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ARTICLE

Chemotherapy plus Radiotherapy Compared with Radiotherapy Alone in the Treatment of Locally Advanced, Unresectable, Non-Small-Cell Lung Cancer

A Meta-Analysis

Robert S. Pritchard, MD, MS, and Stephen P. Anthony, DO

1 November 1996 | Volume 125 Issue 9 | Pages 723-729

Background: Survival of patients with locally advanced, unresectable (stage III), non-small-cell lung cancer treated with radiotherapy is poor. Trials of the addition of chemotherapy to radiotherapy have produced conflicting results.

Objective: To compare chemotherapy plus radiotherapy with radiotherapy alone in patients with stage III, non-small-cell lung cancer.

Data Sources: English-language journal articles published between 1987 and 1995 identified in a MEDLINE search.

Study Selection: Randomized trials that reported survival after previously untreated patients received chemotherapy plus radiotherapy or radiotherapy alone were reviewed.

Data Extraction: For all eligible articles, reported survival curves were used to determine the relative risk for death in each of 3 years. These data were combined to determine a pooled estimate of the relative risk for death at 1, 2, and 3 years.

Data Synthesis: Fourteen articles reporting on a total of 2589 patients were reviewed. Compared with radiotherapy, the combination of chemotherapy and radiotherapy reduced the risk for death at 1 year (relative risk, 0.88 [95% CI, 0.80 to 0.96]), 2 years (relative risk, 0.87 [CI, 0.81 to 0.94]), and 3 years (relative risk, 0.83 [CI, 0.77 to 0.90]). This corresponded to a mean gain in life expectancy of about 2 months. The magnitude of the treatment effect was similar when trials of concurrently and sequentially administered chemotherapy were considered separately.

Conclusion: The addition of chemotherapy to radiotherapy improves survival in patients with locally advanced, unresectable, non-small-cell lung cancer. The absolute benefit is relatively small, however, and should be balanced against the increased toxicity associated with the addition of chemotherapy.

Author and Article Information

From the Department of Veterans Affairs Medical Center, White River Junction, Vermont; and the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Disclaimer: Any opinions expressed herein are those of the authors and do not represent the opinions or policies of the Department of Veterans Affairs or the Dartmouth Medical School.
Acknowledgment: The authors thank H. Gilbert Welch, MD, MPH, for his assistance and advice and for reviewing multiple drafts of this manuscript.
Grant Support: By Veterans Affairs Health Services Research and Development Merit Review Award 92-002 (Dr. Welch).
Requests for Reprints: Robert S. Pritchard, MD, Department of Medicine (111), Department of Veterans Affairs Medical Center, White River Junction, VT 05009.
Current Author Addresses: Dr. Pritchard: Department of Medicine (111), Department of Veterans Affairs Medical Center, White River Junction, VT 05009.

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