Treatment-Related Pneumonitis of EGFR Tyrosine Kinase Inhibitors Plus Thoracic Radiotherapy in Patients with Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis
Abstract
INTRODUCTION
Thoracic radiotherapy (RT) for non-small cell lung cancers (NSCLCs) may overcome resistance to tyrosine kinase inhibitors (TKIs). However, the risk of severe treatment-related pneumonitis (TRP) is a major concern, and the results of the combined treatment remain controversial. Therefore, we aimed to systematically review existing publications and provide a meta-analysis of TRP from a combined therapy of thoracic RT and TKIs.
METHODS
A systematic literature review was performed using the PubMed-MEDLINE and Embase databases to identify eligible publications. The number of severe TRP cases of grade 3 or higher was extracted and then analyzed by fixed or randomized model meta-analysis. Heterogeneity tests were performed using the I² and τ² statistics. Subgroup analyses were conducted on the types of RT and the sequence of the combined treatment.
RESULTS
Our literature search identified 37 eligible studies with 1143 patients. The severe TRP occurred in 3.8% (95 % confidential interval [CI], 1.8 to 6.5%) of patients overall, and fatal pneumonitis occurred rarely in 0.1% (95% CI, 0.0% to 0.3%). In the subgroup analysis, the severe TRP proportion was 2.3% (95% CI, 1.0% to 4.1%) for patients under definitive (chemo)RT (19 studies, n=702) versus 2.9% (95% CI, 1.3% to 5.1%) for patients who received local stereotactic body radiotherapy or palliative RT (15 studies, n=361). The severe TRP rate was 4.9% (95% CI, 2.4% to 8.1%) for concurrent TKI and RT (26 studies, n=765),…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,143 participants or records.
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