Earlier or shorter delivery of thoracic radiotherapy in addition to planned chemotherapy my significantly improve 5-year overall survival, albeit with more acute toxicity, according to a study published in the Annals of Oncology.
While chemotherapy combined with radiotherapy is the standard of care for limited-stage small-cell lung cancer, controversy remains about the optimal timing of thoracic radiotherapy. Therefore, researchers led by Jean-Pierre Gignon, Institut Gustave Roussy (Villejuif, France), performed a meta-analysis of individual patient data in randomized clinical trials to compare earlier and later radiotherapy, or shorter and longer radiotherapy duration. Statistical analyses were used to measure the effect of each on overall survival, the primary outcome of the study.
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A total of 9 trials including 2305 patients were deemed eligible for study inclusion and available for analysis. Among these patients, median follow-up time was 10 years. When trials were analyzed together, the researchers found that the timing of radiotherapy did not affect overall survival. However, hazard ratios for overall survival did tend to favor earlier or shorter delivery among trials with smaller numbers of patients who were compliant with chemotherapy, while patients in trials with different chemotherapy compliance tended to have more favorable hazard ratios with later or longer radiotherapy.
Additionally, the absolute gain in overall survival was 7.7% and -2.2% in patients treated with earlier or shorter thoracic radiotherapy vs those who received later or longer regimens, respectively. However, the earlier or shorter timing was also associated with a higher incidence of severe acute oesophagitis than what was observed in the later or longer group.
Thus, researchers concluded that while earlier or shorter radiotherapy regimens may significantly improve 5-year overall survival compared with later or longer delivery, it also may result in more adverse events, particularly oseophagitis.
