CHEMOTHERAPY PLUS RADIOTHERAPY COMPARED WITH RADIOTHERAPY ALONE IN THE TREATMENT OF LOCALLY ADVANCED, UNRESECTABLE, NON-SMALL-CELL LUNG-CANCER - A METAANALYSIS

Background: Survival of patients with locally advanced, unresectable ( stage III), non-small-cell lung cancer treated with radiotherapy is po or. Trials of the addition of chemotherapy to radiotherapy have produc ed conflicting results. Objective: To compare chemotherapy plus radiot herapy with radiotherapy alone in patients with stage III, nonsmall-ce ll lung cancer. Data Sources: English-language journal articles publis hed between 1987 and 1995 identified in a MEDLINE search. Study Select ion: Randomized trials that reported survival after previously untreat ed patients received chemotherapy plus radiotherapy or radiotherapy al one were reviewed. Data Extraction: For all eligible articles, reporte d survival curves were used to determine the relative risk for death i n each of 3 years. These data were combined to determine a pooled esti mate of the relative risk for death at 1, 2, and 3 years. Data Synthes is: Fourteen articles reporting on a total of 2589 patients were revie wed. Compared with radiotherapy, the combination of chemotherapy and r adiotherapy reduced the risk for death at 1 year (relative risk, 0.88 [95% Cl, 0.80 to 0.96]), 2 years (relative risk, 0.87 [Cl, 0.81 to 0.9 4]), and 3 years (relative risk, 0.83 [Cl, 0.77 to 0.90]). This corres ponded to a mean gain in life expectancy of about 2 months. The magnit ude of the treatment effect was similar when trials of concurrently an d sequentially administered chemotherapy were considered separately. C onclusion: The addition of chemotherapy to radiotherapy improves survi val in patients with locally advanced, unresectable, non-small-cell lu ng cancer. The absolute benefit is relatively small, however, and shou ld be balanced against the increased toxicity associated with the addi tion of chemotherapy.