Abstract
To evaluate the efficacy and safety of whole brain radiotherapy (WBRT) plus chemotherapy versus WBRT alone for treating brain metastases (BM) from lung cancer by performing a meta-analysis based on randomized controlled trials (RCTs). The PubMed, Embase, CENTRAL, ASCO, ESMO, CBM, CNKI, and VIP databases were searched for relevant RCTs performed between January 2000 and March 2012. After quality assessment and data extraction, the meta-analysis was performed using the RevMan 5.1 software, with funnel plot evaluation of publication bias. 19 RCTs involving 1,343 patients were included. The meta-analyses demonstrated that compared to WBRT alone, WBRT plus chemotherapy was more effective with regard to the objective response rate (OR = 2.30, 95% CI = 1.79-2.98; P < 0.001); however, the incidences of gastrointestinal reactions (RR = 3.82, 95% CI = 2.33-6.28, P <0.001), bone marrow suppression (RR = 5.49, 95% CI = 3.65-8.25, P < 0.001), thrombocytopenia (RR = 5.83, 95% CI = 0.39-86.59; P = 0.20), leukopenia (RR = 3.13, 95% CI = 1.77-5.51; P < 0.001), and neutropenia (RR = 2.75, 95% CI = 1.61-4.68; P < 0.001) in patients treated with WBRT plus chemotherapy were higher than with WBRT alone. There was no obvious publication bias detected. WBRT plus chemotherapy can obviously improve total efficacy rate, but also increases the incidence of adverse reactions compared to WBRT alone. From the limitations of this study, more large-scale, high-quality RCTs are suggested for further verification.
Highlights
The PubMed, Embase, CENTRAL, American society of clinical oncology (ASCO), European Society for Medical Oncology (ESMO), Chinese Biological Medicine Database (CBM), China National Knowledge Infrastructure (CNKI), and VIP databases were searched for relevant randomized controlled trials (RCTs) performed between January 2000 and March 2012
The meta-analyses demonstrated that compared to whole brain radiotherapy (WBRT) alone, WBRT plus chemotherapy was more effective with regard to the objective response rate (OR = 2.30, 95% confidence interval (CI) = 1.79 – 2.98; P < 0.001); the incidences of gastrointestinal reactions (RR = 3.82, 95% CI = 2.33 - 6.28, P
Metastasis of advanced lung cancer may occur in various organs, brain is one of the most common sites, which has an incidence of 25% -65% and accounting for 40% -60% of all brain metastases (BM) (Kienast et al, 2010)
Summary
Metastasis of advanced lung cancer may occur in various organs, brain is one of the most common sites, which has an incidence of 25% -65% and accounting for 40% -60% of all brain metastases (BM) (Kienast et al, 2010). Surgery is the standard treatment for stabilized singlesite brain metastasis or for the control of systematic tumors (Bovi et al, 2012). WBRT (whole brain radiotherapy) has long been a standard treatment for patients with BM and can improve survival time, WBRT can rarely eradicate the tumor due to poor tolerance of normal brain tissue to radiation, and approximately one-third patients have remaining uncontrollable localized tumors after WBRT treatment, and 50% patients die of progressive intracranial tumor (Gijtenbeek et al, 2011). The emergence of various new chemotherapy drugs has greatly enhanced the efficacy of the treatment in lung cancer patients, but most drugs cannot pass the blood-brain barrier (BBB), or have difficulty achieving effective concentrations in the brain tissue. Recent studies demonstrated that BBB is damaged in patients with BM, that means many drugs may penetrate the brain tissue (Grimm, 2012). Chemotherapy alone did not significantly improve the survival rate of lung cancer patients with BM (Kyritsis et al, 2012)
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