Wang Xinshuai, Ding Xuezhen, Kong Dejiu, Zhang Li, Guo Yibo, Ren Jing, Hu Xiaochen, Yang Junqiang, Gao Shegan
Henan Key Laboratory of Cancer Epigenetics, Cancer Institute, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, 471003, China.
Department of Medical Oncology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, 24 Jinghua Road, Luoyang, 47100, Henan, China.
Int J Clin Oncol. 2017 Apr;22(2):229-236. doi: 10.1007/s10147-016-1074-x. Epub 2016 Dec 22.
Whether consolidation chemotherapy (CCT) after chemoradiotherapy (CRT) helps in the treatment of locally advanced non-small cell lung cancer (LA-NSCLC) is controversial. The aim of this meta-analysis was to evaluate the impact of CCT on overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and toxicities in patients with inoperable LA-NSCLC. PubMed, Embase, The Cochrane Library, WanFang, VIP, and CNKI were searched to identify any relevant publications. After screening the literature and completing quality assessment and data extraction, the meta-analysis was performed using RevMan5.3 software. Ultimately, 5 eligible studies with a total of 1036 patients were selected for the present meta-analysis. The results of the analysis indicated that treatment of LA-NSCLC patients with CRT followed by CCT improved OS (pooled HR 0.85; 95% CI 0.73-0.99; P = 0.03), but did not improve PFS (pooled HR 0.78; 95% CI 0.60-1.02; P = 0.07) and ORR (P = 0.26). Although it could increase the risk of grade ≥3 infection (P = 0.04), it may not increase the risk of grade ≥3 radiation pneumonitis (P = 0.09) during the CCT period. CCT after concurrent CRT may provide additional benefits in the treatment of LA-NSCLC. Although this therapeutic strategy did not prolong PFS, further assessment is warranted.
放化疗(CRT)后进行巩固化疗(CCT)是否有助于治疗局部晚期非小细胞肺癌(LA-NSCLC)仍存在争议。本荟萃分析的目的是评估CCT对无法手术的LA-NSCLC患者总生存期(OS)、无进展生存期(PFS)、总缓解率(ORR)和毒性的影响。检索了PubMed、Embase、Cochrane图书馆、万方、维普和知网,以确定任何相关出版物。在筛选文献、完成质量评估和数据提取后,使用RevMan5.3软件进行荟萃分析。最终,本荟萃分析共纳入5项符合条件的研究,共计1036例患者。分析结果表明,LA-NSCLC患者先接受CRT再接受CCT可改善OS(合并风险比[HR]0.85;95%置信区间[CI]0.73-0.99;P=0.03),但未改善PFS(合并HR 0.78;95%CI 0.60-1.02;P=0.07)和ORR(P=0.26)。虽然CCT期间可能会增加≥3级感染的风险(P=0.04),但可能不会增加≥3级放射性肺炎的风险(P=0.09)。同步CRT后进行CCT可能会为LA-NSCLC的治疗带来额外益处。尽管这种治疗策略并未延长PFS,但仍有必要进行进一步评估。