Concurrent vs sequential chemoradiotherapy for patients with advanced non-small-cell lung cancer: A meta-analysis of randomized controlled trials

Wei Xiao, Mei Hong, Wei Xiao, Mei Hong

Abstract

Background: Chemotherapy in combination with thoracic radiotherapy yields significant results in patients with advanced non-small-cell lung cancer (NSCLC) compared with thoracic radiotherapy alone. However, whether concurrent or sequential delivery of chemotherapy combined with thoracic radiotherapy is optimal remains unclear. Herein, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of concurrent vs sequential chemoradiotherapy in patients with NSCLC.

Methods: PubMed, EmBase, and Cochrane Library were systematically searched for RCTs focusing on concurrent and sequential chemoradiotherapy for patients with NSCLC. The pooled-effect estimate was calculated using the random-effects model. Sensitivity, subgroup, and publication biases were also evaluated. A total of 14 RCTs (2634 patients with NSCLC) were selected for the final meta-analysis.

Results: Compared with sequential chemoradiotherapy, concurrent chemoradiotherapy did not increase the 1-year survival rates; however, concurrent chemoradiotherapy significantly increased the 2-, 3-, 4-, and 5-year survival rates. Moreover, although there were no significant differences between concurrent and sequential chemoradiotherapy in terms of distant relapse and locoregional plus distant relapse, concurrent chemoradiotherapy significantly reduced the risk of locoregional relapse. Furthermore, concurrent chemoradiotherapy yielded positive results with respect to overall response rates. Unfortunately, concurrent chemoradiotherapy could result in esophagitis, nausea/vomiting, and reduced leukocyte and platelet counts in patients with NSCLC.

Conclusion: Compared with sequential chemoradiotherapy, concurrent chemoradiotherapy may be significantly beneficial in terms of long-term survival and locoregional relapse, although it increases the risk of grade 3 (or greater) adverse events.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Figure 1
Figure 1
PRISMA Statement flowchart regarding the study selection process.
Figure 2
Figure 2
Effect of concurrent vs sequential chemoradiotherapy on 1-year survival rates.
Figure 3
Figure 3
Effect of concurrent vs sequential chemoradiotherapy on 2-year survival rates.
Figure 4
Figure 4
Effect of concurrent vs sequential chemoradiotherapy on 3-year survival rates.
Figure 5
Figure 5
Effect of concurrent vs sequential chemoradiotherapy on 4-year survival rates.
Figure 6
Figure 6
Effect of concurrent vs sequential chemoradiotherapy on 5-year survival rates.
Figure 7
Figure 7
Effect of concurrent vs sequential chemoradiotherapy on the risk of locoregional relapse.
Figure 8
Figure 8
Effect of concurrent vs sequential chemoradiotherapy on the risk of distant relapse.
Figure 9
Figure 9
Effect of concurrent vs sequential chemoradiotherapy on the risk of locoregional plus distant relapse.
Figure 10
Figure 10
Effect of concurrent vs sequential chemoradiotherapy on the incidence of overall response rate.

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Source: PubMed

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