title: Hyperfractionated or accelerated radiotherapy in lung cancer: an individual patient data meta-analysis.
abstract: OBJECTIVE
  In lung cancer, randomized trials assessing hyperfractionated or accelerated radiotherapy seem to yield conflicting results regarding the effects on overall (OS) or progression-free survival (PFS). The Meta-Analysis of Radiotherapy in Lung Cancer Collaborative Group decided to address the role of modified radiotherapy fractionation.
  
  
  METHODS
  We performed an individual patient data meta-analysis in patients with nonmetastatic lung cancer, which included trials comparing modified radiotherapy with conventional radiotherapy.
  
  
  RESULTS
  In non-small-cell lung cancer (NSCLC; 10 trials, 2,000 patients), modified fractionation improved OS as compared with conventional schedules (hazard ratio [HR] = 0.88, 95% CI, 0.80 to 0.97; P = .009), resulting in an absolute benefit of 2.5% (8.3% to 10.8%) at 5 years. No evidence of heterogeneity between trials was found. There was no evidence of a benefit on PFS (HR = 0.94; 95% CI, 0.86 to 1.03; P = .19). Modified radiotherapy reduced deaths resulting from lung cancer (HR = 0.89; 95% CI, 0.81 to 0.98; P = .02), and there was a nonsignificant reduction of non-lung cancer deaths (HR = 0.87; 95% CI, 0.66 to 1.15; P = .33). In small-cell lung cancer (SCLC; two trials, 685 patients), similar results were found: OS, HR = 0.87, 95% CI, 0.74 to 1.02, P = .08; PFS, HR = 0.88, 95% CI, 0.75 to 1.03, P = .11. In both NSCLC and SCLC, the use of modified radiotherapy increased the risk of acute esophageal toxicity (odds ratio [OR] = 2.44 in NSCLC and OR = 2.41 in SCLC; P < .001) but did not have an impact on the risk of other acute toxicities.
  
  
  CONCLUSIONS
  Patients with nonmetastatic NSCLC derived a significant OS benefit from accelerated or hyperfractionated radiotherapy; a similar but nonsignificant trend was observed for SCLC. As expected, there was increased acute esophageal toxicity.
authors: Institut de Cance´rologie Gustave-Roussy, Villejuif, France.
authors: Audrey
authors: A
authors: Mauguen
authors: Cécile
authors: C
authors: Le Péchoux
authors: Michele I
authors: MI
authors: Saunders
authors: Steven E
authors: SE
authors: Schild
authors: Andrew T
authors: AT
authors: Turrisi
authors: Michael
authors: M
authors: Baumann
authors: William T
authors: WT
authors: Sause
authors: David
authors: D
authors: Ball
authors: Chandra P
authors: CP
authors: Belani
authors: James A
authors: JA
authors: Bonner
authors: Aleksander
authors: A
authors: Zajusz
authors: Suzanne E
authors: SE
authors: Dahlberg
authors: Matthew
authors: M
authors: Nankivell
authors: Sumithra J
authors: SJ
authors: Mandrekar
authors: Rebecca
authors: R
authors: Paulus
authors: Katarzyna
authors: K
authors: Behrendt
authors: Rainer
authors: R
authors: Koch
authors: James F
authors: JF
authors: Bishop
authors: Stanley
authors: S
authors: Dische
authors: Rodrigo
authors: R
authors: Arriagada
authors: Dirk
authors: D
authors: De Ruysscher
authors: Jean-Pierre
authors: JP
authors: Pignon
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000532:radiotherapy*; D018288:Carcinoma, Small Cell / Q000401:mortality / Q000532:radiotherapy*; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004947:Esophagus / Q000528:radiation effects; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance