Abstract
Non-small cell lung cancer (NSCLC) patients frequently develop brain metastases (BM), even though the initial imaging with brain CT or MRI was negative. Stage III patients have the highest risk to develop BM, with an incidence of approximately 30%. BM can lead to neurocognitive disorders, loss of quality of life (QoL), and they are the most important factors influencing patient's overall survival (OS). Although a radical local treatment of BM may be possible with primary radiosurgery or after resection, the prognosis often remains poor. Preventing the development of BM through prophylactic cranial irradiation (PCI) may improve the outcome of these patients. Data from published randomized trials comparing PCI with non-PCI were sought using electronic database (PubMed) searching, hand searching, and by contacting experts. Trials were included if they considered a randomized comparison of PCI and non-PCI, enrolled NSCLC patients, excluded patients with recurrent or metastatic disease, and reported results on BM occurrence. Each randomized controlled trial (RCT) was assessed for methodological quality using the Cochrane collaboration's tool for the assessment of risk of bias. Study estimates were pooled using a fixed effects sample-weighted meta-analysis approach to calculate an overall estimate and 95% confidence interval (CI). Results on PCI-related toxicity, QoL, and OS were only reported descriptively. Seven RCTs were included in the meta-analysis. In total, 1,462 patients were analyzed, including 717 patients who received PCI and 745 patients who did not. The risk of developing BM was significantly decreased through PCI (13% reduction, RR 0.33; 95% CI 0.22-0.45). PCI-related toxicity and QoL data were limited. Acute toxicity mostly included fatigue, skin-related toxicity, and nausea or vomiting. Late toxicities such as headache, dyspnea, lethargy, and low grade cognitive impairments were also reported in some of the included RCTs. Results on OS were inconclusive. The risk of developing BM was reduced in patients who received PCI compared to patients who did not. To implement PCI as the standard treatment for patients with NSCLC, the impact of PCI-related toxicity on QoL should be further investigated, as well as long-term OS. A future individual patient data meta-analysis could produce definitive answers to this clinical question.
Highlights
Non-small cell lung cancer (NSCLC) is the most important cause of death due to cancer worldwide, and accounts for about 85% of all lung cancers
The following keywords were used as search terms: “Carcinoma, Non-Small-Cell Lung,” “NSCLC,” “Cranial Irradiation,” “Cranial Neoplasms/radiotherapy,” “Brain Metastasis,” “Overall Survival,” and “randomized controlled trials (RCTs).” Details of the search strategy and corresponding flow chart can be found in Appendix S1 in Supplementary Material
Results reporting on quality of life (QoL) were limited, and no significant differences were observed between both arms
Summary
Non-small cell lung cancer (NSCLC) is the most important cause of death due to cancer worldwide, and accounts for about 85% of all lung cancers. Non-small cell lung cancer patients frequently develop brain metastases (BM), even though the initial staging with brain CT or MRI was negative. The more advanced the disease stage is, the more frequent BM occur They are more frequent in adenocarcinoma than in squamous cell cancer [1]. BM can lead to neurocognitive disorders, loss of quality of life (QoL), and they are the most important factors influencing patients’ OS [2]. Non-small cell lung cancer (NSCLC) patients frequently develop brain metastases (BM), even though the initial imaging with brain CT or MRI was negative. BM can lead to neurocognitive disorders, loss of quality of life (QoL), and they are the most important factors influencing patient’s overall survival (OS). Preventing the development of BM through prophylactic cranial irradiation (PCI) may improve the outcome of these patients
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
