Dados do Trabalho

Título

Once daily (OD) versus twice-daily (BID) chemoradiation for limited stage small cell lung cancer (LS-SCLC): a meta-analysis of randomized clinical trials.

Introdução

Chemotherapy and concurrent thoracic radiotherapy followed by prophylactic cranial irradiation (PCI) is the standard of care for limited-stage small-cell lung cancer (LS-SCLC) but the optimal radiotherapy schedule and dose remains controversial. The aim of this study was to establish a standard chemoradiotherapy treatment regimen in limited-stage small-cell lung cancer comparing once daily with twice daily chemoradiation.

Objetivo

Assess Once daily (OD) chemoradiation effectiveness for LS-SCLC compared with twice daily (BID) chemoradiation.

Método

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, eligible randomized clinical trials (RCT) comparing OD and BID were identified on electronic databases. A meta-analysis was performed to compare overall survival (OS), progression-free survival (PFS), and toxicity. A metaregression analysis was conducted to explore the influence of fractionation, biological effective dose (BED), % of PCI, elective nodal irradiation (ENI), and timing of radiotherapy administration (week 1 or week 4).

Resultados

Five RCTs with a total of 1941 patients (OD vs. BID) were included. The relative risk (RR) for OS and PFS was 0.97 (CI95% 0.8 – 1.1, p=0.731) and 0.90 (CI95% 0.7 – 1.1, p=0.20) at 3-years. In the metaregression analysis, HYPO schedule was associated with a relationship with survival (p=0.03). The timing of radiotherapy (W1 or W4), BED, and ENI had no significant effect on OS and PFS. The completed response rate, partial response and overall response rate for BID vs OD were 40% vs. 33% (p=0.97), 50% vs. 57% (p=0.94), and 89% vs. 93% (p=0.99). The rate of completed planned RT 96% vs. 94%(p=0.66), and the % of ≥ 4 chemotherapy cycles received 74% vs. 74% (p=0.99), did not differ between OD and BID. The local and distant failure rates were not significantly different between OD and BID 40% vs. 33% (p=0.88) and 36% vs. 36% (p=0.99). No difference in grade 2 or grade 3 pneumonitis and esophagitis was observed among the groups (p=NS).

Conclusão

For LS-SCLC, OD chemoradiation results in similar outcomes to BID chemoradiation. The hypofractionated schedule was associated with a better OS and PFS than BID. Additional randomized phase III trials are warranted to validate this outcome.