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Evidence summaries

Concurrent Chemoradiotherapy in Non-Small Cell Lung Cancer

Concurrent chemoradiotherapy appears to reduce risk of death compared to radiotherapy alone or sequential chemoradiation in patients with stage III non small cell lung cancer. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 25 studies with a total of 3 752 subjects; 19 studies (n=2 728) compared concurrent chemoradiotherapy with radiotherapy alone and 6 studies (n=1 024) compared concurrent with sequential chemoradiotherapy.

Addition of concurrent chemotherapy to radical radiotherapy reduced the overall risk of death (HR 0.71, 95% CI 0.64 to 0.80; n=1 607) and increased overall progression-free survival at any site i.e. distant or locoregional, (HR 0.69, 95% CI 0.58 to 0.81; n=1 145). The incidence of acute oesophagitis, neutropenia and anaemia were significantly increased by concurrent chemoradiotherapy.

Concurrent chemoradiotherapy reduced the risk of death compared to sequential chemoradiotherapy (HR 0.74; 95% CI 0.62 to 0.89; n=702). This represented a 10% absolute survival benefit at 2 years. Only two studies reported progression-free survival, which was not significantly different between the two groups. 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; n=950). There was increased severe oesophagitis with concurrent treatment (RR 4.96, 95% CI 2.17 to 11.37, statistical heterogeneity I2 66%; n=947).

Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment).

    References

    • O'Rourke N, Roqué I Figuls M, Farré Bernadó N, Macbeth F. Concurrent chemoradiotherapy in non-small cell lung cancer. Cochrane Database Syst Rev 2010;(6):CD002140[PubMed].

Primary/Secondary Keywords