Is IMRT Superior or Inferior to 3DCRT in Radiotherapy for NSCLC? A Meta-Analysis.
BACKGROUND
There are no adequate data to determine whether intensity-modulated radiotherapy (IMRT) is superior to three-dimensional conformal radiotherapy (3DCRT) in the treatment of non-small cell lung cancer (NSCLC). This meta-analysis was conducted to compare the clinical outcomes of IMRT and 3DCRT in the treatment of NSCLC.


METHODS
No exclusions were made based on types of study design. We performed a literature search in PubMed, EMBASE and the Cochrane library databases from their inceptions to April 30, 2015. The overall survival (OS) and relative risk (RR) of radiation pneumonitis and radiation oesophagitis were evaluated. Two authors independently assessed the methodological quality and extracted data. Publication bias was evaluated by funnel plot using Egger's test results.


RESULTS
From the literature search, 10 retrospective studies were collected, and of those, 5 (12,896 patients) were selected for OS analysis, 4 (981 patients) were selected for radiation pneumonitis analysis, and 4 (1339 patients) were selected for radiation oesophagitis analysis. Cox multivariate proportional hazards models revealed that 3DCRT and IMRT had similar OS (HR = 0.96, P = 0.477) but that IMRT reduced the incidence of grade 2 radiation pneumonitis (RR = 0.74, P = 0.009) and increased the incidence of grade 3 radiation oesophagitis (RR = 2.47, P = 0.000).


CONCLUSIONS
OS of IMRT for NSCLC is not inferior to that of 3DCRT, but IMRT significantly reduces the risk of radiation pneumonitis and increases the risk of radiation oesophagitis compared to 3DCRT.
Department of Oncology, Nanchong Central Hospital (the Second Affiliated Hospital of North Sichuan Medical College), Nanchong, Sichuan Province, China.
Xingsheng
X
Hu
Department of Cardiothoracic surgery, Nanchong Central Hospital, Nanchong, Sichuan Province, China.
Wenwu
W
He
Department of Oncology, Nanchong Central Hospital (the Second Affiliated Hospital of North Sichuan Medical College), Nanchong, Sichuan Province, China.
Shimin
S
Wen
Department of Oncology, Nanchong Central Hospital (the Second Affiliated Hospital of North Sichuan Medical College), Nanchong, Sichuan Province, China.
Xuqin
X
Feng
Department of Oncology, Nanchong Central Hospital (the Second Affiliated Hospital of North Sichuan Medical College), Nanchong, Sichuan Province, China.
Xi
X
Fu
Department of Clinical Laboratory, The People's Hospital of Shifang, Shifang, Sichuan Province, China.
Yusong
Y
Liu
DaZhou college of Chinese medicine, DaZhou, Sichuan Province, China.
Ke
K
Pu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy*; D006801:Humans; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology; D017564:Radiation Pneumonitis / Q000209:etiology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000009:adverse effects / Q000379:methods; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome