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Annals of Oncology Advance Access published online on December 12, 2005
Annals of Oncology, doi:10.1093/annonc/mdj094
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© 2005 European Society for Medical Oncology
Received July 19, 2005
Revised October 31, 2005
Accepted November 2, 2005

review

Systematic review and meta-analysis of randomised, controlled trials of the timing of chest radiotherapy in patients with limited-stage, small-cell lung cancer

D. De Ruysscher 1 *, M. Pijls-Johannesma 2, J. Vansteenkiste 3, A. Kester 4, I. Rutten 5, and P. Lambin 1

1 Department of Radiotherapy, GROW, University Hospital Maastricht, Maastricht, The Netherlands; MAASTRO Clinic, 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 Methodology and Statistics, University Maastricht, Maastricht, The Netherlands
5 Department of Radiotherapy, University Hospital Liège, Liège, Belgium

* To whom correspondence should be addressed.
D. De Ruysscher, E-mail: dirk.deruysscher{at}maastro.nl


  Abstract

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.

Keywords: timing radiotherapy; small-cell lung cancer; limited-stage; meta-analysis; review.
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