Meta-Analysis of Concomitant Versus Sequential Radiochemotherapy in Locally Advanced Non–Small-Cell Lung Cancer

Aupérin, Anne; Péchoux, C. Le; Rolland, Estelle; Curran, Walter J.; Furuse, Kiyoyuki; Fournel, P.; Belderbos, J.; Clamon, Gerald H.; Ulutin, H Cüneyt; Paulus, Rebecca; Yamanaka, T.; Bozonnat, Marie-Cécile; Uitterhoeve, A. L. J.; Wang, Xiaofei; Stewart, Lesley; Arriagada, R.; Burdett, Sarah; Pignon, Jean-Pierre

doi:10.1200/jco.2009.26.2543

Cited by 1,604 publications

(1,197 citation statements)

References 35 publications

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“…For patients who have no indications for surgery, RT, chemotherapy or chemo-radiation could be the possible cure. For one thing, initially, three separate studies performed that the best method to treat locally advanced NSCLC (LAD-NSCLC) was a comprehensive therapy-combined RT and chemotherapy which strengthened and complemented each other in a coordinated fashion [13][14][15]. What's more, three other randomized prospective studies displayed a radio-sensitizing benefit to concurrent chemotherapy and radiation compared with radiation alone, with enhanced survival rates and improved local control later [16].…”

Section: Discussionmentioning

confidence: 99%

“…What's more, three other randomized prospective studies displayed a radio-sensitizing benefit to concurrent chemotherapy and radiation compared with radiation alone, with enhanced survival rates and improved local control later [16]. For another thing, CCRT resulted in better survival than sequential therapy [13]. It is worthwhile noting that these existing literature support that NSCLC patients could benefit from CCRT, however, concerns of excessive toxicity have likely hindered the practice.…”

Section: Discussionmentioning

confidence: 99%

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Concurrent chemoradiotherapy with weekly nedaplatin versus radiotherapy alone in elderly patients with non-small-cell lung cancer

Chen

Liang

et al. 2017

Clin Transl Oncol

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Purpose We conduct this study to compare the efficacy and toxicity of intensity-modulated radiotherapy (IMRT) concurrent weekly nedaplatin (NDP) versus IMRT alone in the stage III/IV non-surgical elderly patients with nonsmall-cell lung cancer (NSCLC). Methods 117 patients were enrolled into our study. The patients were assigned into two different groups: radiotherapy (RT) group and chemoradiotherapy (CRT) group. Patients in RT group were treated with IMRT at a single daily dose of 2 Gy for 5 days per week, totally 52-66 Gy. The CRT group, IMRT concurrent weekly NDP at a dose of 25 mg/m 2 . Results In CRT group, the median survival was 11.0 months (95% confidence interval [CI], 8.894-13.106 months) and in RT group, it was 7.0 months (95% CI 5.771-8.229 months). The 1-year, 2-year, 3-year, survival rates in the combined treatment arm were higher than the radiation therapy arm (46.8 vs 25.9%, 25.1 vs 11.8%, 14.7 vs 8.0%; p \ 0.001). The Cox's multiple regression analysis showed that CRT had significantly better overall survival than RT (HR 0.523; 95.0% CI 0.338-0.807; p = 0.003). The objective response rate provided that 73.3% treated with CRT compared with 51.1% (p = 0.018) received RT alone. Of the hematologic toxicities, leukocytes (35.0 vs 0%; p \ 0.001), neutrophils (33.3 vs 0%; p \ 0.001) were significantly more common in the CRT group than the RT group. Conclusions We first discovered that NDP concurrent IMRT for treating stage III/IV non-surgical elderly patients with NSCLC was good curative effect of better objective response rate and well-tolerated. However, within the low number of patients, only stage IV gained a survival benefit.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Concurrent chemoradiotherapy with weekly nedaplatin versus radiotherapy alone in elderly patients with non-small-cell lung cancer

Chen

Liang

et al. 2017

Clin Transl Oncol

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“…Another strategy to optimise the biological effectiveness of radiotherapy is by co-administration of therapeutic agents that preferentially sensitize malignant cells to radiotherapy. Combining cytotoxic chemotherapy with radiotherapy is such a strategy and has been shown to improve both local control rates and overall survival [5,6]. However, the therapeutic gain achieved by adding cytotoxic chemotherapy to radiotherapy is modest (4.5% gain in overall survival at 5 years with concurrent versus sequential chemotherapy) and is associated with increased toxicity [6].…”

Section: Introductionmentioning

confidence: 99%

“…Combining cytotoxic chemotherapy with radiotherapy is such a strategy and has been shown to improve both local control rates and overall survival [5,6]. However, the therapeutic gain achieved by adding cytotoxic chemotherapy to radiotherapy is modest (4.5% gain in overall survival at 5 years with concurrent versus sequential chemotherapy) and is associated with increased toxicity [6]. With increasing understanding of the molecular mechanisms underlying radioresistance and the emergence of systemic agents that can target these mechanisms there is growing interest in considering what additional benefit these agents may add to radiotherapy and how to combine the two modalities in the most effective manner.…”

Section: Introductionmentioning

confidence: 99%

“…Radiotherapy as a single agent may be offered to patients whose fitness or comorbidities preclude the use of chemotherapy either as induction treatment or concurrent with radiotherapy. In the last decade there has been a shift to using platinum chemotherapy concurrently with high dose radiation, based on data showing better outcomes when compared with induction chemotherapy [6]. However, this approach is suitable for less than half of patients with locally advanced NSCLC [11,12].…”

Section: Introductionmentioning

confidence: 99%

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The Challenges Faced in Developing Novel Drug Radiation Combinations in Non-small Cell Lung Cancer

et al. 2016

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The Strength of Association Between Surrogate End Points and Survival in Oncology

et al. 2015

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The strength of association between surrogate end points and survival in oncology is important to understand because surrogate end points are frequently used in oncology clinical trials, supporting US Food and Drug Administration approvals and National Comprehensive Cancer Network guideline recommendations. OBJECTIVE To identify and evaluate trial-level meta-analyses of randomized clinical trials quantifying the association between a surrogate end point and overall survival in medical oncology. Trial-level correlations test whether treatments that improve the surrogate end point also improve the final end point and are widely considered the strongest evidence to validate a surrogate end point. EVIDENCE REVIEW Our literature search was built on earlier reported data sets and updated with Google Scholar and MEDLINE searches conducted on December 26, 2014. For MEDLINE, search terms included ("regression" or "correlation") and "surrogate" and "end point [or endpoint]" and ("oncology" or "cancer"). For Google scholar, search terms included ("regression" or "correlation") and "surrogate end point [or endpoint]" and "overall survival" and "trial level." A total of 108 abstracts were retrieved, and 62 articles were read in full in addition to articles identified through prior reviews. FINDINGS We found 36 articles in which 65 specific correlations between a surrogate end point and survival were identified. Surrogate end points were studied in the neoadjuvant, adjuvant, locally advanced, and metastatic settings. The most common sources for trials included in the 36 articles were systematic reviews of the published literature (10 of 36; 28%), and published literature and meeting abstracts (14 of 36; 39%). Four meta-analyses (11%) used a convenience sample, and only 5 studies (14%) attempted to include unpublished trials by surveying clinical trial registries. Among these 5 studies, only 352 of 684 eligible trials (51.1%) were included in the analyses. More than half of reported correlations (34 of 65; 52%) were of low strength (r Յ 0.7). Approximately a quarter (16 of 65; 25%) were of medium strength (r > 0.7 to r < 0.85), and 15 of 65 (23%) were highly correlated (r Ն 0.85) with survival. CONCLUSIONS AND RELEVANCE Most trial-level validation studies of surrogate end points in oncology find low correlations with survival. All validation studies use only a subset of available trials. The evidence supporting the use of surrogate end points in oncology is limited.

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Meta-Analysis of Concomitant Versus Sequential Radiochemotherapy in Locally Advanced Non–Small-Cell Lung Cancer

Abstract: Concomitant radiochemotherapy, as compared with sequential radiochemotherapy, improved survival of patients with locally advanced NSCLC, primarily because of a better locoregional control, but at the cost of manageable increased acute esophageal toxicity.

Cited by 1,604 publications

References 35 publications

Concurrent chemoradiotherapy with weekly nedaplatin versus radiotherapy alone in elderly patients with non-small-cell lung cancer

Concurrent chemoradiotherapy with weekly nedaplatin versus radiotherapy alone in elderly patients with non-small-cell lung cancer

The Challenges Faced in Developing Novel Drug Radiation Combinations in Non-small Cell Lung Cancer

The Strength of Association Between Surrogate End Points and Survival in Oncology

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