. Robinson LA, Ruckdeschel JC, Wagner H, Jr, Stevens CW, American College of Chest Physicians Treatment of non-small cell lung cancer-stage IIIA: ACCP evidence-based guidelines (2nd edition) Chest. 2007;132(suppl 3):243S–65S. - PubMed
    1. Ramnath N, Dilling TJ, Harris LJ, Kim AW, Michaud GC, Balekian AA, Diekemper R, Detterbeck FC, Arenberg DA. Treatment of stage III non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;(Suppl):e314S–40S. doi: 10.1378/chest.12-2360. - DOI - PubMed
    1. Ettinger DS, Wood DE, Akerley W, Bazhenova LA, Borghaei H, Camidge DR, Cheney RT, Chirieac LR, D’Amico TA, Dilling TJ, Dobelbower MC, Govindan R, Hennon M, et al. Non-Small Cell Lung Cancer, Version 04.2016. https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf
    1. Eberhardt WE, De Ruysscher D, Weder W, Le Péchoux C, De Leyn P, Hoffmann H, Westeel V, Stahel R, Felip E, Peters S. Panel Members. 2nd ESMO Consensus Conference in Lung Cancer: locally advanced stage III non-small-cell lung cancer. Ann Oncol. 2015;26:1573–88. doi: 10.1093/annonc/mdv187. - DOI - PubMed

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