Modified Radiotherapy May Improve Survival in Lung Cancer
By Zosia Chustecka
Medscape Medical News
May 18, 2010 — Accelerated or hyperfractionated radiotherapy regimens might offer a survival benefit over conventional radiotherapy in patients with nonsmall cell lung cancer (NSCLC) and small-cell lung cancer (SCLC), concludes a new meta-analysis of 2279 patients.
The finding was reported at the recent 2nd European Lung Cancer Conference in Geneva, Switzerland, by Cecile Le?Pechoux, MD, and colleagues from the Institut Gustave-Roussy, in Villejuif, France.
With accelerated or hyperfractionated regimens, patients receive radiation more frequently and over a shorter period of time than with conventional regimens. To date, individual randomized trials comparing these 2 approaches have produced contradictory results, Dr. Le?Pechoux explained. Now that this latest meta-analysis has shown survival benefits from the modified approach, there will be a "renewed interest in this research field," he predicted.
Howard (Jack) West, MD, from the Swedish Cancer Institute in Seattle, Washington, concurred when approached for comment.
This is not "the strongest evidence," he said, but it does suggest that hyperfractionation might contribute to overall survival. It adds to previous — although very limited — evidence that "is certainly supportive that hyperfractionation could translate to improvements in clinical outcomes."
"This approach is certainly not widely practiced in NSCLC, and is underutilized in SCLC," Dr. West told Medscape Oncology. "To me, the results of this meta-analysis suggest that the lung cancer community should explore hyperfractionation carefully and systematically, especially because newer radiation techniques and improved imagining allows us to deliver radiation more precisely, and therefore with lower risk for prohibitive toxicity, which has been a significant concern with hyperfractionation strategies."
Clinical Benefit Is Small
The meta-analysis involved 1594 patients with NSCLC (from 8 trials). Accelerated or hyperfractional radiotherapy improved overall survival, compared with conventional radiotherapy (hazard ratio [HR], 0.87; P?= .009), resulting in an absolute benefit of 3% at 5 years.
"The clinical benefit we found was small but comparable to the benefit found in other meta-analyses concerning nonsmall-cell lung cancer," said Dr. Le?Pechoux.
There was no heterogeneity among the trials, and no subgroup of patients was found to benefit more or less from modified radiotherapy, the researchers explain.
The modified radiotherapy approach significantly reduced deaths from lung cancer (HR, 0.89; P?= .03), and also appeared to reduce nonlung-cancer deaths, although this was not significant (HR, 0.79; P?= .18), they note.
However, there was no benefit for progression-free survival (HR, 0.94; P?= .23).
There were also 2 trials involving 685 patients with SCLC. Similar survival benefit was seen in this group (HR, 0.87; P?= .08), although this was not statistically significant because of a lack of power, the researchers report.
As expected, modified radiotherapy increased the risk for acute esophageal toxicity, compared with conventional radiotherapy (HR, 2.11 in NSCLC and HR, 2.46 in SCLC; P?< .001), the team notes. But there was no increase in acute hematologic, pulmonary, or cardiac toxicity, they add.
The researchers have disclosed no relevant financial relationships.
2nd European Lung Cancer Conference: Abstract?1850. Presented April?30, 2010.