Chemoradiation-Induced Pneumonitis in Patients with Unresectable Stage III Non-Small Cell Lung Cancer: A Systematic Literature Review and Meta-analysis
A partir d'une revue systématique de la littérature publiée entre 2014 et 2020 (17 études), cette méta-analyse évalue le risque de pneumonite sévère (grade 3 à 5) induite par une chimioradiothérapie chez des patients atteints d'un cancer du poumon non à petites cellules de stade III et non résécable
Introduction : High-grade pneumonitis is a severe and potentially life-threatening adverse eventassociated with concurrent chemoradiation (cCRT) in patients with non-small cell lungcancer (NSCLC). The aim of this study was to summarize and quantify the incidenceof severe (grade 3-5) cCRT-induced pneumonitis in unresectable stage III NSCLC patients. Methods : A systematic literature review and meta-analysis were performed in accordance withPRISMA guidelines. Published literature was searched for randomized controlled trials(RCTs), observational studies, and non-randomized trials from 2014 to April 2020.The primary outcome of interest was incidence of grade 3-5 pneumonitis. Results : Included were 17 studies for the review and 11 for the meta-analysis (1,788 participants);all studies examined radiation-related pneumonitis (RP). The pooled incidence of cCRT-inducedgrade 3−5 RP in unresectable stage III NSCLC patients was estimated to be 3.62% [95%confidence interval (CI): 1.65−6.21] in RCTs, 5.98% [95% CI: 2.26−12.91] in observationalstudies, and 7.85% [95% CI: 4.08–13.10] in observational studies using platinum-baseddoublet chemotherapies. Conclusion : These results suggest the incidence of severe and fatal RP in patients with unresectablestage III NSCLC treated with cCRT ranges from 3.62%–7.85%, with incidence varyingby study design and chemotherapy regimen. Estimates of RP incidence were higher inthe real-world setting compared to RCTs. These results can be used to contextualizethe baseline risk of cCRT-induced pneumonitis in unresectable stage III NSCLC to betterunderstand the adverse event of pneumonitis associated with novel immunotherapy treatmentsindicated for concomitant use with this modality.
Lung Cancer 2022