Meta-Analysis of Concomitant Versus Sequential Radiochemotherapy in Locally Advanced Non–Small-Cell Lung Cancer
The previous individual patient data meta-analyses of chemotherapy in locally advanced non-small-cell lung cancer (NSCLC) showed that adding sequential or concomitant chemotherapy to radiotherapy improved survival. The NSCLC Collaborative Group performed a meta-analysis of randomized trials directly...
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| Veröffentlicht in: | Journal of clinical oncology 2010-05, Vol.28 (13), p.2181-2190 |
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| creator | AUPERIN, Anne LE PECHOUX, Cecile YAMANAKA, Takeharu BOZONNAT, Marie-Cecile UITTERHOEVE, Apollonia XIAOFEI WANG STEWART, Lesley ARRIAGADA, Rodrigo BURDETT, Sarah PIGNON, Jean-Pierre ROLLAND, Estelle CURRAN, Walter J FURUSE, Kiyoyuki FOURNEL, Pierre BELDERBOS, Jose CLAMON, Gerald CUNEYT ULUTIN, Hakki PAULUS, Rebecca |
| description | The previous individual patient data meta-analyses of chemotherapy in locally advanced non-small-cell lung cancer (NSCLC) showed that adding sequential or concomitant chemotherapy to radiotherapy improved survival. The NSCLC Collaborative Group performed a meta-analysis of randomized trials directly comparing concomitant versus sequential radiochemotherapy.
Systematic searches for trials were undertaken, followed by central collection, checking, and reanalysis of updated individual patient data. Results from trials were combined using the stratified log-rank test to calculate pooled hazard ratios (HRs). The primary outcome was overall survival; secondary outcomes were progression-free survival, cumulative incidences of locoregional and distant progression, and acute toxicity.
Of seven eligible trials, data from six trials were received (1,205 patients, 92% of all randomly assigned patients). Median follow-up was 6 years. There was a significant benefit of concomitant radiochemotherapy on overall survival (HR, 0.84; 95% CI, 0.74 to 0.95; P = .004), with an absolute benefit of 5.7% (from 18.1% to 23.8%) at 3 years and 4.5% at 5 years. For progression-free survival, the HR was 0.90 (95% CI, 0.79 to 1.01; P = .07). Concomitant treatment decreased locoregional progression (HR, 0.77; 95% CI, 0.62 to 0.95; P = .01); its effect was not different from that of sequential treatment on distant progression (HR, 1.04; 95% CI, 0.86 to 1.25; P = .69). Concomitant radiochemotherapy increased acute esophageal toxicity (grade 3-4) from 4% to 18% with a relative risk of 4.9 (95% CI, 3.1 to 7.8; P < .001). There was no significant difference regarding acute pulmonary toxicity.
Concomitant radiochemotherapy, as compared with sequential radiochemotherapy, improved survival of patients with locally advanced NSCLC, primarily because of a better locoregional control, but at the cost of manageable increased acute esophageal toxicity. |
| doi_str_mv | 10.1200/JCO.2009.26.2543 |
| format | Article |
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Systematic searches for trials were undertaken, followed by central collection, checking, and reanalysis of updated individual patient data. Results from trials were combined using the stratified log-rank test to calculate pooled hazard ratios (HRs). The primary outcome was overall survival; secondary outcomes were progression-free survival, cumulative incidences of locoregional and distant progression, and acute toxicity.
Of seven eligible trials, data from six trials were received (1,205 patients, 92% of all randomly assigned patients). Median follow-up was 6 years. There was a significant benefit of concomitant radiochemotherapy on overall survival (HR, 0.84; 95% CI, 0.74 to 0.95; P = .004), with an absolute benefit of 5.7% (from 18.1% to 23.8%) at 3 years and 4.5% at 5 years. For progression-free survival, the HR was 0.90 (95% CI, 0.79 to 1.01; P = .07). Concomitant treatment decreased locoregional progression (HR, 0.77; 95% CI, 0.62 to 0.95; P = .01); its effect was not different from that of sequential treatment on distant progression (HR, 1.04; 95% CI, 0.86 to 1.25; P = .69). Concomitant radiochemotherapy increased acute esophageal toxicity (grade 3-4) from 4% to 18% with a relative risk of 4.9 (95% CI, 3.1 to 7.8; P < .001). There was no significant difference regarding acute pulmonary toxicity.
Concomitant radiochemotherapy, as compared with sequential radiochemotherapy, improved survival of patients with locally advanced NSCLC, primarily because of a better locoregional control, but at the cost of manageable increased acute esophageal toxicity.</description><identifier>ISSN: 0732-183X</identifier><identifier>EISSN: 1527-7755</identifier><identifier>DOI: 10.1200/JCO.2009.26.2543</identifier><identifier>PMID: 20351327</identifier><language>eng</language><publisher>Alexandria, VA: American Society of Clinical Oncology</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents - administration & dosage ; Antineoplastic Agents - adverse effects ; Biological and medical sciences ; Carcinoma, Non-Small-Cell Lung - drug therapy ; Carcinoma, Non-Small-Cell Lung - mortality ; Carcinoma, Non-Small-Cell Lung - pathology ; Carcinoma, Non-Small-Cell Lung - radiotherapy ; Chemotherapy, Adjuvant ; Chi-Square Distribution ; Disease-Free Survival ; Drug Administration Schedule ; Esophagus - drug effects ; Esophagus - radiation effects ; Evidence-Based Medicine ; Female ; Humans ; Kaplan-Meier Estimate ; Lung Neoplasms - drug therapy ; Lung Neoplasms - mortality ; Lung Neoplasms - pathology ; Lung Neoplasms - radiotherapy ; Male ; Medical sciences ; Middle Aged ; Neoplasm Staging ; Pneumology ; Radiation Dosage ; Radiotherapy, Adjuvant - adverse effects ; Randomized Controlled Trials as Topic ; Time Factors ; Treatment Outcome ; Tumors ; Tumors of the respiratory system and mediastinum</subject><ispartof>Journal of clinical oncology, 2010-05, Vol.28 (13), p.2181-2190</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c553t-b6943410d2a108b4de80eb44ef2d39cdcd93581bf2932b9829e6332b8b1d34b83</citedby><cites>FETCH-LOGICAL-c553t-b6943410d2a108b4de80eb44ef2d39cdcd93581bf2932b9829e6332b8b1d34b83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,3715,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22733197$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20351327$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:120369426$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>AUPERIN, Anne</creatorcontrib><creatorcontrib>LE PECHOUX, Cecile</creatorcontrib><creatorcontrib>YAMANAKA, Takeharu</creatorcontrib><creatorcontrib>BOZONNAT, Marie-Cecile</creatorcontrib><creatorcontrib>UITTERHOEVE, Apollonia</creatorcontrib><creatorcontrib>XIAOFEI WANG</creatorcontrib><creatorcontrib>STEWART, Lesley</creatorcontrib><creatorcontrib>ARRIAGADA, Rodrigo</creatorcontrib><creatorcontrib>BURDETT, Sarah</creatorcontrib><creatorcontrib>PIGNON, Jean-Pierre</creatorcontrib><creatorcontrib>ROLLAND, Estelle</creatorcontrib><creatorcontrib>CURRAN, Walter J</creatorcontrib><creatorcontrib>FURUSE, Kiyoyuki</creatorcontrib><creatorcontrib>FOURNEL, Pierre</creatorcontrib><creatorcontrib>BELDERBOS, Jose</creatorcontrib><creatorcontrib>CLAMON, Gerald</creatorcontrib><creatorcontrib>CUNEYT ULUTIN, Hakki</creatorcontrib><creatorcontrib>PAULUS, Rebecca</creatorcontrib><title>Meta-Analysis of Concomitant Versus Sequential Radiochemotherapy in Locally Advanced Non–Small-Cell Lung Cancer</title><title>Journal of clinical oncology</title><addtitle>J Clin Oncol</addtitle><description>The previous individual patient data meta-analyses of chemotherapy in locally advanced non-small-cell lung cancer (NSCLC) showed that adding sequential or concomitant chemotherapy to radiotherapy improved survival. The NSCLC Collaborative Group performed a meta-analysis of randomized trials directly comparing concomitant versus sequential radiochemotherapy.
Systematic searches for trials were undertaken, followed by central collection, checking, and reanalysis of updated individual patient data. Results from trials were combined using the stratified log-rank test to calculate pooled hazard ratios (HRs). The primary outcome was overall survival; secondary outcomes were progression-free survival, cumulative incidences of locoregional and distant progression, and acute toxicity.
Of seven eligible trials, data from six trials were received (1,205 patients, 92% of all randomly assigned patients). Median follow-up was 6 years. There was a significant benefit of concomitant radiochemotherapy on overall survival (HR, 0.84; 95% CI, 0.74 to 0.95; P = .004), with an absolute benefit of 5.7% (from 18.1% to 23.8%) at 3 years and 4.5% at 5 years. For progression-free survival, the HR was 0.90 (95% CI, 0.79 to 1.01; P = .07). Concomitant treatment decreased locoregional progression (HR, 0.77; 95% CI, 0.62 to 0.95; P = .01); its effect was not different from that of sequential treatment on distant progression (HR, 1.04; 95% CI, 0.86 to 1.25; P = .69). Concomitant radiochemotherapy increased acute esophageal toxicity (grade 3-4) from 4% to 18% with a relative risk of 4.9 (95% CI, 3.1 to 7.8; P < .001). There was no significant difference regarding acute pulmonary toxicity.
Concomitant radiochemotherapy, as compared with sequential radiochemotherapy, improved survival of patients with locally advanced NSCLC, primarily because of a better locoregional control, but at the cost of manageable increased acute esophageal toxicity.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic Agents - administration & dosage</subject><subject>Antineoplastic Agents - adverse effects</subject><subject>Biological and medical sciences</subject><subject>Carcinoma, Non-Small-Cell Lung - drug therapy</subject><subject>Carcinoma, Non-Small-Cell Lung - mortality</subject><subject>Carcinoma, Non-Small-Cell Lung - pathology</subject><subject>Carcinoma, Non-Small-Cell Lung - radiotherapy</subject><subject>Chemotherapy, Adjuvant</subject><subject>Chi-Square Distribution</subject><subject>Disease-Free Survival</subject><subject>Drug Administration Schedule</subject><subject>Esophagus - drug effects</subject><subject>Esophagus - radiation effects</subject><subject>Evidence-Based Medicine</subject><subject>Female</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Lung Neoplasms - drug therapy</subject><subject>Lung Neoplasms - mortality</subject><subject>Lung Neoplasms - pathology</subject><subject>Lung Neoplasms - radiotherapy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Pneumology</subject><subject>Radiation Dosage</subject><subject>Radiotherapy, Adjuvant - adverse effects</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><subject>Tumors of the respiratory system and mediastinum</subject><issn>0732-183X</issn><issn>1527-7755</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkE2P0zAQhi0EYsvCnRPyBXFKscdx4xyraPlSYSUWEDfLsSdbL0nctVNWvfEf-If8Ehy1LKcZzTzve3gIec7ZkgNjrz80l8s86yWsliBL8YAsuISqqCopH5IFqwQUXInvZ-RJSjeM8VIJ-ZicAROSC6gW5PYjTqZYj6Y_JJ9o6GgTRhsGP5lxot8wpn2iV3i7x3HypqefjfPBbnEI0xaj2R2oH-kmWNP3B7p2P81o0dFPYfzz6_fVkK9Fg31PN_vxmjbzMz4ljzrTJ3x2mufk65uLL827YnP59n2z3hRWSjEV7aouRcmZA8OZakuHimFbltiBE7V11tVCKt52UAtoawU1rkTeVMudKFslzklx7E13uNu3ehf9YOJBB-P16fQjb6ilBFAzz468jSGliN19gjM929bZtp5ta1jp2XaOvDhGctmA7j7wT28GXp4Ak7KiLmYDPv3nMiJ4PXOvjtzWX2_vfESdZne5FvSNDaA0Fxq44uIv6_mXPQ</recordid><startdate>20100501</startdate><enddate>20100501</enddate><creator>AUPERIN, Anne</creator><creator>LE PECHOUX, Cecile</creator><creator>YAMANAKA, Takeharu</creator><creator>BOZONNAT, Marie-Cecile</creator><creator>UITTERHOEVE, Apollonia</creator><creator>XIAOFEI WANG</creator><creator>STEWART, Lesley</creator><creator>ARRIAGADA, Rodrigo</creator><creator>BURDETT, Sarah</creator><creator>PIGNON, Jean-Pierre</creator><creator>ROLLAND, Estelle</creator><creator>CURRAN, Walter J</creator><creator>FURUSE, Kiyoyuki</creator><creator>FOURNEL, Pierre</creator><creator>BELDERBOS, Jose</creator><creator>CLAMON, Gerald</creator><creator>CUNEYT ULUTIN, Hakki</creator><creator>PAULUS, Rebecca</creator><general>American Society of Clinical Oncology</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ADTPV</scope><scope>AOWAS</scope></search><sort><creationdate>20100501</creationdate><title>Meta-Analysis of Concomitant Versus Sequential Radiochemotherapy in Locally Advanced Non–Small-Cell Lung Cancer</title><author>AUPERIN, Anne ; 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The NSCLC Collaborative Group performed a meta-analysis of randomized trials directly comparing concomitant versus sequential radiochemotherapy.
Systematic searches for trials were undertaken, followed by central collection, checking, and reanalysis of updated individual patient data. Results from trials were combined using the stratified log-rank test to calculate pooled hazard ratios (HRs). The primary outcome was overall survival; secondary outcomes were progression-free survival, cumulative incidences of locoregional and distant progression, and acute toxicity.
Of seven eligible trials, data from six trials were received (1,205 patients, 92% of all randomly assigned patients). Median follow-up was 6 years. There was a significant benefit of concomitant radiochemotherapy on overall survival (HR, 0.84; 95% CI, 0.74 to 0.95; P = .004), with an absolute benefit of 5.7% (from 18.1% to 23.8%) at 3 years and 4.5% at 5 years. For progression-free survival, the HR was 0.90 (95% CI, 0.79 to 1.01; P = .07). Concomitant treatment decreased locoregional progression (HR, 0.77; 95% CI, 0.62 to 0.95; P = .01); its effect was not different from that of sequential treatment on distant progression (HR, 1.04; 95% CI, 0.86 to 1.25; P = .69). Concomitant radiochemotherapy increased acute esophageal toxicity (grade 3-4) from 4% to 18% with a relative risk of 4.9 (95% CI, 3.1 to 7.8; P < .001). There was no significant difference regarding acute pulmonary toxicity.
Concomitant radiochemotherapy, as compared with sequential radiochemotherapy, improved survival of patients with locally advanced NSCLC, primarily because of a better locoregional control, but at the cost of manageable increased acute esophageal toxicity.</abstract><cop>Alexandria, VA</cop><pub>American Society of Clinical Oncology</pub><pmid>20351327</pmid><doi>10.1200/JCO.2009.26.2543</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of clinical oncology, 2010-05, Vol.28 (13), p.2181-2190 |
| issn | 0732-183X 1527-7755 |
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| source | MEDLINE; American Society of Clinical Oncology Online Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Aged Aged, 80 and over Antineoplastic Agents - administration & dosage Antineoplastic Agents - adverse effects Biological and medical sciences Carcinoma, Non-Small-Cell Lung - drug therapy Carcinoma, Non-Small-Cell Lung - mortality Carcinoma, Non-Small-Cell Lung - pathology Carcinoma, Non-Small-Cell Lung - radiotherapy Chemotherapy, Adjuvant Chi-Square Distribution Disease-Free Survival Drug Administration Schedule Esophagus - drug effects Esophagus - radiation effects Evidence-Based Medicine Female Humans Kaplan-Meier Estimate Lung Neoplasms - drug therapy Lung Neoplasms - mortality Lung Neoplasms - pathology Lung Neoplasms - radiotherapy Male Medical sciences Middle Aged Neoplasm Staging Pneumology Radiation Dosage Radiotherapy, Adjuvant - adverse effects Randomized Controlled Trials as Topic Time Factors Treatment Outcome Tumors Tumors of the respiratory system and mediastinum |
| title | Meta-Analysis of Concomitant Versus Sequential Radiochemotherapy in Locally Advanced Non–Small-Cell Lung Cancer |
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