Risk factors for brain metastases in surgically staged IIIA non-small cell lung cancer patients treated with surgery, radiotherapy and chemotherapy

Petrović, Marina; Ilic, Nevenka; Lončarević, Olivera; Čekerevac, Ivan; Lazić, Zorica; Novkovic, Ljiljana; Cupurdija, Vojislav; Kostić, Gordana

doi:10.2298/vsp1108643p

Cited by 10 publications

(13 citation statements)

References 18 publications

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“…However, more information is still needed from more RCTs to determine whether a specific subset of patients might derive a survival benefit from PCI versus no PCI compared to the rest of patients. Patients at high risk for brain metastases include (1): patients with superior sulcus tumors, also known as Pancoast tumors, who have a 40% risk of failing in the brain ( 76 , 77 ), (2) patients with operable stage IIIA-N2 NSCLC, and/or patients with non-squamous histology ( 6 , 78 , 79 ), and (3) patients with a complete pathological response to neoadjuvant therapy ( 80 ). Other literature gaps include trials addressing the impact of PCI on QoL and NCF.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Cranial Irradiation in Patients With Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2018

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BackgroundWe systematically reviewed the literature for trials addressing the efficacy of prophylactic cranial irradiation (PCI) in patients with non-small-cell lung cancer (NSCLC) treated with a curative intent.MethodsRandomized controlled trials (RCT) comparing PCI to no PCI in patients with NSCLC treated with a curative intent were eligible for inclusion. We searched EMBASE, MEDLINE, PubMed, and CENTRAL between 1946 and July 2016. We also received continual search alerts from PubMed through September 2017. Search terms included “non-small-cell lung carcinoma,” “cranial irradiation,” and “randomized controlled trials.” We conducted meta-analyses using random-effects models for relative measures of treatment effect for the incidence of brain metastasis, overall survival (OS), and disease-free survival (DFS). We used Parmar’s methodology to derive hazard ratios (HR) when not explicitly stated in RCTs. We narratively synthesized data for the impact of PCI on quality of life (QoL) and neurocognitive function (NCF). We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation methodology.ResultsOut of 3,548 citations captured by the search strategy, we retained 8 papers and 1 abstract, reporting on 6 eligible trials. Patients who received PCI had a significant reduction in the risk of developing brain metastases as compared with patients who did not [relative risk (RR) = 0.37; 95% confidence interval (CI): 0.26–0.52; moderate quality evidence]. However, there was no OS benefit (HR = 1.08, 95% CI: 0.90–1.31; moderate quality evidence). Sensitivity analysis excluding older studies did not show substantively different findings. DFS was reported in the two most recent trials that included only stage III patients. There was significant improvement in DFS with PCI (HR = 0.67; 95% CI: 0.46–0.98; high quality evidence). Two studies that reported on QoL reported no statistically significant differences. There was no significant difference in NCF decline in the only study that reported on this outcome, except in immediate and delayed recall, as assessed by the Hopkins Verbal Learning Test.ConclusionThere is moderate quality evidence that the use of PCI in patients with NSCLC decreases the risk of brain metastases, but does not provide an OS benefit. However, data limited to stage III patients suggests that PCI improves DFS, with no effect on QoL.

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Section: Discussionmentioning

confidence: 99%

Prophylactic Cranial Irradiation in Patients With Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2018

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“…Previous studies have shown that BM is a key cause of morbidity and mortality in cancer and that approximately 20-40% of NSCLC patients will develop BM (6). The median survival period of NSCLC patients with BM is only about 3-6 months (7).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for brain metastases in patients with non-small cell lung cancer: a meta-analysis of 43 studies

Chen¹,

Hua²,

Jia³

et al. 2021

Ann Palliat Med

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Background: Lung cancer is a leading cause of cancer-related mortality worldwide. The purpose of our meta-analysis was to assess the risk factors for brain metastases (BM) in patients with non-small cell lung cancer (NSCLC).Methods: Multiple databases, including PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang, were systematically searched to recruit relevant studies investigating the risk factors for BM in NSCLC patients. The Newcastle-Ottawa Scale was used to evaluate literature quality, and the meta-analysis was performed using the Review Manager 5.3. Evidence quality evaluation was carried out according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) standard. The estimated odds ratio (OR) and 95% confidence intervals (CIs) were set as effect measures. Funnel plots and sensitivity analyses were used to assess publication bias and the robustness and reliability of the combined results, respectively.Results: A total of 43 studies with 11,415 participants were included in this meta-analysis. The results indicated that the following factors were significantly associated with an increased risk of BM in NSCLC patients (P<0.05): (I) gender (female) (OR =1.

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“…Among the studies, four (Wang et al, 2009;Horinouchi et al, 2012;Ding et al, 2012;Lee et al, 2012) recruited participants from Asia, four (Robnett et al, 2001;Mamon et al, 2005;Arrieta et al, 2009;Hubbs et al, 2010) recruited participants from North America, and five (Ceresoli et al, 2002;Keith et al, 2002;Bajard et al, 2004;Petrović et al, 2011;Dimitropoulos et al, 2011) recruited participants from Europe. In addition, 11 studies involved retrospective analyses and 2 studies (Arrieta et al, 2009;Dimitropoulos et al, 2011) involved prospective analyses.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

A Systematic Review of Risk Factors for Brain Metastases and Value of Prophylactic Cranial Irradiation in Non-Small Cell Lung Cancer

Sun¹,

Hu²,

Cai³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: The incidence of brain metastases (BM) varies in patients with non-small cell lung cancer (NSCLC), calls into question the value of prophylactic cranial irradiation (PCI). It is possible that clinicopathologic characteristics are associated with the development of BM, but these have yet to be identified in detail. Thus, we conducted the present meta-analysis on risk factors for BM and the value of PCI in patients with NSCLC. Methods: Eligible data were extracted and the risk factors for BM and the value of PCI in patients with NSCLC were analyzed by calculating the pooled odds ratio (OR). Heterogeneity was detected using Q and I-squared statistics, and publication bias was tested by funnel plots and Egger's test. Results: Six randomized controlled trials with a focus on the value of PCI and 13 eligible studies with a focus on risk factors for BM were included. PCI significantly reduced the incidence of BM in patients with NSCLC (p=0.000, pooled OR=0.34, 95% confidence interval = 0.37-0.59). Compared with non-squamous cell carcinoma, squamous cell carcinoma was associated with a low incidence of BM in patients with NSCLC (p=0.000, pooled OR=0.47, 95% confidence interval =0.34-0.65). The funnel plot and Egger's test suggested that there was no publication bias in the current meta-analysis. Conclusions: This meta-analysis provides statistical evidence that compared with non-squamous cell carcinoma, squamous cell carcinoma can be used as a predictor for BM in patients with NSCLC, and PCI might reduce the incidence of BM in patients with NSCLC, but does not provide a survival benefit.

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Risk factors for brain metastases in surgically staged IIIA non-small cell lung cancer patients treated with surgery, radiotherapy and chemotherapy

Abstract: Brain metastases are often site of recurrence in patients with NSCLC (IIIA-N2). Autonomous risk factors for brain metastases in this group of patients are non-squamous NSCLC, N1-N2 nodal status, postoperative radiotherapy without preoperative radiotherapy.

Cited by 10 publications

References 18 publications

Prophylactic Cranial Irradiation in Patients With Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Prophylactic Cranial Irradiation in Patients With Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Risk factors for brain metastases in patients with non-small cell lung cancer: a meta-analysis of 43 studies

A Systematic Review of Risk Factors for Brain Metastases and Value of Prophylactic Cranial Irradiation in Non-Small Cell Lung Cancer

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