Hypofractionated Versus Hyperfractionated Versus Conventionally Fractionated Thoracic Radiotherapy in Limited-Stage Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis
Shuiyu Lin1, Chengbo Ren2, Jun Chen3, Tingting Liu4, Jun Dang51Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China, 2The First Affiliated Hospital of Hebei North University, Zhangjiakou,Hebei, China., 3Department of Radiation Oncology, Shenyang Tenth People’s Hospital, Shenyang, China., 4Department of Radiation Oncology, Anshan Cancer Hospital, Anshan, China., 5Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China.,
Objectives: It remains unclear whether hypofractionated (Hypo) thoracic radiotherapy (TRT) is superior to hyperfractionated or conventionally fractionated (Con) TRT in limited-stage small-cell lung cancer. Methods: PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for eligible studies until April 30, 2023. The outcomes of interest were overall survival (OS), and grade ?3 esophagitis and pneumonitis, reported as hazard ratios (HRs) or odds ratios (ORs) with their 95% confidence intervals (CIs). Results: A total of 23 studies with 7987 patients were identified. Hypo-TRT showed similar OS compared to Hyper-TRT (HR = 1.22, 95% CI: 0.80-1.86 in randomized controlled trials [RCTs] and HR = 1.12, 95% CI: 0.99-1.28 in retrospective studies) and better OS compared to Con-TRT (HR =0.83, 95% CI: 0.70-0.97). Hyper-TRT achieved longer OS compared to Con-TRT in retrospective studies (HR = 0.91, 95% CI: 0.84-0.99), but not in RCTs (HR = 0.90, 95% CI: 0.80-1.01). There were no significant differences in incidence of grade ?3 esophagitis or pneumonitis between the three schedules. Conclusion: Hyper-TRT (45 Gy) or Con-TRT (60-70 Gy) remains a standard schedule. Hypo-TRT (40-45 Gy) is likely to be an alternative regimen. Nevertheless, these findings need to be validated in large phase 3 RCTs. Keywords: Hypofractionated; hyperfractionated; meta-analysis; small cell lung cancer; thoracic radiotherapy
Cite This Article
Lin S, Ren C, Chen J, Liu T, Dang J. Hypofractionated Versus Hyperfractionated Versus Conventionally Fractionated Thoracic Radiotherapy in Limited-Stage Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis. EJMO. 2023; 7(2): 120-134
Corresponding Author: Jun Dang