Efficacy and safety of hyperfractionated versus conventionally fractionated chemoradiotherapy for limited-stage small-cell lung cancer: a meta-analysis

Abstract

Objective To systematically evaluate the differences in efficacy and safety between hyperfractionated and conventionally fractionated radiotherapy for limited-stage small-cell lung cancer (LS-SCLC). Methods A computerized search was performed in PubMed, Embase, Cochrane Library, Web of Science, CBM, Wanfang Data, CNKI, and VIP to collect controlled clinical trials of hyperfractionated versus conventionally fractionated chemoradiotherapy in the treatment of LS-SCLC. The RevMan 5.3 software was used to perform meta-analyses of short-term outcomes, survival data, and adverse events. Results Eight controlled clinical trials involving 1361 patients were enrolled in this study. The results of meta-analysis showed that there were no significant differences in objective response rate or 2-and 5-year overall survival rates between the hyperfractionation group and the conventional fractionation group (odds ratio[OR]=1.31, 95% confidence interval[CI]: 0.64-2.69, P=0.46; risk ratio[RR]=1.10, 95%CI: 0.98-1.24, P=0.12; RR=1.13, 95%CI: 0.75-1.69, P=0.56). Compared with the conventional fractionation group, the hyperfractionation group had a significantly higher incidence of grade ≥2 radiation esophagitis (RR=1.74, 95%CI: 1.39-2.17, P 3 hematological toxicity between the two groups (RR=0.73, 95%CI: 0.24-2.24, P=0.58; RR=1.18, 95%CI: 0.99-1.39, P=0.06). Conclusions In the treatment of LS-SCLC, two fractionation modes show similar short-term efficacy and survival benefits. However, hyperfractionated radiotherapy causes a higher incidence of radiation esophagitis than conventionally fractionated radiotherapy. Given that hyperfractionated radiotherapy is not superior to conventionally fractionated radiotherapy, conventionally fractionated radiotherapy is recommended for treating LS-SCLC. Key words: Carcinoma, small cell lung/radiotherapy; Radiotherapy, hyperfractionated; Radiotherapy, conventionally fractionated; Meta-analysis