Treatment-Related Death during Concurrent Chemoradiotherapy for Locally Advanced Non-Small Cell Lung Cancer: A Meta-Analysis of Randomized Studies.
Treatment related death (TRD) is the worst adverse event in chemotherapy and radiotherapy for patients with cancer, the reports for TRDs were sporadically. We aimed to study TRDs in non-small cell lung cancer (NSCLC) patients treated with concurrent chemoradiotherapy (CCRT), and determine whether high radiation dose and newer chemotherapy regimens were associated with the risk of TRD. Data from randomized clinical trials for locally advanced/unresectable NSCLC patients were analyzed. Eligible studies had to have at least one arm with CCRT. The primary endpoint was TRD. Pooled odds ratios (ORs) for TRDs were calculated. In this study, a total of fifty-three trials (8940 patients) were eligible. The pooled TRD rate (accounting for heterogeneity) was 1.44% for all patients. In 20 trials in which comparison of TRDs between CCRT and non-CCRT was possible, the OR (95% CI) of TRDs was 1.08 (0.70-1.66) (P = 0.71). Patients treated with third-generation chemotherapy and concurrent radiotherapy had an increase of TRDs compared to those with other regimens in CCRT (2.70% vs. 1.37%, OR = 1.50, 95% CI: 1.09-2.07, P = 0.008). No significant difference was found in TRDs between high (≥ 66 Gy) and low (< 66 Gy) radiation dose during CCRT (P = 0.605). Neither consolidation (P = 0.476) nor induction chemotherapy (P = 0.175) had significant effects with increased TRDs in this study. We concluded that CCRT is not significantly associated with the risk of TRD compared to non-CCRT. The third-generation chemotherapy regimens may be a risk factor with higher TRDs in CCRT, while high dose radiation is not significantly associated with more TRDs. This observation deserves further study.
Department of Radiation Oncology, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, GA, United States of America.|Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Jing
J
Zhao
The First Hospital of Yichang, The People's Hospital of Three Gorges University, Yichang, China.
Yingfeng
Y
Xia
Department of Radiation Oncology, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, GA, United States of America.
Joseph
J
Kaminski
Department of Internal Medicine, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, GA, United States of America.
Zhonglin
Z
Hao
Department of Internal Medicine, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, GA, United States of America.
Frank
F
Mott
Department of Radiation Oncology, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, GA, United States of America.
Jeff
J
Campbell
Department of Biostatistics and Epidemiology, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, GA, United States of America.
Ramses
R
Sadek
Department of Radiation Oncology, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, GA, United States of America.
Feng-Ming Spring
FM
Kong
D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008168:Lung / Q000187:drug effects / Q000473:pathology / Q000528:radiation effects; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors