Prophylactic cranial irradiation may impose a detrimental effect on overall survival of patients with nonsmall cell lung cancer: a systematic review and meta-analysis

Shuan-shuan Xie; Ming Li; Cai-cun Zhou; Xiao-lian Song; Chang-hui Wang

doi:10.1371/journal.pone.0103431

Prophylactic cranial irradiation may impose a detrimental effect on overall survival of patients with nonsmall cell lung cancer: a systematic review and meta-analysis

PLoS One. 2014 Jul 29;9(7):e103431. doi: 10.1371/journal.pone.0103431. eCollection 2014.

Authors

Shuan-shuan Xie¹, Ming Li¹, Cai-cun Zhou², Xiao-lian Song¹, Chang-hui Wang¹

Affiliations

¹ Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, Peoples R China.
² Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Tongji University Cancer Institute, Shanghai, Peoples R China.

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: Our results suggest that although PCI decreased the risk of BM, it may impose a detrimental effect on OS of NSCLC patients.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Brain Neoplasms / prevention & control*
Brain Neoplasms / secondary*
Carcinoma, Non-Small-Cell Lung / mortality*
Carcinoma, Non-Small-Cell Lung / pathology*
Case-Control Studies
Cranial Irradiation*
Humans
Lung Neoplasms / mortality*
Lung Neoplasms / pathology*
Non-Randomized Controlled Trials as Topic
Odds Ratio
Premedication*
Proportional Hazards Models
Randomized Controlled Trials as Topic

Grants and funding

This study was funded by the National Natural Science Foundation of China (No. 81172229, 81100018). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.