Correlates of benefit from neoadjuvant chemotherapy before radiotherapy in non-small cell lung cancer: a meta-analytical approach with meta-regression analysis.
OBJECTIVE
Induction chemotherapy before radiotherapy, although inferior to concomitant chemoradiotherapy, is still used in clinical practice, and improves survival compared to radiotherapy alone in unresectable non-small cell lung cancer (NSCLC). In this setting, we assessed the predictors of benefit from neoadjuvant chemotherapy before radiotherapy.


METHODS
Searches were made for randomized clinical trials (RCTs) that compared neoadjuvant chemotherapy with no treatment, administered before definitive radiotherapy. Relative risk (RR) was employed to define the risk of death at 2 and 3 years. Additionally, meta-regression analysis was conducted to explain heterogeneity.


RESULTS
Thirteen RCTs to date, encompassing 2776 patients, were identified. In this updated meta-analysis, neoadjuvant chemotherapy significantly reduced the risk of death, both at 2 and 3 years (RR = 0.91 and 0.94, respectively, both p < 0.001). Additionally, time to radiotherapy was inversely associated with the benefit from neoadjuvant chemotherapy at 2 (t = 2.20, p = 0.050) and 3 years (t = 1.84, p = 0.093).


CONCLUSIONS
This meta-analysis confirms the importance of neoadjuvant chemotherapy before radiotherapy and highlights the importance of shorter time to radiotherapy to maximize NSCLC patients' survival.
Bozcuk
H
H
Akdeniz University Medical Faculty, Department of Internal Medicine, Division of Medical Oncology, Antalya, Turkey. hbozcuk@akdeniz.edu.tr
Artac
M
M
Ozdogan
M
M
D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome