Efficacy and safety of hyperfractionated versus conventionally fractionated chemoradiotherapy for limited-stage small-cell lung cancer:a meta-analysis
Tong Shaodong, Wang Hui, Xie Ruilin, Wang Han, Qin Zhaohui, Yao Yuanhu
Department of Radiation Oncology,The Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China (Tong SD,Wang H,Xie RL,Wang H,Yao YH);School of Public Health,Xuzhou Medical University,Xuzhou 221004,China (Qin ZH)
Abstract：Objective To systematically evaluate the differences in efficacy and safety between hyperfractionated and conventionally fractionated radiotherapy for limited-stage small-cell lung cancer (LS-SCLC). Methods A computerized search was performed in PubMed, Embase, Cochrane Library, Web of Science, CBM, Wanfang Data, CNKI, and VIP to collect controlled clinical trials of hyperfractionated versus conventionally fractionated chemoradiotherapy in the treatment of LS-SCLC. The RevMan 5.3 softwarewas used to perform meta-analyses of short-term outcomes, survival data, and adverse events. Results Eight controlled clinical trials involving 1361 patients were enrolled in this study. The results of meta-analysis showed that there were no significant differences in objective response rate or 2-and 5-year overall survival rates between the hyperfractionation group and the conventional fractionation group (odds ratio[OR]=1.31, 95% confidence interval[CI]:0.64-2.69,P=0.46;risk ratio[RR]=1.10, 95%CI:0.98-1.24,P=0.12;RR=1.13,95%CI:0.75-1.69,P=0.56). Compared with the conventional fractionation group, the hyperfractionation group had a significantly higher incidence of grade ≥2 radiation esophagitis (RR=1.74, 95%CI:1.39-2.17,P<0.05). However, there were no significant differences in incidence rates of grade ≥2 radiation pneumonitis or grade >3 hematological toxicity between the two groups (RR=0.73, 95%CI:0.24-2.24,P=0.58;RR=1.18, 95%CI:0.99-1.39,P=0.06). Conclusions In the treatment of LS-SCLC, two fractionation modes show similar short-term efficacy and survival benefits. However, hyperfractionated radiotherapy causes a higher incidence of radiation esophagitis than conventionally fractionated radiotherapy. Given that hyperfractionated radiotherapy is not superior to conventionally fractionated radiotherapy, conventionally fractionated radiotherapy is recommended for treating LS-SCLC.
Tong Shaodong,Wang Hui,Xie Ruilin et al. Efficacy and safety of hyperfractionated versus conventionally fractionated chemoradiotherapy for limited-stage small-cell lung cancer:a meta-analysis[J]. Chinese Journal of Radiation Oncology, 2018, 27(3): 261-266.
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