PMID- 35196537
OWN - NLM
STAT- MEDLINE
DCOM- 20221018
LR  - 20221103
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 114
IP  - 4
DP  - 2022 Nov 15
TI  - Local Consolidative Therapy Versus Systemic Therapy Alone for Metastatic 
      Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis.
PG  - 635-644
LID - S0360-3016(22)00169-9 [pii]
LID - 10.1016/j.ijrobp.2022.02.023 [doi]
AB  - PURPOSE: The role of local consolidative therapy (LCT) for metastatic cancers 
      most likely varies by the particular cancer type. We therefore performed a 
      systematic review with a comparative meta-analysis of LCT versus systemic therapy 
      alone, specifically for metastatic non-small cell lung cancer (mNSCLC). METHODS 
      AND MATERIALS: Article eligibility for this Preferred Reporting Items for 
      Systematic Reviews and Meta-Analyses/Population, Intervention, Comparison, 
      Outcomes and Design-guided systematic review was histologic confirmation of 
      mNSCLC, comparison of LCT (irradiation/surgery) versus lack thereof in a 
      randomized or propensity-matched retrospective manner, and sufficient 
      quantitative data examining progression-free survival (PFS), overall survival 
      (OS), and/or adverse events (AEs). Both polymetastatic and oligometastatic 
      disease (OMD) were allowed, but not oligoprogressive/oligorecurrent disease. 
      Statistics used the Mantel-Haenszel fixed-effect or random-effect model depending 
      on the heterogeneity (I(2)). RESULTS: From 7 articles, 346 patients received LCT 
      and 347 received systemic therapy alone. With LCT, the hazard ratio (HR) for PFS 
      in all patients was 0.37 (95% confidence interval, 0.25-0.55; P = .01), and for 
      OMD it was 0.30 (0.24-0.38; P < .001). For OS, the HRs were 0.53 (0.45-0.62; P < 
      .001) in all patients, and 0.41 (0.33-0.52; P < .001) in patients with OMD. The 
      findings remained significant when stratifying by epidermal growth factor 
      receptor status (HRs for PFS/OS: 0.29/0.44 for mutants and 0.31/0.39 for 
      wild-type, respectively, P < .001 for all) and study type (HRs for PFS/OS: 
      0.40/0.52 for randomized and 0.33/0.41 for retrospective, respectively, P < .05 
      for all). LCT was not associated with a higher rate of grade >/=3 AEs (odds ratio, 
      1.28; 95% confidence interval, 0.81-2.05; P = .29). CONCLUSIONS: Meta-analyzing 
      the available data shows that LCT may improve the PFS and OS of mNSCLC without 
      increasing the risk of high-grade AEs. However, further data on polymetastatic 
      mNSCLC are required, and these conclusions cannot be extrapolated to other 
      (non-mNSCLC) histologies. Although many existing/ongoing trials of LCT for OMD 
      commonly comprise mixed-histology populations, focusing on the interaction 
      between specific tumor biology and systemic agents is required to enhance the 
      clarity and applicability of these trials.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Wu, Yajing
AU  - Wu Y
AD  - Department of Radiation Oncology, the Fourth Hospital of Hebei Medical 
      University, Hebei Clinical Research Center for Radiation Oncology, Shijiazhuang, 
      China.
FAU - Verma, Vivek
AU  - Verma V
AD  - Department of Radiation Oncology, The University of Texas MD Anderson Cancer 
      Center, Houston, Texas.
FAU - Liang, Fei
AU  - Liang F
AD  - Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, 
      China.
FAU - Lin, Qiang
AU  - Lin Q
AD  - Department of Oncology, North China Petroleum Bureau General Hospital, Hebei 
      Medical University, Renqiu, China.
FAU - Zhou, Zhiguo
AU  - Zhou Z
AD  - Department of Radiation Oncology, the Fourth Hospital of Hebei Medical 
      University, Hebei Clinical Research Center for Radiation Oncology, Shijiazhuang, 
      China.
FAU - Wang, Zhiyu
AU  - Wang Z
AD  - Department of Oncology Immunology, the Fourth Hospital of Hebei Medical 
      University, Shijiazhuang, China.
FAU - Wang, Yi
AU  - Wang Y
AD  - Department of Radiation Oncology, the Fourth Hospital of Hebei Medical 
      University, Hebei Clinical Research Center for Radiation Oncology, Shijiazhuang, 
      China.
FAU - Wang, Jun
AU  - Wang J
AD  - Department of Radiation Oncology, the Fourth Hospital of Hebei Medical 
      University, Hebei Clinical Research Center for Radiation Oncology, Shijiazhuang, 
      China. Electronic address: wangjun0818@hebmu.edu.cn.
FAU - Chang, Joe Y
AU  - Chang JY
AD  - Department of Radiation Oncology, The University of Texas MD Anderson Cancer 
      Center, Houston, Texas. Electronic address: jychang@mdanderson.org.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20220220
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
RN  - EC 2.7.10.1 (ErbB Receptors)
SB  - IM
MH  - *Carcinoma, Non-Small-Cell Lung/drug therapy/radiotherapy
MH  - Consolidation Chemotherapy
MH  - ErbB Receptors
MH  - Humans
MH  - *Lung Neoplasms/drug therapy/radiotherapy
MH  - Retrospective Studies
EDAT- 2022/02/24 06:00
MHDA- 2022/10/19 06:00
CRDT- 2022/02/23 20:08
PHST- 2022/01/11 00:00 [received]
PHST- 2022/02/08 00:00 [revised]
PHST- 2022/02/15 00:00 [accepted]
PHST- 2022/02/24 06:00 [pubmed]
PHST- 2022/10/19 06:00 [medline]
PHST- 2022/02/23 20:08 [entrez]
AID - S0360-3016(22)00169-9 [pii]
AID - 10.1016/j.ijrobp.2022.02.023 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2022 Nov 15;114(4):635-644. doi: 
      10.1016/j.ijrobp.2022.02.023. Epub 2022 Feb 20.