Literature searches were conducted in MEDLlNE (1966 through November 2005), EMBASE (1980 through 2005, week 46), the Cochrane Library (2005, Issue 4), and the Cochrane Central Register of Controlled Trials (2005, issue 4) using the following search terms as MEDLINE or EMBASE subject headings "carcinoma, non-small-cell lung", "lung carcinogenesis", "lung adenocarcinoma", "lung alveolus cell carcinoma", "lung, non small cell cancer", "lung squamous cell carcinoma", "radiotherapy" and "cancer radiotherapy", combined with the text words "non small cell lung", "radiotherapy", "radiation therapy", "chemoradiation", "inoperable", or "unresectable", and the following publication types and study designs: practice guidelines, systematic reviews or meta-analyses, randomized controlled trials, and controlled clinical trials.
In addition, conference proceedings of the annual meetings of the American Society of Clinical Oncology (ASCO, 1999 through 2005) and the American Society for Therapeutic Radiology and Oncology (ASTRO, 1999 through 2004) were searched for abstracts of relevant trials. The Canadian Medical Association Infobase (http://mdm.ca/cpgsnew/cpgs/index.asp) and the National Guidelines Clearinghouse (http://www.guideline.gov) were searched for existing, evidence-based practice guidelines published since 2000.
Relevant articles and abstracts were selected and reviewed by two reviewers, and the reference lists from those sources were searched for additional trials as were the reference lists from relevant review articles.
Inclusion Criteria
Articles were included in this systematic review if they were fully published reports or abstract of meta-analyses or randomized trials (phase II or III) comparing the following in patients with unresectable stage III non-small cell lung cancer (NSCLC):
- Different schedules or doses of radiotherapy as a single modality treatment
- Radiotherapy alone versus the same radiotherapy regimen combined with chemotherapy
- Different chemoradiation regimens that differ only in the radiation regimen used
- Different chemoradiation regimens that differ only in the chemotherapy regimen used
- Timing of radiotherapy and chemotherapy administration within a chemoradiation treatment approach
In addition, evidence-based practice guidelines or systematic reviews were eligible, which addressed radiotherapy-based treatment for unresectable stage III NSCLC and included recommendations published since 2000.
Exclusion Criteria
The following were not considered:
- Trials evaluating any of the following treatment options or comparisons: older radiotherapy equipment (e.g., equipment that antedated Cobalt-60), 3D conformal radiotherapy, bronchial artery infusion chemotherapy, split-course radiotherapy when compared with another radiotherapy schedule, or conventional compared with altered fractionation radiotherapy (see Related Guidelines section of the original guideline document).
- Trials of chemoradiation involving a non-platinum chemotherapy combination and published prior to 1995. Meta-analyses have shown a survival advantage for chemoradiation over radiation alone for platinum-based chemotherapy but not other chemotherapies.
- Trials randomizing only patients that had responded to, or did not progress on, induction chemotherapy
- Trials that did not report the required outcomes by treatment group. For trials with palliative intent, required outcomes included symptom control or quality of life (QOL); for other trials, survival data were required.
- Letters and editorials reporting trial data
- Papers published in a language other than English