Anna Merlotti1, Alessio Bruni2, Paolo Borghetti3, Sara Ramella4, Vieri Scotti5, Marco Trovò6, Rita Chiari7, Frank Lohr8, Umberto Ricardi9, Emilio Bria10, Giovanni L Pappagallo11, Rolando M D'Angelillo12, Stefano Arcangeli13. 1. Department of Radiation Oncology, S. Croce and Carle Teaching Hospital, via M. Coppino 26, 12100, Cuneo, Italy. anna.merlotti@virgilio.it. 2. Radiotherapy Unit, Oncology and Hematology Department, University Hospital of Modena, Modena, Italy. 3. Department of Radiation Oncology, Istituto del Radio O. Alberti, Spedali Civili Hospital and Brescia University, Brescia, Italy. 4. Department of Radiation Oncology, Campus Bio-Medico University, Rome, Italy. 5. Radiotherapy Unit V Scotti, Thoracic Surgery Unit L Voltolini, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy. 6. Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata UD, Udine, Italy. 7. Medical Oncology, Ospedali Riuniti Padova Sud, Padova, Italy. 8. Radiotherapy Unit, Department of Oncology, A.O. U. Di Modena, Modena, Italy. 9. Department of Oncology, University of Torino, Torino, Italy. 10. Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. 11. , Silea, TV, Italy. 12. Department of Biomedicine and Prevention, Università Degli Studi Di Roma Tor Vergata, Rome, Italy. 13. Department of Radiation Oncology, Policlinico S. Gerardo and University of Milan "Bicocca", Milan, Italy.
Abstract
INTRODUCTION: Almost 30% of non-small cell lung cancer (NSCLC) patients have locally advanced-stage disease. In this setting, definitive radiotherapy concurrent to chemotherapy plus adjuvant immunotherapy (cCRT + IO) is the standard of care, although only 40% of these patients are eligible for this approach. AIMS: A comparison between cCRT and hypofractionated radiotherapy regimens (hypo-fx RT) with the addition of sequential chemotherapy (sCHT) could be useful for future combinations with immunotherapy. We developed a recommendation about the clinical question of whether CHT and moderately hypo-fx RT are comparable to cCRT for locally advanced NSCLC MATERIALS AND METHODS: The panel used GRADE methodology and the Evidence to Decision (EtD) framework. After a systematic literature search, five studies were eligible. We identified the following outcomes: progression-free survival (PFS), overall survival (OS), freedom from locoregional recurrence (FFLR), deterioration of quality of life (QoL), treatment-related deaths, severe G3-G4 toxicity, late pulmonary toxicity G3-G4, and acute esophageal toxicity G3-G4. RESULTS: The probability of OS and G3-G4 late lung toxicity seems to be worse in patients submitted to sCHT and hypo-fx RT. The panel judged unfavorable the balance benefits/harms. CONCLUSIONS: The final recommendation was that sCHT followed by moderately hypo-fx RT should not be considered as an alternative to cCRT in unresectable stage III NSCLC patients.
INTRODUCTION: Almost 30% of non-small cell lung cancer (NSCLC) patients have locally advanced-stage disease. In this setting, definitive radiotherapy concurrent to chemotherapy plus adjuvant immunotherapy (cCRT + IO) is the standard of care, although only 40% of these patients are eligible for this approach. AIMS: A comparison between cCRT and hypofractionated radiotherapy regimens (hypo-fx RT) with the addition of sequential chemotherapy (sCHT) could be useful for future combinations with immunotherapy. We developed a recommendation about the clinical question of whether CHT and moderately hypo-fx RT are comparable to cCRT for locally advanced NSCLC MATERIALS AND METHODS: The panel used GRADE methodology and the Evidence to Decision (EtD) framework. After a systematic literature search, five studies were eligible. We identified the following outcomes: progression-free survival (PFS), overall survival (OS), freedom from locoregional recurrence (FFLR), deterioration of quality of life (QoL), treatment-related deaths, severe G3-G4toxicity, late pulmonary toxicityG3-G4, and acute esophageal toxicityG3-G4. RESULTS: The probability of OS and G3-G4 late lung toxicity seems to be worse in patients submitted to sCHT and hypo-fx RT. The panel judged unfavorable the balance benefits/harms. CONCLUSIONS: The final recommendation was that sCHT followed by moderately hypo-fx RT should not be considered as an alternative to cCRT in unresectable stage III NSCLCpatients.
Authors: W E E Eberhardt; D De Ruysscher; W Weder; C Le Péchoux; P De Leyn; H Hoffmann; V Westeel; R Stahel; E Felip; S Peters Journal: Ann Oncol Date: 2015-04-20 Impact factor: 32.976
Authors: Scott J Antonia; Augusto Villegas; Davey Daniel; David Vicente; Shuji Murakami; Rina Hui; Takayasu Kurata; Alberto Chiappori; Ki H Lee; Maike de Wit; Byoung C Cho; Maryam Bourhaba; Xavier Quantin; Takaaki Tokito; Tarek Mekhail; David Planchard; Young-Chul Kim; Christos S Karapetis; Sandrine Hiret; Gyula Ostoros; Kaoru Kubota; Jhanelle E Gray; Luis Paz-Ares; Javier de Castro Carpeño; Corinne Faivre-Finn; Martin Reck; Johan Vansteenkiste; David R Spigel; Catherine Wadsworth; Giovanni Melillo; Maria Taboada; Phillip A Dennis; Mustafa Özgüroğlu Journal: N Engl J Med Date: 2018-09-25 Impact factor: 91.245
Authors: Zheng-Fei Zhu; Hong-Lian Ma; Min Fan; Yong Bao; Ting-Ting Zhuang; Ming Chen; Guo-Liang Jiang; Xiao-Long Fu Journal: Technol Cancer Res Treat Date: 2013-09-20
Authors: Jhanelle E Gray; Augusto Villegas; Davey Daniel; David Vicente; Shuji Murakami; Rina Hui; Takayasu Kurata; Alberto Chiappori; Ki Hyeong Lee; Byoung Chul Cho; David Planchard; Luis Paz-Ares; Corinne Faivre-Finn; Johan F Vansteenkiste; David R Spigel; Catherine Wadsworth; Maria Taboada; Phillip A Dennis; Mustafa Özgüroğlu; Scott J Antonia Journal: J Thorac Oncol Date: 2019-10-14 Impact factor: 15.609