Department of Radiation Oncology, CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada.
BioIRC Centre for Biomedical Research, Kragujevac, Serbia.
Eur J Cancer. 2019 Mar;110:110-119. doi: 10.1016/j.ejca.2019.01.003. Epub 2019 Feb 18.
Extensive stage small cell lung cancer (ES-SCLC) carries a poor prognosis, and the thoracic progression is common. Consolidation radiation to thoracic disease (cRT) could improve progression-free survival (PFS) and overall survival (OS). We conducted an electronic search of PubMed and Embase with no language, year or publication status restrictions and evaluated randomised controlled trials (RCTs) addressing the role of cRT in ES-SCLC. Preferred Reporting of Systematic Reviews and Meta-Analyses guidelines for systematic review and Cochrane methodology for meta-analysis were followed. Effect estimates (hazard ratios [HRs] and confidence intervals [CIs]) and risk ratios were extracted, with a fixed/random-effects model created to estimate treatment effects. I2 statistics and heterogeneity statistics were performed. Comprehensive and systematic search identified 1107 records, after removal of duplicate records screened 922 records, assessed 31 full-text articles for eligibility and 3 RCTs with a total of 690 patients were included. Pooled analysis showed cRT significant improved PFS (p < 0.0001) with HR 0.72 (95% CI: 0.61-0.83, I2-0%). In addition, cRT significantly (p < 0.001) reduced the risk of thoracic progression as the first site of progression with a relative risk of 0.52 (95% CI: 0.44-0.61, I2-0%). OS analysis showed no significant (p = 0.36) benefit with HR of 0.88 (95% CI 0.66-1.18, I2-52%) with cRT. Pooled meta-analysis of 3 randomised controlled studies shows consolidation thoracic radiotherapy (RT) offers significant improvement in PFS and reduction in thoracic failures. Further research on subclassification of ES-SCLC (limited vs extensive metastasis), optimise strategy for RT integration (sequential vs concurrent) and optimal RT dose is needed to identify the subset of ES-SCLC likely to have significant OS benefit.
广泛期小细胞肺癌（ES-SCLC）预后不良，且常见胸部进展。对胸部疾病进行巩固性放疗（cRT）可改善无进展生存期（PFS）和总生存期（OS）。我们对 PubMed 和 Embase 进行了电子检索，未对语言、年份或发表状态进行限制，并评估了针对 ES-SCLC 中 cRT 作用的随机对照试验（RCT）。遵循了系统评价和荟萃分析的 Preferred Reporting of Systematic Reviews and Meta-Analyses 指南和 Cochrane 荟萃分析方法。提取了效应估计值（风险比[HR]和置信区间[CI]）和风险比，并使用固定/随机效应模型来估计治疗效果。进行了 I2 统计和异质性统计。全面和系统的搜索确定了 1107 条记录，在去除重复记录后筛选了 922 条记录，评估了 31 篇全文文章的资格，并纳入了 3 项共 690 名患者的 RCT。汇总分析表明，cRT 显著改善了 PFS（p<0.0001），HR 为 0.72（95%CI：0.61-0.83，I2-0%）。此外，cRT 显著降低了胸部进展作为首次进展部位的风险（相对风险为 0.52，95%CI：0.44-0.61，I2-0%）（p<0.001）。OS 分析显示，cRT 无显著获益（p=0.36），HR 为 0.88（95%CI 0.66-1.18，I2-52%）。3 项随机对照研究的汇总荟萃分析表明，巩固性胸部放疗（RT）可显著改善 PFS 并减少胸部失败。需要进一步对 ES-SCLC（局限性 vs 广泛转移）进行亚分类研究，优化 RT 整合策略（序贯 vs 同步）和最佳 RT 剂量，以确定可能具有显著 OS 获益的 ES-SCLC 亚组。
