Abstract
BackgroundThe efficacy of prophylactic cranial irradiation (PCI) in treating patients with small cell lung cancer (SCLC) has not been clear, and recent randomized studies have demonstrated conflicting results from previously published findings. The purpose of this study was to reevaluate the efficacy of PCI in patients with SCLC and to assess factors associated with its efficacy.MethodsWe conducted a quantitative meta-analysis to explore the efficacy of PCI in patients with SCLC. A literature search was performed using EMBASE, MEDLINE, Cochrane and ClinicalTrials.gov databases. We pooled the data and compared overall survival (OS) and brain metastasis (BM) between patients treated with PCI (PCI group) and patients without PCI treatment (observation group).ResultsOf the 1074 studies identified in our analysis, we selected seven studies including 2114 patients for the current meta-analysis. Our results showed that the PCI group showed decreased BM (HR = 0.45, 95% CI: 0.38–0.55, P < 0.001) and prolonged OS (HR = 0.81, 95% CI: 0.67–0.99, P < 0.001). However, in terms of OS, the pooled analysis showed a high heterogeneity (I2 = 74.1%, P = 0.001). In subgroup analyses of OS, we found that the heterogeneity mainly came from patients with brain imaging after initial chemoradiotherapy (HR = 0.94, 95% CI: 0.74–1.18, P = 0.59).ConclusionsThe results of this study showed that PCI has a significant effect on decreasing BM but little benefit in prolonging OS when brain imaging was introduced to confirm lack of BM after initial chemoradiotherapy and before irradiation.
Highlights
The efficacy of prophylactic cranial irradiation (PCI) in treating patients with small cell lung cancer (SCLC) has not been clear, and recent randomized studies have demonstrated conflicting results from previously published findings
A meta-analysis of studies that mainly included patients with limited stage SCLC (LS-SCLC) [10] showed that PCI decreased the incidence of brain metastasis (BM) and prolonged overall survival (OS)
The aim of the present study was to reassess the effect of PCI in SCLC by performing a systematic review of randomized controlled trials (RCTs) published in the literature over the past 30 years
Summary
The efficacy of prophylactic cranial irradiation (PCI) in treating patients with small cell lung cancer (SCLC) has not been clear, and recent randomized studies have demonstrated conflicting results from previously published findings. Patients initially respond well to CRT, the 2-year cumulative risk of Because the blood brain barrier restricts the penetration of most chemotherapeutic agents into the brain, leaving the brain as a susceptible site for relapse, prophylactic cranial irradiation (PCI) has been used for patients with SCLC [9]. A meta-analysis of studies that mainly included patients with limited stage SCLC (LS-SCLC) [10] showed that PCI decreased the incidence of BM and prolonged overall survival (OS). The European Organization for Research and Treatment of Cancer (EORTC) trial in 2007 found that PCI decreased the risk of BM and prolonged OS in ES-SCLC [11]
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