Prophylactic cranial irradiation for patients with small-cell lung cancer: a systematic review of the literature with meta-analysis

Abstract

BackgroundSmall cell lung cancer (SCLC) accounts for about 13% of all lung cancer cases. Small cell lung cancer (SCLC) accounts for about 13% of all lung cancer cases. The purpose of the present article is to assess the role of prophylactic cranial irradiation (PCI) in small cell lung cancer (SCLC) by performing a systematic review of the randomized trials published in the literature.MethodsRandomized controlled trials were identified that compared brain metastases incidence and overall survival between PCI and No PCI in patients with SCLC. Search strategies were limited to the English language and to articles published since 1997, and included: databases searched from 1997 to March 2013 –CINAHL, Embase, Medline, Web of Science, and CENTRAL. Methodological quality was assessed with the Jadad scale. The main end points were brain metastasis and survival.ResultsThe review identified 5 trials, although few were of high quality. Two trials reported the one-year incidence of brain metastasis. PCI reduced the incidence of brain metastasis in one year, with a pooled relative risk of 0.45 (95% CI, 0.35 to 0.58; P < 0.00001). Four trials described the one year survival rate. The combined result revealed a significant (P = 0.01) survival benefit in the group assigned to PCI as compared with the control group, with a pooled relative risk of 0.87 (95% CI, 0.79 to 0.97). Three trials reported the three-year survival rate. The combined result revealed a great significant (P < 0.00001) survival benefit in the PCI group as compared with the No PCI group, with a pooled relative risk of 0.87 (95% CI, 0.83 to 0.91). the Five-year survival rate was compared in four trials Compared with the No PCI group, the PCI group had a significant (P < 0.00001) survival benefit with a pooled relative risk of 0.92 (95% CI, 0.88 to 0.95).ConclusionsThe present systematic review indicates that PCI decreases brain metastases incidence and that PCI improves survival in SCLC patients. Prophylactic cranial irradiation should be part of standard care for all patients with small-cell lung cancer who have a response to initial chemotherapy, and it should be part of the standard treatment in future studies involving these patients.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2407-14-793) contains supplementary material, which is available to authorized users.

Current Patterns of Care for Patients with Extensive-Stage SCLC: Survey of U.S. Radiation Oncologists on Their Recommendations Regarding Prophylactic Cranial Irradiation

“…2,3 Brain metastases are common, with a 10% prevalence at presentation and a 50% incidence within 2 years of diagnosis. 4 At the time of diagnosis 70% of patients have extensive-stage SCLC (ES-SCLC), 5 which is initially treated with systemic chemotherapy and has a higher rate of brain metastases than limited-stage SCLC. For patients with ES-SCLC who respond to chemotherapy, clinical evidence indicates benefit from addition of prophylactic cranial irradiation (PCI) and thoracic consolidation radiotherapy (RT).…”

Herbal medicine for hand–foot syndrome induced by fluoropyrimidines: A systematic review and meta‐analysis

“…In accordance with this scale, each study received an overall score from 0 to 7, with a greater score indicating better quality. Studies with Jadad scores equal to or greater than 4 were considered to be of high quality (Bañares et al, 2002;Jadad, Moore, & Carroll, 1996;Rong et al, 2017;Zhang et al, 2014).…”

Risk factors and treatments for brain metastasis in patients with adenocarcinoma of the lung: a retrospective analysis of 373 patients

“…The brain is one of the most common sites of distant metastasis. Prophylactic cranial irradiation (PCI) has been the standard of care for patients with small cell lung cancer (SCLC), which has been shown not only to decrease the incidence of BM but also to improve long-term survival [3][4][5][6]. Similar studies have been conducted in patients with NSCLC.…”