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Early versus late chest radiotherapy in patients with limited-stage small cell lung cancer

  • Review
  • Intervention




This is an update of the original review published in Issue 1, 2005. It is standard clinical practice to combine chemotherapy and chest radiotherapy in treating patients with limited-stage small cell lung cancer. However, the best way to integrate both modalities is unclear.


To establish the best timing of chest radiotherapy with chemotherapy for patients with limited-stage small cell lung cancer in order to improve long-term survival.

Search methods

We ran a new search in January 2009. We searched MEDLINE (through PubMed), EMBASE (through Ovid), CINAHL (through EBSCO), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 1) and reference lists, handsearched journals and conference proceedings, and contacted experts to identify potentially eligible trials, published and unpublished.

Selection criteria

Randomised controlled clinical trials comparing different timing of chest radiotherapy in patients with limited-stage small cell lung cancer.

Data collection and analysis

Seven randomised trials were included. There were differences in the timing and overall treatment time of chest radiotherapy, and the type of chemotherapy used.

Main results

We found no significant differences in overall survival, whether chest radiotherapy was delivered within 30 days after the start of chemotherapy or later, even after exclusion of the only study that delivered chest radiotherapy during cycles of non-platinum chemotherapy (HR 0.86 in favour of early radiation, P = 0.11). The same was observed for studies having early chest radiotherapy delivered in an overall treatment time of less than 30 days compared to a longer treatment time (HR 0.82, P = 0.13). These results should be interpreted with caution because the largest trial has follow-up data up to three years only. The outcome of longer follow up for overall survival remains to be seen. Local tumour control was not significantly different between early and late chest radiotherapy, nor the incidence of severe pneumonitis or severe oesophagitis. However, we observed a trend towards a higher chance of developing oesophagitis and pneumonitis when early chest radiotherapy was delivered during chemotherapy, which remained for oesophagitis, but not pneumonitis, after exclusion of studies with non-platinum based chemotherapy.

Authors' conclusions

At present, it is uncertain whether the timing of chest radiotherapy as such is important for survival. The optimal integration of chemotherapy and chest radiotherapy in patients with limited-stage small cell lung cancer is unknown. Further research is needed to establish the best combination of radiotherapy and chemotherapy in this disease.








利用電子資料庫(MEDLINE, EMBASE, Cancerlit and the Cochrane Central Register of Controlled Trials (CENTRAL))參考文獻清單、人工搜尋期刊和學術會議手冊、以及與專家連絡確認潛在的合格的已發表和未發表的試驗。






不管是在化學治療開始之後的30天內或30天後給予胸部放射線治療,對於2年和5年的存活率的影響都沒有顯著的差別。當唯一試驗因為合併胸部放射線治療與非鉑類化學治療被排除之後,早期胸部放射線治療的五年存活率,看起來似乎有改善的趨勢(RR 0.93, P = 0.07)),兩年的存活率則否。不管是哪一種療法,早期給予胸部放射線治療跟晚期比起來五年的存活率確實比較好(RR 0.90, P = 0.006)。然而這些結果必需被小心解讀,因為即將有更大型的試驗有追蹤三年的結果,但是仍需要較長的追蹤來觀察對五年存活率的影響。早期或晚期的胸部放射線治療,對於局部的腫瘤控制沒有顯著的差別。然而早期的胸部放射線治療與非鉑類化學治療合併似乎有較高的機率會產生肺炎。





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。


早期(開始化學治療之後30天內)或晚期(開始化學治療30天之後)的胸部放射線治療對侷限期小細胞肺癌病人的長期存活率沒有明顯的影響。約7% – 8%的肺癌是屬於侷限期的小細胞肺癌。這類病人被化學治療加放射線治療治癒的機會相當有限。把放射線治療加進已有的化學治療的最佳時機仍未知。這篇回顧指出早期或晚期的加入胸部放射線治療對於存活的改善仍不清楚。雖然早期胸部放射線治療的五年存活率看起來似乎有改善的趨勢,但是在二年的存活率是沒有差別的。數據的解釋是困難的,也需要進一步研究。

Plain language summary

Early (less than 30 days after the start of chemotherapy) or late (more than 30 days after the start of chemotherapy) chest radiotherapy for patients suffering from limited small cell lung cancer

Between 7% and 8% of lung cancers are of the type known as limited-stage small cell tumours. People with this type of cancer have a limited chance of being cured with chemotherapy and radiotherapy. It is not known when the optimum time to give chest radiotherapy is in relation to administering chemotherapy treatment. This review indicates that it is unclear whether administering chest radiotherapy within 30 days of beginning chemotherapy or later improves survival. The effect on patients' overall survival is not statistically different, although there is a possibility that the effect is in favour of early chest radiotherapy. The interpretation of the current data is difficult and further research is needed.