Concurrent versus sequential chemotherapy with hypofractionated radiotherapy in patients with inoperable locally advanced non-small cell lung cancer

The previous individual studies of chemoradiotherapy in locally advanced non-small cell lung cancer (LA-NSCLC) showed that sequential or concurrent chemotherapy with hypofractionated radiotherapy had obtained favorable survival and acceptable toxicity. However, which treatment scheme has superior therapeutic effects for inoperable LA-NSCLC is inconclusive. The aim of this study was to compare concurrent (concurrent arm) versus sequential chemotherapy (sequential arm) with hypofractionated radiotherapy in the treatment of inoperable LA-NSCLC by pooling data. Relevant studies were identified through searching PubMed, Embase and Web of Science databases till July, 2016. Odds ratio (OR) or risk ratio (RR) with its corresponding 95% confidence interval (CI) was used as pooled statistics for all analyses. The analysis was conducted based on the data from 3 studies with 370 patients. The pooled data showed that 1-year OS was OR=1.64, 95% CI: 1.03-2.61, P=0.037, whereas the combined results for 3-year OS was not improved in concurrent arm compared to sequential arm [OR=0.72, 95% CI: 0.42-1.24, P=0.235]. There was no significant difference of 1-year PFS [OR=1.16, 95% CI: 0.72-1.84, P=0.542] and 3-year PFS [OR=1.09, 95% CI: 0.48-2.50, P=0.833] between these arms. Moreover, no significant difference was found regarding Grade >= 3 late adverse events [RR=1.16, 95% CI: 0.78-1.74, P=0.454]. Our study demonstrated that concurrent arm was not significantly better than sequential arm in clinical outcomes. However, concurrent chemotherapy with hypofractionated radiotherapy had a tendency to improve survival and the late adverse events could be tolerated.