Annals of Oncology Advance Access originally published online on December 12, 2005
Annals of Oncology 2006 17(4):543-552; doi:10.1093/annonc/mdj094
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© 2005 European Society for Medical Oncology
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Systematic review and meta-analysis of randomised, controlled trials of the timing of chest radiotherapy in patients with limited-stage, small-cell lung cancer
1 Department of Radiotherapy, GROW, University Hospital Maastricht, Maastricht, The Netherlands; 2 MAASTRO Clinic, Maastricht, The Netherlands; 3 Respiratory Oncology Unit (Dept. Pulmonology) and Leuven Lung Cancer Group, University Hospital, Leuven, Belgium; 4 Department of Radiotherapy, University Hospital Liège, Liège, Belgium; 5 Department of Methodology and Statistics, University Maastricht, Maastricht, The Netherlands
* Correspondence to: Dr D. De Ruysscher, Department of Radiotherapy, University Hospital Maastricht, Dr Tanslaan 12, 6229 ET Maastricht, The Netherlands. E-mail: dirk.deruysscher{at}maastro.nl
Background: We undertook a systematic review and literature-based meta-analysis to determine whether the timing of chest radiotherapy may influence the survival of patients with limited-stage small-cell lung cancer (LS-SCLC).
Materials: Eligible randomised controlled clinical trials were identified according to the Cochrane Collaboration Guidelines, comparing different timing of chest radiotherapy in patients with LS-SCLC. Early chest irradiation was defined as beginning within 30 days after the start of chemotherapy.
Results: Considering all seven eligible trials, the overall survival at 2 or 5 years was not significantly different between early or late chest radiotherapy. When only trials were considered that used platinum chemotherapy concurrent with chest radiotherapy, a significantly higher 5-year survival was observed when chest radiotherapy was started within 30 days after the start of chemotherapy (2-year survival: OR: 0.73, 95% CI 0.51–1.03, P = 0.07; 5-year survival: OR: 0.64, 95% CI 0.44–0.92, P = 0.02). This was even more pronounced when the overall treatment time of chest radiotherapy was less than 30 days.
Conclusions: There are indications that the 5-year survival rates of patients with LS-SCLC are in favour of early chest radiotherapy, with a significant difference if the overall treatment time of chest radiation is less than 30 days.
Key words: timing radiotherapy, small-cell lung cancer, limited-stage, meta-analysis, review
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