Meta-analysis
Comparison of the effectiveness of radiotherapy with photons, protons and carbon-ions for non-small cell lung cancer: A meta-analysis

https://doi.org/10.1016/j.radonc.2009.08.003Get rights and content

Abstract

Purpose: To provide a comparison between radiotherapy with photons, protons and carbon-ions in the treatment of Non-Small-Cell Lung Cancer (NSCLC), performing a meta-analysis of observational studies. Methods: Eligible studies on conventional radiotherapy (CRT), stereotactic radiotherapy (SBRT), concurrent chemoradiation (CCR), proton therapy and carbon-ion therapy were searched through a systematic review. To obtain pooled estimates of 2- and 5-year disease-specific and overall survival and the occurrence of severe adverse events for each treatment modality, a random effects meta-analysis was carried out. Pooled estimates were corrected for effect modifiers. Results: Corrected pooled estimates for 2-year overall survival in stage I inoperable NSCLC ranged from 53% for CRT to 74% for carbon-ion therapy. Five-year overall survival for CRT (20%) was statistically significantly lower than that for SBRT (42%), proton therapy (40%) and carbon-ion therapy (42%). However, caution is warranted due to the limited number of patients and limited length of follow-up of the particle studies. Conclusion: Survival rates for particle therapy were higher than those for CRT, but similar to SBRT in stage I inoperable NSCLC. Particle therapy may be more beneficial in stage III NSCLC, especially in reducing adverse events.

Section snippets

Methods

This meta-analysis was performed according to the guidelines proposed by the Meta-Analysis of Observational Studies in Epidemiology group [15].

Selected articles and characteristics

Regarding the search on CRT and SBRT, on the basis of the keywords, 1711 articles were found. Excluding papers with review as publication type left 1289, of which another 1102 were excluded based on the screening of the titles. Most excluded references were papers on chemoradiation, advanced stage NSCLC or planning studies. Of the remaining 187 references the abstracts were screened and, if necessary, the papers were retrieved and the data were analyzed. Of these 187 references another 159 were

Discussion

To the best of our knowledge, this meta-analysis was the first to pool the effectiveness of CRT, SBRT, proton therapy and carbon-ion therapy in the treatment of stage I NSCLC, to allow for a comparison between particle therapy and photon therapy. A total of 30 studies met the inclusion criteria and were used in the meta-analysis. Two- and five-year (disease-specific) survival rates, corrected for differences in the percentage of medically inoperable patients in the studies, were lower for CRT

Acknowledgement

This study was funded by an unrestricted grant from Siemens Medical Solutions.

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    These authors contributed equally to this work.

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