title: An updated systematic review of lung chemo-radiotherapy using a new evidence aggregation method.
abstract: OBJECTIVE
  The main treatment for locally-advanced, unresectable non-small cell lung cancer (NSCLC) is radical radiotherapy, with or without chemotherapy. Numerous trials have been performed, the results of which often disagree. Despite publication of several systematic reviews, there is not a consensus on practice, and outcomes are poor. To address this problem, we have applied a recently published evidence aggregation method to update the Cochrane systematic review (CSR) of lung chemo-radiotherapy.
  
  
  METHODS
  We extracted data on 28 trials consisting of 4352 patients treated using 54 different regimens. We aggregated trials involving heterogeneous outcomes (both effects and side-effects). Our method identifies the evidence for the "best" treatment using preference criteria over outcomes and criteria concerning evidence quality.
  
  
  RESULTS
  Concurrent, platinum-based, conventionally fractionated chemo-radiotherapy was the most strongly supported option. 60 Gy in 30 fractions with concurrent cisplatin and vinblastine was superior under all combinations of preference criteria and evidence quality criteria that were considered. There was evidence for the use of concurrent and consolidation chemotherapy with conventionally-fractionated radiotherapy, but the choice of individual regimen was highly dependent on the choices for preference criteria over outcomes and for the criteria concerning evidence quality.
  
  
  CONCLUSIONS
  Using evidence from the trials analysed in the CSR, together with some more recent studies, we identify a finer-grained recommendation than the CSR, though our findings are consistent with that of the CSR. Furthermore, we have identified individual regimens that may be optimal.
authors: Department of Clinical Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, United Kingdom; Department of Computer Science, University College London, Gower Street, London, United Kingdom. Electronic address: Matthew.williams2@imperial.nhs.uk.
authors: Matt
authors: M
authors: Williams
authors: Department of Otolaryngology, Head and Neck Surgery, Broomfield Hospital, Chelmsford CM1 7ET, United Kingdom.
authors: Zi Wei
authors: ZW
authors: Liu
authors: Department of Computer Science, University College London, Gower Street, London, United Kingdom.
authors: Anthony
authors: A
authors: Hunter
authors: Wales Cancer Trials Unit, Cardiff University, Heath Park, Cardiff CF14 4YS, United Kingdom.
authors: Fergus
authors: F
authors: Macbeth
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D059248:Chemoradiotherapy; D002986:Clinical Trials as Topic; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D016896:Treatment Outcome
keywords: Chemotherapy; Computer Science; Hyperfractionated radiotherapy; Meta-analysis; Methodology; Radical radiotherapy