| Is concurrent chemoradiation the standard of care for locally advanced non-small cell lung cancer? A review of guidelines and evidence. | |
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MedLine Citation:
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PMID: 20427167 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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In the past 15 years, the treatment of locally advanced non-small cell lung cancer (NSCLC) has shifted from radiotherapy alone. There are now schedules using induction chemotherapy, concurrent chemoradiation using either radiosensitising doses of chemotherapy or full-dose chemotherapy, consolidation chemotherapy after radiation or combinations of these options. There is no consensus on the optimal chemotherapy regimen and its scheduling and the issue of radiation dose and optimal fractionation equally remains unresolved. This overview is in two sections. First, we have evaluated a selection of international guidelines on the management of locally advanced NSCLC. We assessed the methodology by which individual guidelines were produced and the levels of evidence quoted in support of the recommendations. Second, we have updated the literature search of the 2004 Cochrane review on concurrent chemoradiation. Trials were identified that compared sequential with concurrent chemoradiation using median survival as the primary outcome measure. Two-year survival and toxicity were evaluated as secondary outcome measures. Eleven trials were identified, of which six fulfilled criteria for inclusion. The median survival for concurrent treatment was 16-17 months compared with 13-15 months with sequential treatment. Treatment-related mortality was 3% for concurrent treatment and 1.7% for sequential treatment. The rate of grade 3 or worse oesophagitis was 19% in concurrent treatment compared with 3% for sequential treatment. In conclusion, chemotherapy adds benefit to radiotherapy treatment of locally advanced NSCLC. Concurrent chemoradiation is associated with significant toxicity. The evidence to support concurrent chemoradiation as the standard of care is not robust, in spite of its recommendation within a number of guidelines. Further trials should be supported. |
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Authors:
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N O'Rourke; F Macbeth |
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Publication Detail:
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Type: Journal Article; Review Date: 2010-04-27 |
Journal Detail:
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Title: Clinical oncology (Royal College of Radiologists (Great Britain)) Volume: 22 ISSN: 1433-2981 ISO Abbreviation: Clin Oncol (R Coll Radiol) Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-05-14 Completed Date: 2010-08-12 Revised Date: 2011-01-12 |
Medline Journal Info:
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Nlm Unique ID: 9002902 Medline TA: Clin Oncol (R Coll Radiol) Country: England |
Other Details:
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Languages: eng Pagination: 347-55 Citation Subset: IM |
Copyright Information:
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Copyright 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. |
Affiliation:
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Cochrane Lung Cancer Group, Beatson Oncology Centre, Gartnavel General Hospital, Glasgow, UK. Noelle.O'Rourke@ggc.scot.nhs.uk |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Antineoplastic Agents
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administration & dosage Carcinoma, Non-Small-Cell Lung / drug therapy*, radiotherapy* Clinical Trials as Topic Combined Modality Therapy Humans Lung Neoplasms / drug therapy*, radiotherapy* Practice Guidelines as Topic* Radiotherapy |
| Chemical | |
Reg. No./Substance:
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0/Antineoplastic Agents |
| Comments/Corrections | |
Comment In:
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Clin Oncol (R Coll Radiol). 2011 Feb;23(1):62-3; author reply 63-4
[PMID:
20934861
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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