PURPOSE: In lung cancer, randomized trials assessing hyperfractionated or accelerated radiotherapy seem to yield conflicting results regarding the effects on overall (OS) or progression-free survival (PFS). The Meta-Analysis of Radiotherapy in Lung Cancer Collaborative Group decided to address the role of modified radiotherapy fractionation. MATERIAL AND METHODS: We performed an individual patient data meta-analysis in patients with nonmetastatic lung cancer, which included trials comparing modified radiotherapy with conventional radiotherapy. RESULTS: In non-small-cell lung cancer (NSCLC; 10 trials, 2,000 patients), modified fractionation improved OS as compared with conventional schedules (hazard ratio [HR] = 0.88, 95% CI, 0.80 to 0.97; P = .009), resulting in an absolute benefit of 2.5% (8.3% to 10.8%) at 5 years. No evidence of heterogeneity between trials was found. There was no evidence of a benefit on PFS (HR = 0.94; 95% CI, 0.86 to 1.03; P = .19). Modified radiotherapy reduced deaths resulting from lung cancer (HR = 0.89; 95% CI, 0.81 to 0.98; P = .02), and there was a nonsignificant reduction of non-lung cancer deaths (HR = 0.87; 95% CI, 0.66 to 1.15; P = .33). In small-cell lung cancer (SCLC; two trials, 685 patients), similar results were found: OS, HR = 0.87, 95% CI, 0.74 to 1.02, P = .08; PFS, HR = 0.88, 95% CI, 0.75 to 1.03, P = .11. In both NSCLC and SCLC, the use of modified radiotherapy increased the risk of acute esophageal toxicity (odds ratio [OR] = 2.44 in NSCLC and OR = 2.41 in SCLC; P < .001) but did not have an impact on the risk of other acute toxicities. CONCLUSION: Patients with nonmetastatic NSCLC derived a significant OS benefit from accelerated or hyperfractionated radiotherapy; a similar but nonsignificant trend was observed for SCLC. As expected, there was increased acute esophageal toxicity.
PURPOSE: In lung cancer, randomized trials assessing hyperfractionated or accelerated radiotherapy seem to yield conflicting results regarding the effects on overall (OS) or progression-free survival (PFS). The Meta-Analysis of Radiotherapy in Lung Cancer Collaborative Group decided to address the role of modified radiotherapy fractionation. MATERIAL AND METHODS: We performed an individual patient data meta-analysis in patients with nonmetastatic lung cancer, which included trials comparing modified radiotherapy with conventional radiotherapy. RESULTS: In non-small-cell lung cancer (NSCLC; 10 trials, 2,000 patients), modified fractionation improved OS as compared with conventional schedules (hazard ratio [HR] = 0.88, 95% CI, 0.80 to 0.97; P = .009), resulting in an absolute benefit of 2.5% (8.3% to 10.8%) at 5 years. No evidence of heterogeneity between trials was found. There was no evidence of a benefit on PFS (HR = 0.94; 95% CI, 0.86 to 1.03; P = .19). Modified radiotherapy reduced deaths resulting from lung cancer (HR = 0.89; 95% CI, 0.81 to 0.98; P = .02), and there was a nonsignificant reduction of non-lung cancer deaths (HR = 0.87; 95% CI, 0.66 to 1.15; P = .33). In small-cell lung cancer (SCLC; two trials, 685 patients), similar results were found: OS, HR = 0.87, 95% CI, 0.74 to 1.02, P = .08; PFS, HR = 0.88, 95% CI, 0.75 to 1.03, P = .11. In both NSCLC and SCLC, the use of modified radiotherapy increased the risk of acute esophageal toxicity (odds ratio [OR] = 2.44 in NSCLC and OR = 2.41 in SCLC; P < .001) but did not have an impact on the risk of other acute toxicities. CONCLUSION:Patients with nonmetastatic NSCLC derived a significant OS benefit from accelerated or hyperfractionated radiotherapy; a similar but nonsignificant trend was observed for SCLC. As expected, there was increased acute esophageal toxicity.
Authors: Steven E Schild; Philip J Stella; Susan M Geyer; James A Bonner; Randolph S Marks; William L McGinnis; Steven P Goetz; Steven A Kuross; James A Mailliard; John W Kugler; Paul L Schaefer; James R Jett Journal: Int J Radiat Oncol Biol Phys Date: 2002-10-01 Impact factor: 7.038
Authors: Steven E Schild; James A Bonner; Thomas G Shanahan; Burke J Brooks; Randolph S Marks; Susan M Geyer; Shauna L Hillman; Gist H Farr; Henry D Tazelaar; James E Krook; Francois J Geoffroy; Muhammad Salim; Robert M Arusell; James A Mailliard; Paul L Schaefer; James R Jett Journal: Int J Radiat Oncol Biol Phys Date: 2004-07-15 Impact factor: 7.038
Authors: Jean-Pierre Pignon; Hélène Tribodet; Giorgio V Scagliotti; Jean-Yves Douillard; Frances A Shepherd; Richard J Stephens; Ariane Dunant; Valter Torri; Rafael Rosell; Lesley Seymour; Stephen G Spiro; Estelle Rolland; Roldano Fossati; Delphine Aubert; Keyue Ding; David Waller; Thierry Le Chevalier Journal: J Clin Oncol Date: 2008-05-27 Impact factor: 44.544
Authors: Steven E Schild; Shauna L Hillman; Angelina D Tan; Helen J Ross; William L McGinnis; Yolanda A Garces; David L Graham; Alex A Adjei; James R Jett Journal: J Thorac Oncol Date: 2017-01-12 Impact factor: 15.609
Authors: D De Ruysscher; B Lueza; C Le Péchoux; D H Johnson; M O'Brien; N Murray; S Spiro; X Wang; M Takada; B Lebeau; W Blackstock; D Skarlos; P Baas; H Choy; A Price; L Seymour; R Arriagada; J-P Pignon Journal: Ann Oncol Date: 2016-07-19 Impact factor: 32.976
Authors: M Majem; J Hernández-Hernández; F Hernando-Trancho; N Rodríguez de Dios; A Sotoca; J C Trujillo-Reyes; I Vollmer; R Delgado-Bolton; M Provencio Journal: Clin Transl Oncol Date: 2019-06-06 Impact factor: 3.405
Authors: Willem Grootjans; Lioe-Fee de Geus-Oei; Esther G C Troost; Eric P Visser; Wim J G Oyen; Johan Bussink Journal: Nat Rev Clin Oncol Date: 2015-04-28 Impact factor: 66.675
Authors: Samhita Chakraborty; Monica M Morris; Todd W Bauer; Reid B Adams; Edward B Stelow; Gina Petroni; Hanna K Sanoff Journal: Gastrointest Cancer Res Date: 2014-01