Title: Hyperfractionated or accelerated radiotherapy in lung cancer: an individual patient data meta-analysis
Authors: Mauguen, Audrey ×
Le Péchoux, Cécile
Saunders, Michele I
Schild, Steven E
Turrisi, Andrew T
Baumann, Michael
Sause, William T
Ball, David
Belani, Chandra P
Bonner, James A
Zajusz, Aleksander
Dahlberg, Suzanne E
Nankivell, Matthew
Mandrekar, Sumithra J
Paulus, Rebecca
Behrendt, Katarzyna
Koch, Rainer
Bishop, James F
Dische, Stanley
Arriagada, Rodrigo
De Ruysscher, Dirk
Pignon, Jean-Pierre #
Issue Date: Aug-2012
Publisher: Grune & Stratton
Series Title: Journal of Clinical Oncology vol:30 issue:22 pages:2788-2797
Abstract: 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.
ISSN: 0732-183X
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Non-KU Leuven Association publications
× corresponding author
# (joint) last author

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