title: Systematic review and meta-analysis of randomised, controlled trials of the timing of chest radiotherapy in patients with limited-stage, small-cell lung cancer.
abstract: BACKGROUND
  We undertook a systematic review and literature-based meta-analysis to determine whether the timing of chest radiotherapy may influence the survival of patients with limited-stage small-cell lung cancer (LS-SCLC).
  
  
  METHODS
  Eligible randomised controlled clinical trials were identified according to the Cochrane Collaboration Guidelines, comparing different timing of chest radiotherapy in patients with LS-SCLC. Early chest irradiation was defined as beginning within 30 days after the start of chemotherapy.
  
  
  RESULTS
  Considering all seven eligible trials, the overall survival at 2 or 5 years was not significantly different between early or late chest radiotherapy. When only trials were considered that used platinum chemotherapy concurrent with chest radiotherapy, a significantly higher 5-year survival was observed when chest radiotherapy was started within 30 days after the start of chemotherapy (2-year survival: OR: 0.73, 95% CI 0.51-1.03, P = 0.07; 5-year survival: OR: 0.64, 95% CI 0.44-0.92, P = 0.02). This was even more pronounced when the overall treatment time of chest radiotherapy was less than 30 days.
  
  
  CONCLUSIONS
  There are indications that the 5-year survival rates of patients with LS-SCLC are in favour of early chest radiotherapy, with a significant difference if the overall treatment time of chest radiation is less than 30 days.
authors.affiliation: Department of Radiotherapy, GROW, University Hospital Maastricht, Maastricht, The Netherlands. dirk.deruysscher@maastro.nl
authors.forename: D
authors.initials: D
authors.lastname: De Ruysscher
authors.forename: M
authors.initials: M
authors.lastname: Pijls-Johannesma
authors.forename: J
authors.initials: J
authors.lastname: Vansteenkiste
authors.forename: A
authors.initials: A
authors.lastname: Kester
authors.forename: I
authors.initials: I
authors.lastname: Rutten
authors.forename: P
authors.initials: P
authors.lastname: Lambin
mesh_terms: D018288:Carcinoma, Small Cell / Q000532:radiotherapy*; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors