Non‐conventional radiotherapy versus conventional radiotherapy for inoperable non‐small‐cell lung cancer: A meta‐analysis of randomized clinical trials

摘要

AbstractBackground:  The aim of this study was to evaluate the efficacy and safety of non-conventional radiotherapy versus conventional radiotherapy for inoperable non-small-cell lung cancer and to conduct a meta-analysis to compare these two methods of radiotherapy for inoperable NSCLC.Methods:  We included randomized controlled trials, which were compared with non-conventional radiotherapy with or without concurrent chemotherapy versus conventional radiotherapy with or without concurrent chemotherapy.Results:  Meta-analysis of 13 randomized controlled trials with a total of 2206 patients showed that the non-conventional radiotherapy group could significantly improve the objective response rate (OR 1.68, 95% confidence intervals (CI) 1.19–2.37) and overall survival of up to 1-year (OR 1.30, 95% CI 1.09–1.54), 2-year (OR 1.41, 95% CI 1.17–1.70), 3-year (OR 1.55, 95% CI 1.24–1.94), 4-year (OR 1.60, 95% CI 1.20–2.15), 5-year (OR 1.63, 95% CI 1.11–2.38); and local control rate in 1-year (OR 1.35, 95% CI 1.09–1.68), 2-year (OR 1.57, 95% CI 1.23–1.99), 3-year (OR 1.45, 95% CI 1.10–1.91) compared with the conventional radiotherapy group. With regard to the side effects, non-conventional radiotherapy was more likely to result in level III and IV radioactive esophagitis (OR 1.64, 95% CI 1.09–2.46), but there was no significant difference in the incidence of radioactive pneumonitis (OR 0.96, 95% CI 0.67–1.39). In the subgroup analysis we found late course accelerated hyperfractionated radiotherapy (LCHRT) could obviously improve 1-year OS (OR 2.29, 95% CI 1.29–4.06), 2-year OS (OR 4.22, 95% CI 2.03–8.77), 3-year OS (OR 2.49, 95% CI 1.24–5.02) and Objective response rate (OR 2.38, 95% CI 1.17–4.83). However, hyperfractionated radiotherapy (HRT) and accelerated hyperfractionated radiotherapy (AHRT) could not improve 1-, 2-, 3-year OS or OR compared with conventional fractionation radiotherapy.Conclusions:  Our findings indicate that NCRT could improve OR, reduce the risk of death by 1–5 years, and significantly increase level III and IV radioactive esophagitis incidence. The late course accelerated hyperfractionated radiotherapy (LCAHRT) group seemed to improve compared with the AHRT and conventional radiotherapy (CRT) groups.