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Impact of thoracic radiotherapy timing in limited-stage small-cell lung cancer: usefulness of the individual patient data meta-analysis

De Ruysscher, D; Lueza, B; Le Péchoux, C; Johnson, DH; O'Brien, M; Murray, N; Spiro, S; ... RTT-SCLC Collaborative Group; + view all (2016) Impact of thoracic radiotherapy timing in limited-stage small-cell lung cancer: usefulness of the individual patient data meta-analysis. Annals of Oncology , 27 (10) pp. 1818-1828. 10.1093/annonc/mdw263. Green open access

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Abstract

Background: Chemotherapy (CT) combined with radiotherapy is the standard treatment of ‘limited-stage’ small-cell lung cancer. However, controversy persists over the optimal timing of thoracic radiotherapy and CT. / Materials and methods: We carried out a meta-analysis of individual patient data in randomized trials comparing earlier versus later radiotherapy, or shorter versus longer radiotherapy duration, as defined in each trial. We combined the results from trials using the stratified log-rank test to calculate pooled hazard ratios (HRs). The primary outcome was overall survival. / Results: Twelve trials with 2668 patients were eligible. Data from nine trials comprising 2305 patients were available for analysis. The median follow-up was 10 years. When all trials were analysed together, ‘earlier or shorter’ versus ‘later or longer’ thoracic radiotherapy did not affect overall survival. However, the HR for overall survival was significantly in favour of ‘earlier or shorter’ radiotherapy among trials with a similar proportion of patients who were compliant with CT (defined as having received 100% or more of the planned CT cycles) in both arms (HR 0.79, 95% CI 0.69–0.91), and in favour of ‘later or longer’ radiotherapy among trials with different rates of CT compliance (HR 1.19, 1.05–1.34, interaction test, P < 0.0001). The absolute gain between ‘earlier or shorter’ versus ‘later or longer’ thoracic radiotherapy in 5-year overall survival for similar and for different CT compliance trials was 7.7% (95% CI 2.6–12.8%) and -2.2% (-5.8% to 1.4%), respectively. However, ‘earlier or shorter’ thoracic radiotherapy was associated with a higher incidence of severe acute oesophagitis than ‘later or longer’ radiotherapy. / Conclusion: ‘Earlier or shorter’ delivery of thoracic radiotherapy with planned CT significantly improves 5-year overall survival at the expense of more acute toxicity, especially oesophagitis.

Type: Article
Title: Impact of thoracic radiotherapy timing in limited-stage small-cell lung cancer: usefulness of the individual patient data meta-analysis
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/annonc/mdw263
Publisher version: https://doi.org/10.1093/annonc/mdw263
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: individual participant data meta-analysis; randomized clinical trials; thoracic radiotherapy; radiotherapy timing; small-cell lung cancer;chemotherapy compliance
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute > CRUK Cancer Trials Centre
URI: https://discovery.ucl.ac.uk/id/eprint/10113313
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