Essay About Small Cell Lung Cancer And Lung Tumours

Concomitant Radio-Chemotherapy Based On Platin
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introduction
Lung cancer remains a major cause of death worldwide with
over 1.1 million deaths per year [1]. Non-small cell lung
cancer (NSCLC) accounts for at least 80% of all lung tumours.
About 35% of these patients present with locally advanced
non-metastatic disease [2] for whom radical thoracic
radiotherapy is frequently part of treatment. The NSCLC
Collaborative Group meta-analysis [3] showed that sequential
cisplatin-based chemotherapy given in addition to radical
radiotherapy prolonged survival in patients with locally
advanced NSCLC. However, the prognosis for these patients
remained poor with a 3-year survival rate of approximately
14%. Cytotoxic agents used as radiosensitisers given at the
same time as radiotherapy have been evaluated against
radiotherapy alone in several randomised trials [4—14].
A primary aim of this combined approach was to improve
survival by increasing loco-regional control, while the
sequential use of chemotherapy has been directed at reducing
the rate of distant metastasis. However, the majority of the
trials performed have reported inconclusive results and it is
original
article
*Correspondence to: Dr A. AupeÐÒ rin, Unit of Biostatistics and Epidemiology,
Institut Gustave-Roussy, 94805 Villejuif Cedex, France. E-mail: [email protected]
ÐЄ 2006 European Society for Medical Oncology
still controversial whether concomitant radio-chemotherapy
does in fact improve survival of patients with locally advanced
NSCLC. The size of most of these trials has not been large
enough to detect a 5 to 10% increase in survival and there
were also some heterogeneities in the trial designs.
The Meta-Analysis of Cisplatin/carboplatin based
Concomitant Chemotherapy in non-small cell Lung Cancer
(MAC3-LC) Group was therefore created to undertake
a meta-analysis based on all available individual patient data
from randomised trials. Combining the data of these trials
could provide increased statistical power, time to event
analyses conducted in intention-to-treat and subgroup
analyses leading to greater ability to determine whether
concomitant chemotherapy might lead to a moderate
improvement in survival in patients with locally
advanced NSCLC.
methods
selection criteria
Trials were eligible provided they randomised patients with locally
advanced unresectable or inoperable NSCLC without distant metastasis
to receive radiotherapy alone or radiotherapy combined with concomitant
systemic chemotherapy based on cisplatin or carboplatin. Trials had to
have been adequately randomised. Trials were considered if the
radiotherapy regimen was the same in both arms. Patients should not
have received prior radiotherapy or chemotherapy. Published and
unpublished trials without language restriction were eligible. Trials with
patient accrual completed after 2000 were ineligible.
search methods
Trials published between 1985 and 2002 were sought by searching
electronic databases (Medline, Embase, Cancerlit) without language
restriction, using the search terms: (Carcinoma, Non-Small Cell Lung/drug
therapy, lung neoplasms) and (Carcinoma, Non-Small Cell Lung/
radiotherapy, lung neoplasms) and (clinical trial phase III, randomised
controlled trials). This was supplemented by manual searches (reference
lists of trial publications, review articles, relevant books, meeting
proceedings of American Society of Clinical Oncology and International
Association for the Study of Lung Cancer). The Physician Data Query
(PDQ) clinical trial registry and the Cochrane library were also searched
and investigators and experts were asked to help identify trials.
individual patient data
Individual patient data were collected for all randomised patients.
The following data were requested: gender, age, performance status at the
time of randomisation, stage, histopathology, randomisation date,
allocated treatment, and updated information on survival and on first
recurrence. Data were checked for internal consistency and with published
results. Amendments were made as necessary through discussion with the
investigators.
statistical analysis
The main endpoint was overall survival which was evaluated from the
time of randomisation until death due to any