title: Potential of Amifostine for Chemoradiotherapy and Radiotherapy-associated Toxicity Reduction in Advanced NSCLC: A Meta-Analysis.
abstract: OBJECTIVE
  The addition of amifostine to chemoradiotherapy (CRT) or radiotherapy (RT) in advanced, inoperable NSCLC presents varying toxicity. The present study examined amifostine's effect on toxicity and efficacy of CRT or RT alone.
  
  
  METHODS
  Database searches yielded 16 eligible trials comprising of 1,057 patients. Results of randomised trials were pooled and used to estimate the overall effect.
  
  
  RESULTS
  Amifostine reduced the risk of >grade 2 acute oesophagitis by 26% [risk ratio (RR), 0.74; 95% confidence interval (CI)=0.65-0.86; p<0.0001] and the risk of acute pulmonary toxicity by 44% (RR, 0.56; 95%CI=0.41-0.75; p=0.0001). Risk of complete response was unchanged (RR, 1.64; 95%CI=0.99-2.73; p=0.06), partial response was unchanged (RR, 0.92; 95% CI=0.73-1.16; p=0.48). Statistical heterogeneity was high for toxicity but low for response.
  
  
  CONCLUSIONS
  Statistical heterogeneity of retrived results casts doubt over amifostine's efficacy in this setting, despite decreased acute oesophageal and pulmonary toxicity. Amifostine did not compromise treatment efficacy.
authors.affiliation: Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, Trinity College Dublin, Dublin, Ireland.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Devine
authors.affiliation: Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, Trinity College Dublin, Dublin, Ireland marignol@ted.ie.
authors.forename: Laure
authors.initials: L
authors.lastname: Marignol
mesh_terms: D004999:Amifostine / Q000009:adverse effects / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D016009:Chi-Square Distribution; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D016017:Odds Ratio; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011837:Radiation-Protective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D011837:Radiation-Protective Agents; D004999:Amifostine
keywords: Amifostine; NSCLC; chemoradiotherapy; non-small cell lung cancer; radiotherapy; review; toxicity