A prospective and randomized study of radiotherapy, sequential chemotherapy radiotherapy and concomitant chemo therapy-radiotherapy in unresectable non small cell carcinoma of the lung

Dasgupta, Anirban; Dasgupta, Chandan; Basu, Siddhartha; Majumdar, Anup

doi:10.4103/0973-1482.25849

Cited by 18 publications

(20 citation statements)

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“…Similar results were obtained for subgroup analysis of the five Phase-III trials. 15,19,20,21,37 Patterns of failure Pooling data of the initial relapse sites (Figure 2), difference between overall relapses (locoregional or distant) in both groups was statistically significant (OR ¼ 0.82; 95%CI: 0.69-0.97; p ¼ 0.02) in favor of concurrent group. Subset analyses revealed that isolated loco-regional relapses (primary tumor and/or regional nodes) were significantly lower frequent in the concurrent RT-CT than in the sequential arm (OR ¼ 0.68; 95%CI: 0.52-0.87; p ¼ 0.002), while the number of distant (e.g., brain, bone, or liver) relapses (OR ¼ 1.01; 95%CI: 0.79-1.30; p ¼ 0.927) and relapses at both sites (locoregional þ distant) (OR ¼ 0.74; 95%CI: 0.43-1.12; p ¼ 0.267) were similar in the two arms.…”

Section: Progression-free Survivalmentioning

confidence: 99%

“…[15][16][17][18][19][20][21][22][23]37,38 Main characteristics of the 11 trials are described in Table 1. Of the 11 trials, 6 were randomized phase III trials, 15,16,[19][20][21]37 and the remaining 5 were randomized phase II trials. As of August 2009, 10 trials have already been published as full length articles and one was presented at the 2003 Annual Meeting of the ASCO.…”

Section: Trial Flow and Characteristics Of The Eligible Trialsmentioning

confidence: 99%

“…[18][19][20] Furthermore, comparisons between concurrent RT-CT and sequential RT-CT have been mainly based on small sample size data, with inadequate statistical power to detect modest therapeutic advances. [21][22][23] The determination of the best sequence of RT-CT for advanced NSCLC has potential importance for offering clinicians a further basis when making treatment choices.…”

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confidence: 99%

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Chemo‐radiotherapy for advanced non‐small cell lung cancer: concurrent or sequential? It's no longer the question: a systematic review

Lee

Zhou

et al. 2010

Intl Journal of Cancer

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There has been conflicting evidence concerning the best sequence of radiotherapy (RT) and chemotherapy (CT) for advanced non-small-cell-lung-cancer (NSCLC). To investigate whether current clinical trials can clarify this schedule and offer further bases for clinical decision making, we performed a systematic review of 11 trials (2,043 patients; concurrent-1,019, sequential-1,024) that compared concurrent RT-CT with sequential arm in advanced NSCLC patients. Primary end point was overall survival (OS). Pooled median ratios (MRs) and progression-free-survival ratios (FRs) for median survival and progression-free survival (PFS) were calculated using the weighted sum of the log ratio of MR and FR of individual study. Pooled odds ratios (ORs) for the objective response rate, relapse control rate, and toxic events were calculated using the Mantel-Haenszel estimate. Results confirmed that concurrent RT-CT determined a statistically significant increase in median survival time (16.3 vs. 13.9 months; MR 5 1.17,95%CI:1.09-1.26), response rate (64.0% vs. 56.3%; OR 5 1.38,95%CI:1.10-1.72), and tumor-relapse control (OR 5 0.82,95%CI:0.69-0.97), though at the expense of increased hematological toxicity (neutropenia and thrombocytopenia) and non-hematological toxicity (nausea/vomiting, stomatitis, and esophagitis). Similar results were obtained from the sensitivity analysis of all Phase-III/trials designed to evaluate the primary end point of OS. Subgroup analysis revealed that concurrent strategy was mainly associated with improved loco-regional control (OR 5 0.68,95%CI:0.52-0.87). However, no difference in PFS is shown. While careful interpretation of our conclusions is required because of potential bias, the present study, to some extent, exhibits the superiority of the concurrent arm over the sequential in the treatment of advanced NSCLC. Further improvements will be obtained by optimizing the conditions for a concurrent regimen.Lung cancer, with its high incidence and grim prognosis, remains a major public health menace for both men and women worldwide. 1,2 Non-small-cell lung cancer (NSCLC) accounts for more than 80% of all lung tumors. 3,4 For early stage NSCLC, surgical resection continues to be the standard treatment with curative intent. 5 Unfortunately, approximately 70% of NSCLC patients are diagnosed in advanced stage of the disease (locoregionally advanced or distant metastatic disease). 3,6 Advanced NSCLC, characterized by large primary lesions and/or widespread involvement of the ipsilateral or contralateral mediastinum or supraclavicular regions, 7,8 poses a major therapeutic challenge not only due to poor response to treatment but also due to treatment related morbidities. 9 Although there is currently no official consensus on the definitive treatment of advanced NSCLC, it has been well documented that the addition of chemotherapy to radiotherapy improves survival. [10][11][12][13][14] Combined modality approaches have been studied intensively, including concurrent radio-chemotherapy (RT-CT) and sequential RT...

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Section: Progression-free Survivalmentioning

confidence: 99%

Section: Trial Flow and Characteristics Of The Eligible Trialsmentioning

confidence: 99%

mentioning

confidence: 99%

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Chemo‐radiotherapy for advanced non‐small cell lung cancer: concurrent or sequential? It's no longer the question: a systematic review

Lee

Zhou

et al. 2010

Intl Journal of Cancer

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“…One trial 56 reported details of co-interventions; however, it was unclear how many patients in each treatment arm had received any of the co-interventions. Two trials 49,51 were reported as 'open' and it was assumed that assessors, administrators and participants were not blinded to treatment; blinding was not stated in the remaining 17 trials.…”

Section: Qualitymentioning

confidence: 99%

“…51 Eighteen trials clearly reported the number of participants randomised. [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][61][62][63] All trials reported details of participant comparability at baseline.…”

Section: Qualitymentioning

confidence: 99%

Clinical effectiveness of first-line chemoradiation for adult patients with locally advanced non-small cell lung cancer: a systematic review

Brown

Pilkington

Boland

et al. 2013

Health Technol Assess

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Reports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA programme findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'.For more information about the HTA programme please visit the website:

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Comparison of Concurrent Use of Thoracic Radiation With Either Carboplatin-Paclitaxel or Cisplatin-Etoposide for Patients With Stage III Non–Small-Cell Lung Cancer

et al. 2017

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A prospective and randomized study of radiotherapy, sequential chemotherapy radiotherapy and concomitant chemo therapy-radiotherapy in unresectable non small cell carcinoma of the lung

Abstract: Addition of chemotherapy with radiation in unresectable NSCLC improves response rates, time to tumour progression and disease free survival, though the same effect is not translated in overall survival.

Cited by 18 publications

References 0 publications

Chemo‐radiotherapy for advanced non‐small cell lung cancer: concurrent or sequential? It's no longer the question: a systematic review

Chemo‐radiotherapy for advanced non‐small cell lung cancer: concurrent or sequential? It's no longer the question: a systematic review

Clinical effectiveness of first-line chemoradiation for adult patients with locally advanced non-small cell lung cancer: a systematic review

Comparison of Concurrent Use of Thoracic Radiation With Either Carboplatin-Paclitaxel or Cisplatin-Etoposide for Patients With Stage III Non–Small-Cell Lung Cancer

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