Efficacy of chemoradiotherapy versus radiation alone in patients with inoperable locally advanced non–small-cell lung cancer: A meta-analysis and systematic review

BACKGROUND: This meta-analysis compared radiotherapy (RT) versus concurrent chemoradiotherapy (RT+CT) in treating patients with inoperable stage III non–small-cell lung cancer (NSCLC). METHODS: Medline, Cochrane, EMBASE, Google Scholar databases were searched until July 28, 2015 using the following keywords non-small cell lung cancer, advanced cancer, incurable/inoperable/unresectable, chemotherapy, radiotherapy, chemoradiotherapy/chemoradiation. Randomized controlled trials (RCTs) and two-armed prospective studies that compared combined RT+CT with RT alone in patients with locally advanced (stage III) nonresectable NSCLC were eligible for inclusion. Treatment effect on overall survival, progression-free survival (PFS), and objective response rate (ORR) were evaluated. RESULTS: Ultimately, 13 RCT studies were included in the systematic review and meta-analysis. The 13 studies included a total of 1936 patients with incurable/inoperable stage III NSCLC, of which 975 received RT alone and 961 received RT+CT combination therapy. The average age ranged from 54 to 77 years. At 1 and 2 years after treatment, the pooled data reveal that patients receiving CT+RT combination therapy had higher overall survival (pooled hazard ratio (HR), 0.72; 95% CI, 0.62–0.84; P < .001; 1-yr: HR, 0.67; 95% CI, 0.54–0.84; P < .001; 2-year: HR, 0.57; 95% CI, 0.45–0.73; P < .001), higher PFS (pooled HR, 0.73, 95% CI, 0.60–0.89; P = .002; 1-year: HR, 0.36; 95% CI, 0.24–0.53; P < .001; 2-year: HR, 0.38; 95% CI, 0.23–0.63; P < .001). CONCLUSION: Our findings show higher efficacy for concurrent CT+RT over RT alone in treating locally-advanced, unresectable stage III NSCLC.