Concurrent Chemoradiotherapy After Induction Chemotherapy For Unresectable Locally Advanced Non-small Cell Lung Cancer:A Meta-analysis And A Retrospective Study

Objective:1.To evaluate the effectiveness and safety of the induction chemotherapy plus concomitant chemoradiation in unresectable locally advanced non-small cell lung cancer(NSCLC)patients,we performed a meta-analysis of randomized trials directly comparing induction plus concomitant chemoradiation versus concomitant chemoradiation.2.To observe the patients with unresectable locally advanced NSCLC receiving the treatment of Induction chemotherapy plus concomitant chemoradiotherapy in our hospital.Then evaluating the short-term efficacy,long-term efficacy and toxicity,understanding the advantages and disadvantages of this treatment model,and exploring its clinical feasibility.Methods:1.We searched The Cochrane Library,Pub Med,Embase,Web of Science,CBM,CNKI,as well as other auxiliary retrieval,and collected RCTs on the past 15 years of induction chemotherapy plus concomitant chemoradiation Versus concomitant chemoradiation in locally advanced NSCLC.The quality of study was evaluated with Cochrane quality standards,and statistical analysis was performed using Review Manager 5.2 software.2.52 patients diagnosed with unresectable locally advanced non-small cell lung cancer receiving initial treatment in affiliated Hospital of Zunyi Medical College were retrospective analyzed from January 2007 to January 2016.The cases all received the treatment of induction chemotherapy plus concomitant chemoradiation.And the radiotherapy model use the Intensity-modulated Radiation Therapy(IMRT).To evaluate tumor response after the treatment: complete remission(CR),partial response(PR),stable disease(SD),disease progression(PD)ratio,1 year overall survival(OS)rates,2 year overall survival rates,3year overall survival rates,5 year overall survival rates and toxicity.And the efficacy was evaluated by RECIST 1.1 criteria,the side effects were evaluated by WHO criteria.Results:1.The results of meta-analysis show that short-term effects: the total effective rate(ORR)has no significant difference(OR=1.30,95%CI: 0.96~1.77,P=0.10).Long term effect: the1 year and 2 years survival rate period showed no significant difference(OR=1.51,95%CI:0.97~2.43,P=0.07),(OR=1.34,95%CI: 1.00~1.79,P=0.05),but the 3 years survival rate period showed differences(OR=1.43,95%CI: 1.02~2.01,P=0.04).Grade ?~?toxicity: esophagitis,leukopenia showed differences(OR=1.96,95%CI: 1.06 ~ 3.62,P=0.03),(OR=1.84,95%CI: 1.24~2.74,P=0.002),pneumonitis and vomiting showed no differences in both arms(OR=1.31,95%CI: 0.62 ~ 2.77,P=0.48),(OR=1.46,95%CI:0.82~2.59,P=0.19).2.The results of retrospective study in our hospital showed that the median of the whole group were 24 months,and the 1-year,2-year,3-year,5-year survival rates of the whole group were 80.8%,50.8%,38.0% and 9.5%.The objective response rate(ORR)was 86.5%.Grade ?~? toxicity: the incidence of leukopenia,thrombocytopenia,anemia for 32.7%,2% snd 2%,the incidence of vomiting for 5.8%,the esophagitis and pneumonitis for 5.8%and13.5%.Conclusion:.The results of meta-analysis showed that the level of ?~? toxicity of induction chemotherapy plus concurrent chemoradiotherapy was higher than that of concurrent chemoradiotherapy,but the 3 year overall survival rates also higher than that of concurrent chemoradiotherapy.The results of retrospective study in our hospital showed that the treatment of induction chemotherapy plus concomitant chemoradiation.has tolerable toxic reaction,and the means is safe and effective.The short-term effects is remarkable,the long-term effects is considerable,but the long-term effects need more clinical trials to confirm.