Meta-analysis of hypofractionated radiotherapy versus conventional radiotherapy in locally advanced non-small-cell lung cancer

Purpose: For inoperable locally advanced non-small cell lung cancer (LA-NSCLC), the efficacy of hypo-fractionated radiotherapy (Hypo-RT) has not been clearly established. The present meta-analysis was performed to estimate the effect of Hypo-RT on survival outcomes and toxicity in inoperable locally advanced non-small cell lung cancer. Material and methods: We performed a meta-analysis of patients with LA-NSCLC using Hypo-RT versus conventional RT, with the endpoints studied being overall survival (OS), progression-free survival (PFS), locoregional failure, distant failure and toxicity. Results: Data from six trials with 1211 patients were extracted. There were no significant differences in overall survival (HR 0.97; 95% CI, 0.86-1.10; P=0.64), progression-free survival (HR 1.03; 95% CI, 0.85 to 1.25; P=0.76), locoregional failure (HR 1.12; 95% CI, 0.83 to 1.49; P=0.46) or distant failure (HR 1.02; 95% CI, 0.73 to 1.43; P=0.92). Hypo-RT significantly reduced the risk of esophagitis toxicity from 13% to 24% (OR 0.32; 95% CI, 0.19 to 0.54; P < 0.0001) and reduced the risk of pneumonitis toxicity by 2% (OR 0.58; 95% CI, 0.34 to 0.99; P=0.05). Conclusion: Hypo-RT was not inferior to conventional RT in patients who had inoperable LA-NSCLC. With advanced technologies, it reduced the occurrence of toxicity. It is also convenient and safe. However, there was no evidence that this treatment improved the survival rate or decreased treatment failure.