Prophylactic Cranial Irradiation May Impose a Detrimental Effect on Overall Survival of Patients with Nonsmall Cell Lung Cancer: A Systematic Review and Meta-Analysis

• Published in: PloS one Vol. 9; no. 7; p. e103431
• Main Authors: Xie, Shuan-shuan, Li, Ming, Zhou, Cai-cun, Song, Xiao-lian, Wang, Chang-hui
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 29.07.2014; Public Library of Science (PLoS)
• Subjects: Analysis; Bias; Brain; Brain cancer; Brain Neoplasms - prevention & control; Brain Neoplasms - secondary; Cancer; Cancer therapies; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Cardiac patients; Case-Control Studies; Cell survival; Chemotherapy; Clinical trials; Collaboration; Confidence intervals; Cranial Irradiation; Drug dosages; Heterogeneity; Humans; Identification methods; Irradiation; Lung cancer; Lung diseases; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Medical research; Medicine; Medicine and Health Sciences; Meta-analysis; Metastases; Metastasis; Non-Randomized Controlled Trials as Topic; Non-small cell lung cancer; Non-small cell lung carcinoma; Odds Ratio; Oncology; Patient outcomes; Patients; Premedication; Proportional Hazards Models; Quality; Quality assessment; Radiation therapy; Randomization; Randomized Controlled Trials as Topic; Risk reduction; Skull; Studies; Survival; Systematic review; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0103431

To determine the role of brain metastases (BM) and overall survival (OS) in patients with non-small cell lung cancer (NSCLC) by performing a meta-analysis of the RCTs (randomized controlled clinical trials) and non-RCTs (non-randomized controlled clinical trials) published in the literature. A meta-analysis was performed using trials identified through PubMed, EMBASE and Cochrane databases. Two investigators independently assessed the quality of the trials and extracted data. The outcomes included BM, OS, median survival (MS), response rate (RR), Hazard ratios (HRs) and odds ratios (ORs), and their 95% confidence intervals (CIs) were pooled using ReMan software. Twelve trials (6 RCTs and 6 non-RCTs) involving 1,718 NSCLC patients met the inclusion criteria. They were grouped on the basis of study design for separate Meta-analyses. The results showed that prophylactic cranial irradiation (PCI) reduced the risk of BM as compared with non-PCI in NSCLC patients (OR = 0.30, 95% [CI]: 0.21-0.43, p<0.00001). However, HRs for OS favored non-PCI (HR = 1.19, 95% [CI]: 1.06-1.33, p = 0.004), without evidence of heterogeneity between the studies. Our results suggest that although PCI decreased the risk of BM, it may impose a detrimental effect on OS of NSCLC patients.