The Role of Additional Chemotherapy in Combination with Concurrent Chemoradiation Therapy for Locally Advanced Inoperable Non–small Cell Lung Cancer: A Meta-analysis of 11 Randomized Trials

Considering the controversial evidence of induction chemotherapy (I-CRT) before or consolidation chemotherapy (CRT-C) after concurrent chemoradiotherapy (CRT) for locally advanced inoperable non-small cell lung cancer (LA-NSCLC), we conducted a meta-analysis to obtain a more accurate evaluation of the benefits of these treatment strategies. A systematic review of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) was performed with retrieval methodology. The end points included the object response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). Eleven randomized trials with a total of 1986 eligible patients were enrolled in our analysis. According to the pooled analysis of the relative rates (RRs) for ORR and DCR, there were no differences among I-CRT, CRT, and CRT-C treatments. Induction chemotherapy did not have significant survival benefits compared with CRT alone in terms of the OS [hazard ratio (HR) 0.92, 95% confidence interval (CI) 0.75-1.12]. Similar results were observed in our analysis comparing CRT-C with CRT, with a HR of 1.11 for PFS (95% CI 0.95-1.30) and 1.12 for OS (95% CI 0.93-1.35). Furthermore, I-CRT was not associated with a more favourable survival than that from CRT-C with respect to OS (HR 0.95, 95% CI 0.76-1.19) and PFS (HR 0.98, 95% CI 0.68-1.41). Our meta-analysis suggests that CRT should be administered to patients with unresectable LA-NSCLC to maximize survival. However, the effects of additional chemotherapy added to CRT were limited for the unselected group. Thus, new and efficient chemotherapy strategies in the smaller subgroup of patients who displayed a higher risk of metastases are warranted through further clinical investigation.