Randomized trials of radiotherapy alone versus combined chemotherapy and radiotherapy in stages IIIa and IIIb nonsmall cell lung cancer. A meta-analysis

Abstract

Background. For patients with Stage III nonsmall cell lung cancer (NSCLC), radiation is the standard treatment, but survival remains poor. The authors performed a meta‐analysis study using clinical trials that evaluated combined radiotherapy plus chemotherapy versus radiotherapy alone in patients with Stages IIIa and IIIb NSCLC. Methods. For the meta‐analysis study and the point estimates, essential data were extracted directly from published reports. Results. Survival probabilities at 1, 2, 3, and 5 years, as estimated from published survival curves, were considered as the endpoints of interest. For survival at 3 and 5 years, the point estimates and the confidence intervals were used. Quality scoring of the studies also was performed. Fourteen trials were selected, comprising 1887 patients in the meta‐analysis. For the cisplatin‐based group, the estimated pooled odds ratio of death at 1 and 2 years was 0.76 (0.6–0.9 CI) and 0.70 (0.5–0.9 CI), with a reduction in mortality of 24% and 30%, respectively. For the noncisplatin‐based group, the estimated pooled odds ratio at 1 and 2 years was 1.05 (0.7–1.5 CI) and 0.82 (0.5–1.3 CI), with a reduction in morality of 5% and 18%, respectively. However, no significant differences were found between the percentage of survival and the CI at 3 and 5 years using the point estimates. Conclusions. These results favor combined cisplatin‐based chemotherapy and radiotherapy, although it was not so at 3 and 5 years of survival. These data must, however, be considered in the light of their clinical relevance and of the balance between quality of life, toxicity, and costs of chemotherapy. Cancer 1995; 76:593–601.

Phase I/II study of docetaxel and cisplatin with concurrent thoracic radiation therapy for locally advanced non-small-cell lung cancer

“…This stage has been intensively investigated for the last 10 years. Several studies and meta-analyses have documented an improvement in patients with stage III disease treated with chemotherapy followed by thoracic radiation therapy, compared with radiation therapy alone (Marino et al, 1995;Dillman et al, 1996;Sause et al, 2000). Full-dose cisplatin-based chemotherapy with concurrent thoracic radiation therapy produced encouraging results with relatively severe toxicities (Lee et al, 1996;Reboul et al, 1996;Segawa et al, 2000).…”

Radioterapia no câncer de pulmão

“…A QT deve ser baseada em esquemas que utilizam cisplatina ou derivados. A mortalidade é reduzida, com benefício absoluto na sobrevida global de 4% e 2%, em dois e cinco anos, respectivamente (8,9) . É oportuno lembrar que os estudos que foram publicados utilizaram esquemas de QT, doses, volumes e técnicas de irradiação considerados não ideais atualmente.…”

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

“…treatment is not an option [9]. Those patients who have a good performance status and acceptable lung function can usually be treated with curative intent radiotherapy, and the addition of chemotherapy has been shown to improve outcomes in this population [10]. 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.…”