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Thoracic radiotherapy schedules in limited-stage small cell lung cancer: A systematic review and network
Xiao Zhong1, Yingnan Liu2, Yuhan Ji1
1Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, China; Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Background:
Currently, the accepted standard management of limited-stage small cell lung cancer (LS-SCLC) is concurrent chemoradiotherapy; however, the thoracic radiotherapy regimen remains controversial. Therefore, this meta-analysis aims to compare efficacy and safety of different thoracic radiotherapy regimens.
Methods:
Relevant randomized controlled trials (RCTs) were sourced in PubMed, Cochrane Library, Web of Science, and EMBASE to assess antitumor effects (overall survival, OS; progression-free survival, PFS; overall response rate, ORR) and toxicity (adverse effects, AEs).
Results:
Of the 2225 screened articles, 8 RCTs (involving 2363 patients) were included. The control arm was defined as 45 Gy/30f BID. The experimental arms were categorized into three groups: high-dose hyper-fractionation (hHyper-RT: 54 Gy/30f BID, 60 Gy/40f BID), hypo-fractionation (Hypo-RT: 42 Gy/15f QD, 65 Gy/26f QD), and conventional fractionation (Conv-RT: 45 Gy/25f QD, 66 Gy/33f QD, 70 Gy/35f QD). Compared with 45 Gy/30f BID, hHyper-RT (54 Gy/30f BID and 60 Gy/40f BID) showed improved OS (HR = 0.55, 95 % CI: 0.37---0.82; HR = 0.69, 95 % CI: 0.48---0.99), hHyper-RT (54 Gy/30f BID) and Hypo-RT (65 Gy/26f QD) improved PFS (HR = 0.70, 95 % CI: 0.49---0.99; HR = 0.78, 95 % CI: 0.62---0.98), whereas OS and PFS with Conv-RT was comparable to that of 45 Gy/30f BID. AE development was comparable among 45 Gy/30f, hHyper-RT, and Hypo-RT, whereas Conv-RT (45 Gy/25f QD) reduces the risk of esophagitis and grade 3-5 esophagitis (RR = 0.70, 95 % CI: 0.58-0.85; RR = 0.50, 95 % CI: 0.35-0.72). No significant difference was found for ORR, pneumonitis or grade 3-5 pneumonitis between the study arms.
Conclusions:
Compared with 45 Gy/30f BID, hHyper-RT (54 Gy/30f BID and 60 Gy/40f BID) improved OS, while hHyper-RT (54 Gy/30f BID) and Hypo-RT (65 Gy/26f QD) prolonged PFS in LS-SCLC patients, with accepted toxicity.
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