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.
Sequential or concomitant chemotherapy with hypofractionated radiotherapy for locally advanced non-small cell lung cancer: a meta-analysis of randomized trials
