P Marino1, A Preatoni, A Cantoni. 1. Department of Internal Medicine, University of Milano, S. Paolo Hospital, Italy.
Abstract
BACKGROUND: For patients with Stage III nonsmall cell lung cancer (NSCLC), radiation is the standard treatment, but survival remains poor. The authors performed a meta-analysis study using clinical trials that evaluated combined radiotherapy plus chemotherapy versus radiotherapy alone in patients with Stages IIIa and IIIb NSCLC: METHODS: For the meta-analysis study and the point estimates, essential data were extracted directly from published reports. RESULTS:Survival probabilities at 1, 2, 3, and 5 years, as estimated from published survival curves, were considered as the endpoints of interest. For survival at 3 and 5 years, the point estimates and the confidence intervals were used. Quality scoring of the studies also was performed. Fourteen trials were selected, comprising 1887 patients in the meta-analysis. For the cisplatin-based group, the estimated pooled odds ratio of death at 1 and 2 years was 0.76 (0.6-0.9 CI) and 0.70 (0.5-0.9 CI), with a reduction in mortality of 24% and 30%, respectively. For the noncisplatin-based group, the estimated pooled odds ratio at 1 and 2 years was 1.05 (0.7-1.5 CI) and 0.82 (0.5-1.3 CI), with a reduction in mortality of 5% and 18%, respectively. However, no significant differences were found between the percentage of survival and the CI at 3 and 5 years using the point estimates. CONCLUSIONS: These results favor combined cisplatin-based chemotherapy and radiotherapy, although it was not so at 3 and 5 years of survival. These data must, however, be considered in the light of their clinical relevance and of the balance between quality of life, toxicity, and costs of chemotherapy.
RCT Entities:
BACKGROUND: For patients with Stage III nonsmall cell lung cancer (NSCLC), radiation is the standard treatment, but survival remains poor. The authors performed a meta-analysis study using clinical trials that evaluated combined radiotherapy plus chemotherapy versus radiotherapy alone in patients with Stages IIIa and IIIb NSCLC: METHODS: For the meta-analysis study and the point estimates, essential data were extracted directly from published reports. RESULTS: Survival probabilities at 1, 2, 3, and 5 years, as estimated from published survival curves, were considered as the endpoints of interest. For survival at 3 and 5 years, the point estimates and the confidence intervals were used. Quality scoring of the studies also was performed. Fourteen trials were selected, comprising 1887 patients in the meta-analysis. For the cisplatin-based group, the estimated pooled odds ratio of death at 1 and 2 years was 0.76 (0.6-0.9 CI) and 0.70 (0.5-0.9 CI), with a reduction in mortality of 24% and 30%, respectively. For the noncisplatin-based group, the estimated pooled odds ratio at 1 and 2 years was 1.05 (0.7-1.5 CI) and 0.82 (0.5-1.3 CI), with a reduction in mortality of 5% and 18%, respectively. However, no significant differences were found between the percentage of survival and the CI at 3 and 5 years using the point estimates. CONCLUSIONS: These results favor combined cisplatin-based chemotherapy and radiotherapy, although it was not so at 3 and 5 years of survival. These data must, however, be considered in the light of their clinical relevance and of the balance between quality of life, toxicity, and costs of chemotherapy.