Tong Shaodong, Qin Zhaohui, Wan Minghui, Zhang Longzhen, Cui Yan, Yao Yuanhu
Department of Radiation Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou 221000, China.
Jiangsu Key Laboratory of Biological Therapies for Tumors, Xuzhou Medical University, Xuzhou 221000, China.
J Thorac Dis. 2018 Apr;10(4):2428-2436. doi: 10.21037/jtd.2018.04.24.
Non-small cell lung cancer (NSCLC) accounts for 85% to 90% of lung cancer cases. At diagnosis, around 30% of NSCLC patients are already at stage IIIA (N2). One standard treatment for this stage is induction chemotherapy followed by surgery, whether induction chemoradiotherapy is superior to induction chemotherapy remains uncertain. We therefore performed a systematic review and meta-analysis of published randomized control trials to evaluate the therapeutic efficacy and toxicity of induction chemoradiotherapy versus induction chemotherapy for potentially resectable stage IIIA (N2) NSCLC.
We systematically searched for relevant studies in PubMed, Embase, Web of Science and Cochrane Library from the inception of each database to September 10, 2017. The primary endpoints were objective response rate (ORR), pathological complete response (pCR) rate of mediastinal lymph nodes, toxicity (grade 3-4 adverse events, i.e., nausea and vomiting, infections, leukopenia and anemia), overall survival (OS) and progression-free survival (PFS). Statistical analyses were performed using Review Manager v5.3.
Four studies, containing 461 patients in total, were included for meta-analysis. Our analyses suggest that compared with induction chemotherapy, induction chemoradiotherapy improved ORR [odds ratio (OR) =1.97, 95% confidence interval (CI): 1.25-3.10, P<0.05] and pCR rate of mediastinal lymph nodes (OR =1.97, 95% CI: 1.00-3.86, P=0.05); but it did not significantly improve OS [hazard ratio (HR) =0.91, 95% CI: 0.73-1.14, P=0.42] or PFS (HR =1.01, 95% CI: 0.81-1.26, P=0.91); also it did not exacerbate the toxicity.
Induction chemoradiotherapy may have limited value concerning tumor response and pCR of mediastinal lymph nodes. However, current evidence does not support that addition of radiotherapy to induction chemotherapy followed by surgery can bring significant benefits to operable stage IIIA (N2) NSCLC patients. More studies are required to draw a better conclusion.
非小细胞肺癌（NSCLC）占肺癌病例的85%至90%。在确诊时，约30%的NSCLC患者已处于IIIA期（N2）。该阶段的一种标准治疗方法是诱导化疗后进行手术，诱导放化疗是否优于诱导化疗仍不确定。因此，我们对已发表的随机对照试验进行了系统评价和荟萃分析，以评估诱导放化疗与诱导化疗对潜在可切除的IIIA期（N2）NSCLC的治疗效果和毒性。
我们从每个数据库建立至2017年9月10日，在PubMed、Embase、Web of Science和Cochrane图书馆中系统检索相关研究。主要终点为客观缓解率（ORR）、纵隔淋巴结病理完全缓解（pCR）率、毒性（3-4级不良事件，即恶心、呕吐、感染、白细胞减少和贫血）、总生存期（OS）和无进展生存期（PFS）。使用Review Manager v5.3进行统计分析。
纳入四项研究，共461例患者进行荟萃分析。我们的分析表明，与诱导化疗相比，诱导放化疗提高了ORR[比值比（OR）=1.97，95%置信区间（CI）：1.25-3.10，P<0.05]和纵隔淋巴结pCR率（OR =1.97，95%CI：1.00-3.86，P=0.05）；但未显著改善OS[风险比（HR）=0.91，95%CI：0.73-1.14，P=0.42]或PFS（HR =1.01，95%CI：0.81-1.26，P=0.91）；也未加重毒性。
诱导放化疗在肿瘤反应和纵隔淋巴结pCR方面可能价值有限。然而目前证据不支持在诱导化疗后加放疗再行手术能给可手术的IIIA期（N2）NSCLC患者带来显著益处。需要更多研究以得出更好的结论。
