Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Departments of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Departments of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Radiother Oncol. 2023 Jul;184:109696. doi: 10.1016/j.radonc.2023.109696. Epub 2023 May 6.
When concurrent chemoradiotherapy (CCRT) is administered for limited-stage small cell lung cancer (LS-SCLC), the early incorporation of thoracic radiotherapy (TRT) is generally recommended. However, it is controversial if this approach is really beneficial with most commonly used daily fractionated TRT in the modern era.
A systematic literature search was performed using several databases following the PRISMA guidelines from Jan 2000 to Nov 2022. We excluded twice-daily TRT-based studies. The hazard ratio (HR) for survival following late TRT as a primary effect size was pooled from comparisons within individual studies according to the timing of daily fractionated TRT (early vs. late).
A total of 10 studies including 10,164 analyzable patients met all inclusion criteria. 'Early' timing usually referred to TRT within 1-2 cycles of concurrent chemotherapy. The pooled results demonstrated that the risk of death was not significantly increased following late TRT compared with early TRT (HR 1.01, 95% CI 0.84-1.20, p = 0.94). All sensitivity analysis and planned subgroup analyses showed similar results. In comparison with early TRT, late TRT did not significantly increase the risk of progression (HR 0.94, 95% CI 0.80-1.11, p = 0.48). Furthermore, late TRT was beneficial in alleviating grade 3 or higher esophagitis (OR 0.42, p = 0.01), but no significant differences was found in pneumonitis (OR 0.62, p = 0.38), and neutropenia (OR 0.57, p = 0.11). No evidence of publication bias was found.
This is the first meta-analysis to support the late incorporation of TRT in managing patients with LS-SCLC undergoing daily fractionated CCRT in the modern era. This approach may not compromise survival and can prevent severe acute toxicities. Further prospective studies of the daily fractionated TRT timing are warranted.
在局限期小细胞肺癌（LS-SCLC）的同步放化疗（CCRT）中，一般建议早期进行胸部放疗（TRT）。然而，在现代常用的每日分割 TRT 时代，这种方法是否真的有益，仍存在争议。
根据 PRISMA 指南，我们从 2000 年 1 月至 2022 年 11 月在多个数据库中进行了系统文献检索。我们排除了基于每日两次 TRT 的研究。根据每日分割 TRT 的时间（早期与晚期），对个体研究内的比较，将生存的风险比（HR）作为主要效应大小进行了汇总。
共有 10 项研究，包括 10164 例可分析患者，符合所有纳入标准。“早期”时间通常指的是在同步化疗的 1-2 个周期内进行 TRT。汇总结果表明，与早期 TRT 相比，晚期 TRT 并不会显著增加死亡风险（HR 1.01，95%CI 0.84-1.20，p=0.94）。所有敏感性分析和计划的亚组分析均得出类似结果。与早期 TRT 相比，晚期 TRT 并不会显著增加进展风险（HR 0.94，95%CI 0.80-1.11，p=0.48）。此外，晚期 TRT 有利于缓解 3 级或更高级别的食管炎（OR 0.42，p=0.01），但在肺炎（OR 0.62，p=0.38）和中性粒细胞减少症（OR 0.57，p=0.11）方面无显著差异。未发现发表偏倚的证据。
这是第一项支持在现代接受每日分割 CCRT 的 LS-SCLC 患者中晚期加入 TRT 的荟萃分析。这种方法不会影响生存，并且可以预防严重的急性毒性。需要进一步开展关于每日分割 TRT 时间的前瞻性研究。
