A Cochrane review [Abstract] 1 included 37 studies with a total of 9 312 subjects. Combined chemo-radiotherapy (CRT) was superior to chemotherapy (CT) in terms of progression-free survival (OR=0.77, CI 0.68 to 0.87). Overall survival was better with CRT for early stages only (OR=0.62, CI 0.44 to 0.88). Risk of second malignancies was higher with CRT (OR=1.38, CI 1.00 to 1.89), although not significant for early stages alone. CRT was superior to radiotherapy (RT) in terms of overall survival (OR=0.76, CI=0.66 to 0.89), progression-free survival (OR=0.49, CI=0.43 to 0.56) and risk of second malignancies (OR=0.78. CI=0.62 to 0.98). The superiority of CRT also applied to early and advanced stages (mainly IIIA) separately. Extended-field (EF-) radiotherapy was superior to involved-field (IF-) radiotherapy (each additional to CT in most trials) in terms of progression free survival (OR=81, CI 0.68 to 0.95) but not overall survival.
A meta-analysis 2 including 23 studies with a total of 3 888 subjects was abstracted in DARE. More extensive radiotherapy reduced the risk of failure at 10 years by more than one third (31.3 vs 43.4% failures) but had no apparent effect on survival (77.1 vs 77% alive). The addition of chemotherapy halved the 10-year risk of failure (15.8% vs 32.7%) with a small non-significant improvement in survival (79.4% bs 76.5% alive).
Another meta-analysis 3 included 14 studies with a total of 1 755 subjects. Patients who received additional radiotherapy showed an 11% overall improvement in tumour control rate after 10 years (p<0.0001, 95% CI 4% to 18%). There was no difference in overall survival. In the parallel-design trials there was no difference in tumour control rates, but overall survival at 10 years was significantly better in the group that did not receive radiotherapy (p=0.045, 8%, 95% CI 1% to 15%).
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