Chemotherapy plus Radiotherapy Compared with Radiotherapy Alone in the Treatment of Locally Advanced, Unresectable, Non-Small-Cell Lung Cancer

doi:10.1059/0003-4819-125-9-199611010-00003

Chemotherapy plus Radiotherapy Compared with Radiotherapy Alone in the Treatment of Locally Advanced, Unresectable, Non-Small-Cell Lung Cancer

A Meta-Analysis

Robert S. Pritchard, MD, MS; and
Stephen P. Anthony, DO

From the Department of Veterans Affairs Medical Center, White River Junction, Vermont; and the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Disclaimer: Any opinions expressed herein are those of the authors and do not represent the opinions or policies of the Department of Veterans Affairs or the Dartmouth Medical School. Acknowledgment: The authors thank H. Gilbert Welch, MD, MPH, for his assistance and advice and for reviewing multiple drafts of this manuscript. Grant Support: By Veterans Affairs Health Services Research and Development Merit Review Award 92-002 (Dr. Welch). Requests for Reprints: Robert S. Pritchard, MD, Department of Medicine (111), Department of Veterans Affairs Medical Center, White River Junction, VT 05009. Current Author Addresses: Dr. Pritchard: Department of Medicine (111), Department of Veterans Affairs Medical Center, White River Junction, VT 05009.

Abstract

Background: Survival of patients with locally advanced, unresectable (stage III), non-small-cell lung cancer treated with radiotherapy is poor. Trials of the addition of chemotherapy to radiotherapy have produced conflicting results.

Objective: To compare chemotherapy plus radiotherapy with radiotherapy alone in patients with stage III, non-small-cell lung cancer.

Data Sources: English-language journal articles published between 1987 and 1995 identified in a MEDLINE search.

Study Selection: Randomized trials that reported survival after previously untreated patients received chemotherapy plus radiotherapy or radiotherapy alone were reviewed.

Data Extraction: For all eligible articles, reported survival curves were used to determine the relative risk for death in each of 3 years. These data were combined to determine a pooled estimate of the relative risk for death at 1, 2, and 3 years.

Data Synthesis: Fourteen articles reporting on a total of 2589 patients were reviewed. Compared with radiotherapy, the combination of chemotherapy and radiotherapy reduced the risk for death at 1 year (relative risk, 0.88 [95% CI, 0.80 to 0.96]), 2 years (relative risk, 0.87 [CI, 0.81 to 0.94]), and 3 years (relative risk, 0.83 [CI, 0.77 to 0.90]). This corresponded to a mean gain in life expectancy of about 2 months. The magnitude of the treatment effect was similar when trials of concurrently and sequentially administered chemotherapy were considered separately.

Conclusion: The addition of chemotherapy to radiotherapy improves survival in patients with locally advanced, unresectable, non-small-cell lung cancer. The absolute benefit is relatively small, however, and should be balanced against the increased toxicity associated with the addition of chemotherapy.