The efficacy and safety of concurrent versus sequential chemoradiotherapy for locally advanced non-small cell lung cancer: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Kai ^1,2 , DOU Li ² , CAO Wei ^1,2 , JIN Dacheng ² , WANG Qi ^1,2 ,  GOU Yunjiu ²

1. First Clinical Medical School, Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
2. First Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;

Corresponding?author：

GOU Yunjiu, Email: gouyunjiu@163.com

Keywords：

Non-small cell lung cancer; synchronous; sequential; chemoradiotherapy; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202312016

Video：

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Objective To evaluate the efficacy and safety of concurrent chemoradiotherapy versus sequential chemoradiotherapy in the treatment of locally advanced non-small cell lung cancer. Methods The relevant literature was searched in PubMed, Web of Science, CNKI and Wanfang databases from the inception to October 15, 2023, and the literature was screened according to the inclusion and exclusion criteria. Review Manager 5.3 software was used for meta-analysis of the literature, and the Cochrane bias risk assessment tool was used to evaluate the quality of the literature. Results Finally, 14 randomized controlled studies were included covering a total of 1048 patients. The results of meta-analysis showed that the overall response rate [OR=2.39, 95%CI (1.83, 3.11)], 1-year survival rate [OR=1.81, 95%CI (1.39, 2.35)], 2-year survival rate [OR=1.75, 95%CI (1.27, 2.42)] and 3-year survival rate [OR=2.33, 95%CI (1.49, 3.66)] were superior to sequential chemoradiotherapy (P<0.001). In terms of safety, concurrent chemoradiotherapy increased the incidence of radiation esophagitis (P<0.05), but there was no statistical difference in the incidence of leukopenia and radiation pneumonia (P>0.05). Conclusion For patients with locally advanced non-small cell lung cancer, the short-term efficacy of concurrent chemoradiotherapy is better than that of sequential chemoradiotherapy and can improve the 1-, 2- and 3-year survival rates, but the toxic side effects of the treatment are slightly greater than those of the sequential chemoradiotherapy.

Citation： YANG Kai, DOU Li, CAO Wei, JIN Dacheng, WANG Qi, GOU Yunjiu. The efficacy and safety of concurrent versus sequential chemoradiotherapy for locally advanced non-small cell lung cancer: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(12): 1777-1785. doi: 10.7507/1007-4848.202312016 Copy

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	Chen P, Liu Y, Wen Y, et al. Non-small cell lung cancer in China. Cancer Commun (Lond), 2022, 42(10): 937-970.
3.	Gridelli C, Rossi A, Carbone DP, et al. Non-small-cell lung cancer. Nat Rev Dis Primers, 2015, 1: 15009.
4.	Guo Q, Liu L, Chen Z, et al. Current treatments for non-small cell lung cancer. Front Oncol, 2022, 12: 945102.
5.	Kim HC, Ji W, Lee JC, et al. Prognostic factor and clinical outcome in stage Ⅲ non-small cell lung cancer: a study based on real-world clinical data in the Korean population. Cancer Res Treat, 2021, 53(4): 1033-1041.
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7.	Atagi S, Kawahara M, Yokoyama A, et al. Thoracic radiotherapy with or without daily low-dose carboplatin in elderly patients with non-small-cell lung cancer: a randomised, controlled, phase 3 trial by the Japan Clinical Oncology Group (JCOG0301). Lancet Oncol, 2012, 13(7): 671-678.
8.	Dawe DE, Christiansen D, Swaminath A, et al. Chemoradiotherapy versus radiotherapy alone in elderly patients with stageⅢnon-small cell lung cancer: a systematic review and meta-analysis. Lung Cancer, 2016, 99: 180-185.
9.	O'Rourke N, Roqué I Figuls M, Farré Bernadó N, et al. Concurrent chemoradiotherapy in non-small cell lung cancer. Cochrane Database Syst Rev, 2010, 6: CD002140.
10.	Verfaillie S, Lambrecht M, Berkovic P, et al. Treatment of unresectable stageⅢNSCLC: real world cohort study and literature review. Cancer Treat Res Commun, 2023, 36: 100727.
11.	Furuse K, Fukuoka M, Kawahara M, et al. PhaseⅢstudy of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stageⅢnon-small-cell lung cancer. J Clin Oncol, 1999, 17(9): 2692-2699.
12.	Hung MS, Wu YF, Chen YC. Efficacy of chemoradiotherapy versus radiation alone in patients with inoperable locally advanced non-small-cell lung cancer: a meta-analysis and systematic review. Medicine (Baltimore), 2019, 98(27): e16167.
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23.	李紅波, 盧緒菁, 湯華, 等. 放化療同步與序貫治療局部晚期非小細胞肺癌臨床療效比較. 臨床醫學工程, 2011, 18(6): 878-879.Li HB, Lu XJ, Tang H, et al. Comparison of clinical efficacy of radiotherapy concurrent with chemotherapy and sequential therapy for locally advanced non-small-cell lung cancer. Clin Med Eng, 2011, 18(6): 878-879.
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25.	侯良寶, 王守林, 王清, 等. 超分割放療同步化療治療Ⅲ期非小細胞肺癌. 中國腫瘤臨床與康復, 2006, 13(4): 322-324.Hou LB, Wang SL, Wang Q, et al. Hyperfractionation radiotherapy combined with chemotherapy for stage-Ⅲ non-small cell lung cancer. Chin J Clin Oncol Rehabil, 2006, 13(4): 322-324.
26.	高亞麗. 同步和序貫放化療治療Ⅲ期非小細胞肺癌的比較分析. 腫瘤基礎與臨床, 2011, 24(1): 29-31.Gao YL. The comparative analyses of curative effect of concurrent radiochemotherapy and sequential 8adioehemotherapy on stage Ⅲ non-small cell lung cancer . J Basic Clin Oncol, 2011, 24(1): 29-31.
27.	房麗, 王紅陽, 王玲玲, 等. 放化療聯合治療局部晚期非小細胞肺癌臨床療效觀察. 臨床肺科雜志, 2014(7): 1291-1294.Fang L, Wang HY, Wang LL, et al. Clinical observation of chemoradiotherapy in the treatment of locally advanced non-small lung cancer. J Clin Pulm Med, 2014(7): 1291-1294.
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1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. Chen P, Liu Y, Wen Y, et al. Non-small cell lung cancer in China. Cancer Commun (Lond), 2022, 42(10): 937-970.
3. Gridelli C, Rossi A, Carbone DP, et al. Non-small-cell lung cancer. Nat Rev Dis Primers, 2015, 1: 15009.
4. Guo Q, Liu L, Chen Z, et al. Current treatments for non-small cell lung cancer. Front Oncol, 2022, 12: 945102.
5. Kim HC, Ji W, Lee JC, et al. Prognostic factor and clinical outcome in stage Ⅲ non-small cell lung cancer: a study based on real-world clinical data in the Korean population. Cancer Res Treat, 2021, 53(4): 1033-1041.
6. Vansteenkiste J, De Ruysscher D, Eberhardt WE, et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2013, Suppl 6: vi89-vi98.
7. Atagi S, Kawahara M, Yokoyama A, et al. Thoracic radiotherapy with or without daily low-dose carboplatin in elderly patients with non-small-cell lung cancer: a randomised, controlled, phase 3 trial by the Japan Clinical Oncology Group (JCOG0301). Lancet Oncol, 2012, 13(7): 671-678.
8. Dawe DE, Christiansen D, Swaminath A, et al. Chemoradiotherapy versus radiotherapy alone in elderly patients with stageⅢnon-small cell lung cancer: a systematic review and meta-analysis. Lung Cancer, 2016, 99: 180-185.
9. O'Rourke N, Roqué I Figuls M, Farré Bernadó N, et al. Concurrent chemoradiotherapy in non-small cell lung cancer. Cochrane Database Syst Rev, 2010, 6: CD002140.
10. Verfaillie S, Lambrecht M, Berkovic P, et al. Treatment of unresectable stageⅢNSCLC: real world cohort study and literature review. Cancer Treat Res Commun, 2023, 36: 100727.
11. Furuse K, Fukuoka M, Kawahara M, et al. PhaseⅢstudy of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stageⅢnon-small-cell lung cancer. J Clin Oncol, 1999, 17(9): 2692-2699.
12. Hung MS, Wu YF, Chen YC. Efficacy of chemoradiotherapy versus radiation alone in patients with inoperable locally advanced non-small-cell lung cancer: a meta-analysis and systematic review. Medicine (Baltimore), 2019, 98(27): e16167.
13. Bruni A, Giaj-Levra N, Ciammella P, et al. Management of locally advanced non-small cell lung cancer in the modern era: a national Italian survey on diagnosis, treatment and multidisciplinary approach. PLoS One, 2019, 14(11): e0224027.
14. Gadgeel SM, Ruckdeschel JC, Patel BB, et al. PhaseⅡstudy of pemetrexed and cisplatin, with chest radiotherapy followed by docetaxel in patients with stageⅢnon-small cell lung cancer. J Thorac Oncol, 2011, 6(5): 927-933.
15. 朱禮, 吳榮. Ⅲ期非小細胞肺癌同期放化療與序貫放化療的對照研究. 中華腫瘤防治雜志, 2009, 16(14): 1105-1107.Zhu L, Wu R. Sequential and concurrent radiochemotherapy for stage Ⅲ non-small cell lung cancer. Chin J Cancer Prev Treat, 2009, 16(14): 1105-1107.
16. 張西, 李浩, 周從明, 等. 吉西他濱和順鉑方案同步三維適形放療治療局部晚期非小細胞肺癌的臨床研究. 中國臨床藥理學雜志, 2014, 30(4): 300-302.Zhang X, Li H, Zhou CM, et al. Clinical study on gemcitabine plus cisplatin regimen chemotherapy combined with three dimensional conformal radiation therapy in the treatment of locally advanced non-small cell lung cancer. Chin J Clin Pharmacol, 2014, 30(4): 300-302.
17. 楊杰, 季海峰, 王勇. 長春瑞濱聯合同步三維適形放療治療局部晚期非小細胞肺癌的臨床研究. 中國臨床實用醫學, 2009, 3(7): 63-64.Yang J, Ji HF, Wang Y. Clinical study of Navelbine and concurrent three-dimensional conformal radiotherapy(3D-CRT) in the treatment of locally advanced non-small cell lung cancer. Chin J Clin Pract Med, 2009, 3(7): 63-64.
18. 陽美玲. 紫杉醇配伍順鉑化療聯合放療同步與序貫治療晚期非小細胞肺癌的對比研究. 世界臨床醫學, 2017, 11(20): 85, 89.Yang ML. Comparative study of paclitaxel combined with cisplatin chemotherapy with concurrent versus sequential radiotherapy for advanced non-small cell lung cancer. World Clin Med, 2017, 11(20):85, 89.
19. 王忠民. 晚期非小細胞肺癌三維適形放療與紫杉醇加順鉑同期化療和序貫化療的對比觀察. 現代醫藥衛生, 2011, 27(6): 844-845.Wang ZM. Comparative observation of three-dimensional conformal radiotherapy with concurrent versus sequential paclitaxel plus cisplatin chemotherapy for advanced non-small cell lung cancer. Mod Med Health, 2011, 27(6): 844-845.
20. 王玉洲, 楊志雄, 廖思海, 等. 同步放化療治療局部晚期非小細胞肺癌的Ⅲ期臨床研究. 臨床腫瘤學雜志, 2009, 14(5): 390-395.Wang YZ, Yang ZX, Liao SH, et al. Study on concurrent chemotherapy and radiotherapy for locally advanced unresectable (stage Ⅲ) non-small cell lung cancer. Chin Clin Oncol, 2009, 14(5): 390-395.
21. 王頌平, 宋海平, 徐建華, 等. 多西他賽聯合順鉑同步放療治療局部晚期非小細胞肺癌隨機對照臨床研究. 中國腫瘤臨床, 2009, 36(13): 736-739.Wang SP, Song HP, Xu JH, et al. Docetaxel plus cisplatin chemotherapy with concurrent three dimensional conformal radiotherapy for locally advanced non-small-cell lung cancer . Chin J Clin Oncol, 2009, 36(13): 736-739.
22. 王鵬遠. 序貫化放療與同步化放療治療Ⅲ期非小細胞肺癌療效觀察. 醫學信息(上旬刊), 2011, 24(9): 5704-5706.Wang PY. Sequential chemoradiotherapy and concurrent chemoradiotherapy for stage Ⅲ non-small-cell lung cancer. Med Info, 2011, 24(9): 5704-5706.
23. 李紅波, 盧緒菁, 湯華, 等. 放化療同步與序貫治療局部晚期非小細胞肺癌臨床療效比較. 臨床醫學工程, 2011, 18(6): 878-879.Li HB, Lu XJ, Tang H, et al. Comparison of clinical efficacy of radiotherapy concurrent with chemotherapy and sequential therapy for locally advanced non-small-cell lung cancer. Clin Med Eng, 2011, 18(6): 878-879.
24. 賈正飛, 馮永, 仲琴, 等. 多西紫杉醇/順鉑化療同步放療對局部晚期非小細胞肺癌療效觀察. 山東大學學報(醫學版), 2008, 46(9): 898-900.Jia ZF, Feng Y, Zhong Q, et al. Concurrent chemoradiotherapy with docetaxel/cisplatin for local advanced non-small cell lung cancer . J Shandong Univ (Health Sci), 2008, 46(9): 898-900.
25. 侯良寶, 王守林, 王清, 等. 超分割放療同步化療治療Ⅲ期非小細胞肺癌. 中國腫瘤臨床與康復, 2006, 13(4): 322-324.Hou LB, Wang SL, Wang Q, et al. Hyperfractionation radiotherapy combined with chemotherapy for stage-Ⅲ non-small cell lung cancer. Chin J Clin Oncol Rehabil, 2006, 13(4): 322-324.
26. 高亞麗. 同步和序貫放化療治療Ⅲ期非小細胞肺癌的比較分析. 腫瘤基礎與臨床, 2011, 24(1): 29-31.Gao YL. The comparative analyses of curative effect of concurrent radiochemotherapy and sequential 8adioehemotherapy on stage Ⅲ non-small cell lung cancer . J Basic Clin Oncol, 2011, 24(1): 29-31.
27. 房麗, 王紅陽, 王玲玲, 等. 放化療聯合治療局部晚期非小細胞肺癌臨床療效觀察. 臨床肺科雜志, 2014(7): 1291-1294.Fang L, Wang HY, Wang LL, et al. Clinical observation of chemoradiotherapy in the treatment of locally advanced non-small lung cancer. J Clin Pulm Med, 2014(7): 1291-1294.
28. 白樺, 侯敏全, 白曉寧. 同步放化療與序貫化放療治療Ⅲ期不能手術非小細胞肺癌的臨床療效. 昆明醫科大學學報, 2015, 36(6): 42-45.Bai H, Hou MQ, Bai XN. Comparison of the curative effect of concurrent chemoradiotherapy and sequential chemoradiotherapy in non-small cell lung cancer. J Kunming Med Univ, 2015, 36(6): 42-45.
29. 石安輝, 朱廣迎. 局部晚期非小細胞肺癌放化療的現狀與進展. 臨床外科雜志, 2016, 24(7): 505-508.Shi AH, Zhu GY. Current status and progress of chemoradiotherapy for locally advanced non-small cell lung cancer. J Clin Surg, 2016, 24(7): 505-508.
30. Aupérin A, Le Péchoux C, Rolland E, et al. Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol, 2010, 28(13): 2181-2190.
31. Curran WJ, Paulus R, Langer CJ, et al. Sequential vs. concurrent chemoradiation for stage Ⅲnon-small cell lung cancer: randomized phase Ⅲ trial RTOG 9410. J Natl Cancer Inst, 2011, 103(19): 1452-1460.
32. Belderbos J, Uitterhoeve L, van Zandwijk N, et al. Randomised trial of sequential versus concurrent chemo-radiotherapy in patients with inoperable non-small cell lung cancer (EORTC 08972-22973). Eur J Cancer, 2007, 43(1): 114-121.
33. Chang SC, Lai YC, Hung JC, et al. Oral glutamine supplements reduce concurrent chemoradiotherapy-induced esophagitis in patients with advanced non-small cell lung cancer. Medicine (Baltimore), 2019, 98(8): e14463.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The efficacy and safety of concurrent versus sequential chemoradiotherapy for locally advanced non-small cell lung cancer: A systematic review and meta-analysis

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