Comparative effectiveness and toxicity of radiotherapy regimens in limited stage small cell lung cancer: A network meta-analysis

Purpose The aim of this Network Meta-analysis was to compare the current radiotherapy regimens of limited-stage small cell lung cancer (LS-SCLC), in terms of overall survival (OS), progression-free survival (PFS), and the incidence of acute radioactive esophagitis and radioactive pneumonia. Methods PubMed, Embase, Web of Science, and the Cochrane Library were comprehensively searched until January 2022. The studies were included, comparing radiotherapy regimens in LS-SCLC patients. We compared hypofractionated radiotherapy (HypoTRT), hyperfractionated radiotherapy (HyperTRT), and conventionally fractionated radiotherapy (ConvTRT1(<60 Gy), ConvTRT2(>= 60 Gy)). Results There was similar efficacy among the contemporary radiotherapy regimens for PFS of LS-SCLC. HypoTRT and HyperTRT significantly improved the OS of LS-SCLC compared with ConvTRT1 (<60 Gy), while not improving the OS of LS-SCLC compared with ConvTRT2 (>= 60 Gy). There was no significant difference between HypoTRT and HyperTRT, between ConvTRT1(<60 Gy) and ConvTRT2(>= 60 Gy), respectively. HyperTRT developed the highest odds of acute radioactive esophagitis compared to ConvTRT1(<60 Gy) and ConvTRT2(>= 60 Gy). There was no significant difference in the incidence of acute radioactive esophagitis between HypoTRT and HyperTRT, ConvTRT1(<60 Gy), ConvTRT2(>= 60 Gy), respectively and between ConvTRT1 and ConvTRT2. There was no statistically significant difference among radiotherapy regimens for the incidence of acute radioactive pneumonia. Conclusion The current radiotherapy regimens are similar in efficacy and toxicity for LS-SCLC, except for ConvTRT1(<60 Gy). Given the lower costs and convenient logistics management of HypoTRT comparatively, it is an acceptable alternative for LS-SCLC.

Automated summary

The current radiotherapy regimens for limited-stage small cell lung cancer (LS-SCLC) have similar efficacy and toxicity, except for certain conventionally fractionated radiotherapy regimens (ConvTRT1(<60 Gy)). Hypofractionated radiotherapy (HypoTRT) and hyperfractionated radiotherapy (HyperTRT) are acceptable alternatives given their comparable effectiveness and lower costs compared to ConvTRT1(<60 Gy).