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In spite of 16 randomized trials conducted during the past 15 years, the effect of thoracic radiotherapy on the survival of patients with limited small-cell lung cancer remains controversial. The majority of these trials did not have enough statistical power to detect a difference in survival of 5 to 10 percent at five years. This meta-analysis was designed to evaluate the hypothesis that thoracic radiotherapy contributes to a moderate increase in overall survival in limited small-cell lung cancer. Crash Bandicoot Ps1 Iso Android here. The meta-analysis included 13 trials and 2140 patients with limited disease. A total of 433 patients with extensive disease were excluded. Overall, 1862 of 2103 patients who could be evaluated died; the median follow-up period for the surviving patients was 43 months.

The relative risk of death in the combined-therapy group as compared with the chemotherapy group was 0.86 (95 percent confidence interval, 0.78 to 0.94; P = 0.001), corresponding to a 14 percent reduction in the mortality rate. The benefit in terms of overall survival at three years (±SD) was 5.4±1.4 percent. Indirect comparison of early with late radiotherapy and of sequential with non-sequential radiotherapy did not reveal any optimal time for treatment. There was a trend toward a larger reduction in mortality among younger patients: the relative risk of death in the combined-therapy as compared with the chemotherapy group ranged from 0.72 for patients less than 55 years old (95 percent confidence interval, 0.56 to 0.93) to 1.07 (0.70 to 1.64) for patients over 70. THE role of thoracic radiotherapy in the management of limited small-cell lung cancer remains controversial. Most investigators agree that it decreases the risk of thoracic recurrence significantly, but no agreement has been reached concerning its possible effect on survival.

Sixteen randomized trials have been conducted in the past 15 years, with inconsistent results (Appendix 2); thus, the controversy persists. Identification of Trials Multiple sources of information were used to identify trials. The first step involved discussion with the investigators and scrutiny of review articles; this was supplemented by a MEDLINE literature search and examination of proceedings of oncology meetings. The list of identified trials was sent to all trial members participating in the meta-analysis.

The comparison of our list with the list of randomized trials of treatments of lung cancer compiled by Nicolucci et al. Revealed no additional trials. Appendix 2 lists the included and excluded trials and the reasons for exclusion. Data from Individual Trials We sought data on each patient ever enrolled in the trials studied. All trial members provided such data on either a standard paper questionnaire or a magnetic tape. Aria Soho Pc Admin Download Manager. The collected data included identifying information, the extent of disease as defined in each trial, the treatment assigned, the dates of randomization and of the last follow-up evaluation, vital status at the last evaluation, and three covariates — sex, age, and performance status. Because the coding of performance status varied among trials, it could only be summarized in two ways: as a performance status of 0 or 1 as defined by the World Health Organization (WHO) or a Karnofsky index above 60 percent, and as a WHO performance status of 2 to 4 or a Karnofsky index of 60 percent or less.