Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Ann Thorac Surg. 2012 Jun;93(6):1807-12. doi: 10.1016/j.athoracsur.2012.03.018.
The optimal treatment strategy for patients with operable stage IIIA (N2) non-small cell lung cancer is uncertain. We performed a systematic review and meta-analysis to test the hypothesis that the addition of radiotherapy to induction chemotherapy prior to surgical resection does not improve survival compared with induction chemotherapy alone.
A comprehensive search of PubMed for relevant studies comparing patients with stage IIIA (N2) non-small cell lung cancer undergoing resection after treatment with induction chemotherapy alone or induction chemoradiotherapy was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards. Hazard ratios were extracted from these studies to give pooled estimates of the effect of induction therapy on overall survival.
There were 7 studies that met criteria for analysis, including 1 randomized control trial, 1 phase II study, 3 retrospective reviews, and 2 published abstracts of randomized controlled trials. None of the studies demonstrated a survival benefit to adding induction radiation to induction chemotherapy versus induction chemotherapy alone. The meta-analysis performed on randomized studies (n=156 patients) demonstrated no benefit in survival from adding radiation (hazard ratio 0.93, 95% confidence interval 0.54 to 1.62, p=0.81), nor did the meta-analysis performed on retrospective studies (n=183 patients, hazard ratio 0.77, 95% confidence interval 0.50 to 1.19, p=0.24).
Published evidence is sparse but does not support the use of radiation therapy in induction regimens for stage IIIA (N2). Given the potential disadvantages of adding radiation preoperatively, clinicians should consider using this treatment strategy only in the context of a clinical trial to allow better assessment of its effectiveness.
可手术的 IIIA 期（N2）非小细胞肺癌患者的最佳治疗策略仍不明确。我们进行了一项系统评价和荟萃分析，以检验假设，即与单纯诱导化疗相比，在手术切除前增加放疗并不能改善生存。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）标准，对比较接受单纯诱导化疗或诱导放化疗治疗后行切除术的 IIIA 期（N2）非小细胞肺癌患者的相关研究进行了全面的 PubMed 检索。从这些研究中提取风险比，以汇总诱导治疗对总生存的影响的估计值。
有 7 项研究符合分析标准，包括 1 项随机对照试验、1 项 II 期研究、3 项回顾性研究和 2 项随机对照试验的已发表摘要。没有研究表明，与单纯诱导化疗相比，增加诱导放疗可带来生存获益。对随机研究（n=156 例患者）进行的荟萃分析显示，增加放疗并未带来生存获益（风险比 0.93，95%置信区间 0.54 至 1.62，p=0.81），对回顾性研究（n=183 例患者，风险比 0.77，95%置信区间 0.50 至 1.19，p=0.24）进行的荟萃分析也未显示出获益。
目前发表的证据很少，但不支持在 IIIA 期（N2）诱导方案中使用放疗。鉴于术前增加放疗的潜在劣势，临床医生应仅在临床试验的背景下考虑使用这种治疗策略，以便更好地评估其有效性。
