title: Chemoradiotherapy versus radiotherapy alone in elderly patients with stage III non-small cell lung cancer: A systematic review and meta-analysis.
abstract: In stage III non-small cell lung cancer (NSCLC), the standard of care in young patients is chemoradiotherapy, but this standard is not as clearly established for older patients. We aimed to determine the efficacy and harm associated with chemoradiotherapy versus radiotherapy alone in elderly (≥70 years), stage III NSCLC patients through a systematic review. We conducted a systematic search of MEDLINE, EMBASE, CENTRAL, Scopus, Web of Science and conference proceedings. Two reviewers independently identified randomized trials (RCT) and extracted trial-level data. Risk of bias was assessed and meta-analysis was conducted looking at survival and safety outcomes. We included three trials and subgroup data from one systematic review. The three RCTs had high risk of bias due primarily to lack of blinding and the systematic review scored 4/11 using the AMSTAR tool. Overall survival (HR 0.66, 95% CI 0.53-0.82; I2 0%; 3 trials; 407 patients) and progression-free survival (HR 0.67, 95% CI 0.53-0.85; I2 0%; 2 trials; 327 patients) both favored chemoradiotherapy. Risk of treatment-related death and grade 3+ pneumonitis were not significantly different between groups. In conclusion, treatment of stage III NSCLC patients 70 years or older with chemotherapy and radiotherapy is associated with improved overall survival compared to radiotherapy alone. With the exception of increased hematological toxicity, CRT appears to be tolerable in fit elderly patients and represents a reasonable standard of clinical care.
authors: University of Manitoba, Department of Internal Medicine, Winnipeg, Manitoba, Canada. Electronic address: ddawe@cancercare.mb.ca.
authors: David E
authors: DE
authors: Dawe
authors: University of Manitoba, Department of Internal Medicine, Winnipeg, Manitoba, Canada.
authors: David
authors: D
authors: Christiansen
authors: McMaster University, Department of Oncology, Hamilton, Ontario, Canada.
authors: Anand
authors: A
authors: Swaminath
authors: McMaster University, Department of Oncology, Hamilton, Ontario, Canada.
authors: Peter M
authors: PM
authors: Ellis
authors: University of Manitoba, Neil John Maclean Health Sciences Library, Winnipeg, Manitoba, Canada.
authors: Janet
authors: J
authors: Rothney
authors: University of Manitoba/Winnipeg Regional Health Authority, The George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada.
authors: Rasheda
authors: R
authors: Rabbani
authors: University of Manitoba, Department of Community Health Sciences, Winnipeg, Manitoba, Canada; University of Manitoba/Winnipeg Regional Health Authority, The George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada.
authors: Ahmed M
authors: AM
authors: Abou-Setta
authors: University of Manitoba, Department of Internal Medicine, Winnipeg, Manitoba, Canada; University of Manitoba, Department of Community Health Sciences, Winnipeg, Manitoba, Canada; University of Manitoba/Winnipeg Regional Health Authority, The George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada.
authors: Ryan
authors: R
authors: Zarychanski
authors: University of Manitoba, Department of Community Health Sciences, Winnipeg, Manitoba, Canada; University of Manitoba/Winnipeg Regional Health Authority, The George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada.
authors: Salaheddin M
authors: SM
authors: Mahmud
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D009367:Neoplasm Staging; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
keywords: Chemoradiotherapy; Elderly; Non-small cell lung cancer; Systematic review; Treatment