Abstract
ObjectiveThe aim of the present meta-analysis is to evaluate the response rate, median survival time (MST) and toxicity in patients with brain metastases (BM) originating from non-small cell lung cancer (NSCLC) and who were treated using either whole brain radiotherapy (WBRT) plus concurrent chemotherapy or WBRT alone.MethodsPubMed, EMBASE, Web of Science, The Cochrane Library, clinical trials and current controlled trials were searched to identify any relevant publications. After screening the literature and undertaking quality assessment and data extraction, the meta-analysis was performed using Stata11.0 software.ResultsIn total, six randomized controlled trials (RCT) involving 910 participants were included in the meta-analysis. The results of the analysis indicate that WBRT plus concurrent chemotherapy was more effective at improving response rate (RR = 2.06, 95% CI [1.13, 3.77]; P = 0.019) than WBRT alone. However, WBRT plus concurrent chemotherapy did not improve median survival time (MST) (HR = 1.09, 95%CI [0.94, 1.26]; P = 0.233) or time of neurological progression (CNS-TTP) (HR = 0.93, 95%CI [0.75, 1.16]; P = 0.543), and increased adverse events (Grade≥3) (RR = 2.59, 95% CI [1.88, 3.58]; P = 0.000). There were no significant differences in Grade 3–5 neurological or hematological toxicity between two patient groups (RR = 1.08, 95%CI [0.23, 5.1]; P = 0.92).ConclusionThe combination of chemotherapy plus WBRT in patients with BM originating from NSCLC may increase treatment response rates of brain metastases with limited toxicity. Although the therapy schedule did not prolong MST or CNS-TTP, further assessment is warranted.
Highlights
20% to 40% of patients with cancer develop brain metastases (BM) during their disease course
General characteristics of included studies There were 910 patients with BM originating from non-small cell lung cancer (NSCLC) in the six selected randomized controlled trials (RCT) trials, with 478 patients having received whole brain radiotherapy (WBRT) concurrent with chemotherapy and 432 patients having received only WBRT; these results are summarized in table 1
The results indicate that WBRT plus concurrent chemotherapy resulted in superior response rates when compared with WBRT alone (RR = 2.06, 95%CI [1.13, 3.77]; P = 0.019)
Summary
20% to 40% of patients with cancer develop brain metastases (BM) during their disease course. Patients with solid tumors, such as lung and, breast cancer or melanoma, are at high risk for BM. It has been estimated that approximately 50% of primary lung cancers develop into BM [1]. It has been estimated that 25% to 30% of newly diagnosed NSCLC patients suffer from brain metastases [2]. NSCLC patients who develop BM often have poor prognoses, severe neurological symptoms, poor quality of life and dismal survival rates. The overall survival time (OS) for NSCLC patients with BM is less than 3–6 months when left untreated [3]; effective treatment options for NSCLC patients with BM are needed urgently
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