The Role of Additional Chemotherapy in Combination with Concurrent Chemoradiotherapy for Locally Advanced Inoperable Non-Small Cell Lung Cancer, a Systematic Review and Meta-Analysis of 12 Randomized Trials

Abstract Background: Concurrent chemoradiotherapy (CCRT) is the cornerstone treatment for patients with locally advanced non-small cell lung cancer (LA-NSCLC). The aim of this study was to compare the efficacy and toxicity of different CCRT regimens in the treatment of LA-NSCLC by adopting a network meta-analysis.Methods: PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) were exhaustively searched to identify relevant studies from inception up to October 1, 2020. Direct and indirect evidence were combined to calculate the odds radio (OR) and its 95% confidence interval (CI), as well as to draw the surface under the cumulative ranking (SUCRA) curves. Cluster analyses were adopted to compare efficacy and toxicity of different CCRT regimens according to the similarity of 2 variables. Publication bias was detected by comparison-adjusted funnel plot.Results: Twenty-two studies were enrolled in this network meta-analysis, including 18 CCRT regimens: CCRT (cisplatin+etoposide), CCRT (carboplatin+paclitaxel), CCRT (pemetrexed+carboplatin), CCRT (pemetrexed+cisplatin), CCRT (docetaxel+cisplatin), CCRT (S-1+cisplatin), CCRT (mitomycin+vindesine+cisplatin), CCRT (cisplatin+vinorelbine), CCRT (cisplatin), CCRT (etoposide+cisplatin+amifostine), RT, CCRT (5-FU), CCRT (paclitaxel+cisplatin), CCRT (irinotecan+carboplatin), CCRT (nedaplatin), CCRT (carboplatin+etoposide), CCRT (paclitaxel), and CCRT (carboplatin). The results indicated that the regimens with CCRT (cisplatin+etoposide), CCRT (carboplatin+paclitaxel), CCRT (pemetrexed+cisplatin), CCRT (S-1+cisplatin), and CCRT (cisplatin+vinorelbine) had relatively better efficacy compared with other regimens. As for toxicity of different CCRT regimens, the CCRT (carboplatin+paclitaxel), CCRT (pemetrexed+cisplatin), and CCRT (docetaxel+cisplatin) were relatively lower.Conclusions: Our study demonstrated that CCRT (pemetrexed+cisplatin) and CCRT (carboplatin+paclitaxel) might be the best choice of CCRT regimens in the treatment of LA-NSCLC, and the 3-year overall survival (OS) rate of CCRT (pemetrexed+cisplatin) was the highest among these regimens.

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Indications and Parameters Around Postoperative Radiation Therapy for Lung Cancer

Journal of Clinical Oncology ◽

10.1200/jco.21.01774 ◽

2022 ◽

Author(s):

Antonin Levy ◽

Olaf Mercier ◽

Cécile Le Péchoux

Keyword(s):

Lung Cancer ◽

Radiation Therapy ◽

High Risk ◽

Randomized Trials ◽

Meta Analysis ◽

Small Cell ◽

Postoperative Radiation ◽

Small Cell Lung ◽

Postoperative Radiation Therapy

Patients with locally advanced resected non–small-cell lung cancer present a high risk of relapse. Although adjuvant platinum–based chemotherapy has become the standard of care, the role of postoperative radiation therapy (PORT) has been controversial for years. In patients with incomplete resection, PORT should be proposed, on the basis of a strong consensus, despite the absence of randomized evidence. In patients with completely resected (R0) non–small-cell lung cancer, a meta-analysis showed poorer outcomes after PORT in the absence of mediastinal involvement (pN0 and pN1). In patients with pN2, the role of PORT was less clear and required further research. The meta-analysis included trials using older radiation techniques and poorer quality of surgery according to today's standards, and selection of patients was not positron emission tomography–based. Newer retrospective and nonrandomized studies and subgroup analyses of randomized trials evaluating adjuvant chemotherapy suggested a survival benefit of PORT in patients with pN2 R0. Two recent randomized trials (Lung ART and PORT-C) evaluating conformal PORT versus no PORT retrieved no disease-free survival advantage for stage IIIA-N2 patients, even if mediastinal relapse was significantly decreased with PORT. PORT had no effect on survival, possibly given the high rate of distant relapse and risk of additional cardiopulmonary toxicity. Ongoing and future analyses are planned in Lung ART to identify patients for whom PORT could be recommended. Incorporation of newer systemic treatments (immune checkpoint inhibitors or targeted therapy in oncogene-addicted patients) is underway in the neoadjuvant and/or adjuvant setting. Better identification of patients at a high risk of disease recurrence, with analysis of circulating tumor DNA, on the basis of the detection of postsurgical minimal (or molecular) residual disease is warranted in future studies.

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