title: Is consolidation chemotherapy after concurrent chemo-radiotherapy beneficial for patients with locally advanced non-small-cell lung cancer? A pooled analysis of the literature.
abstract: BACKGROUND
  The purpose of this study was to evaluate whether consolidation chemotherapy (CCT) after concurrent chemo-radiotherapy is beneficial for patients with locally advanced non-small-cell lung cancer (LA-NSCLC).
  
  
  METHODS
  We systematically searched PubMed for phase II/III trials published before December 31, 2011, examining survival of LA-NSCLC treated with concurrent chemo-radiotherapy. Median overall survival and other study characteristics were collected from each study and pooled. We extracted log-transformed hazards and standard errors under the assumption that survival follows an exponential distribution, and computed a pooled median overall survival and a 95% confidence interval (CI) using random-effects model. Collected trial arms were categorized as having CCT or not having it, CCT+ and CCT-, respectively.
  
  
  RESULTS
  Forty-one studies were identified including seven phase III studies and 34 phase II studies with 45 arms (CCT+: 25; CCT-: 20). Clinical data were comparable for clinical stage, performance status, cancer histology, sex, and median age between the two groups. There was no statistical difference in pooled mOS between CCT+ (19.0 month; 95% CI, 17.3-21.0) and CCT- (17.9 month; 95% CI, 16.1-19.9). Predicted hazard ratio of CCT+ to CCT- was 0.94 (95% CI, 0.81-1.09; p = 0.40). There were no differences between the two groups with regard to grade 3-5 toxicities in pneumonitis, esophagitis, and neutropenia. These models estimated that addition of CCT could not lead to significant survival prolongation or risk reduction in death for LA-NSCLC patients.
  
  
  CONCLUSIONS
  The pooled analysis based on a publication basis failed to provide evidence that CCT yields significant survival benefit for LA-NSCLC.
authors.affiliation: Department of Respiratory Medicine, Kinki Central Hospital, Itami, Hyogo, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Tsujino
authors.forename: Takayasu
authors.initials: T
authors.lastname: Kurata
authors.forename: Satomi
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Tomoya
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Akihito
authors.initials: A
authors.lastname: Kubo
authors.forename: Shunichi
authors.initials: S
authors.lastname: Isa
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Sai-Hong Ignatius
authors.initials: SH
authors.lastname: Ou
authors.forename: Minoru
authors.initials: M
authors.lastname: Takada
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ando
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy / Q000401:mortality*; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D060830:Consolidation Chemotherapy / Q000401:mortality*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate