Significant reduction in risk of death at 2 years with concurrent vs.Only 3 trials fulfilled selection criteria for review.Radiosensitising effect of chemotherapy if given concurrently with radiationĮvidence to support concurrent chemoradiotherapy over sequential treatment.Sequential treatment increases overall treatment time - not good in tumours shown to undergo accelerated repopulation during treatment.Tumour biology suggests that tumours which shrink with chemotherapy may then undergo accelerated repopulation.Risk of disease progression during chemotherapy – 1/3 patients in one RCT did not go on to receive RT.Theoretical advantages of concurrent chemoradiotherapy over sequential treatment In 2004 an individual patient meta-analysis comparing concurrent chemoradiotherapy to radiotherapy alone based on 9 trials and 1764 patients showed that concurrent chemoradiotherapy improved survival– absolute survival advantage of 4% at 2 years (Ann Oncol 2006 17:473).In mid-1990’s meta-analysis showed that the sequential addition of chemotherapy to radical radiotherapy improved survival for these patients - absolute survival advantage of 4% at 2 years (BMJ 1995 311:899). Poor survival rates (10% or less at 5 years) reflected low local control rates and high risk of micrometastatic disease leading to systemic relapse.Until mid-1990’s patients of good performance status whose disease could be encompassed in a radical radiotherapy treatment volume were offered conventionally fractionated radical radiotherapy alone.Radical treatment of locally advanced disease 40% of patients present with locally advanced unresectable disease (Stage 3A and 3B).Non-small cell lung cancer accounts for 80% of cases.Lung cancer remains leading cause of cancer death in UK.concurrent chemoradiotherapy for locally advanced non-small cell carcinoma
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