Treatment of Small Cell Lung Cancer: Two-drug versus four-drug chemotherapy and loco-regional irradiation with or without prophylactic cranial irradiation

Trinta anos de irradiação craniana profilática em pacientes com câncer de pulmão de pequenas células: uma meta-análise de ensaios clínicos randomizados

“…A total of 16 RCTs, (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) published between 1977 and 2007, were considered eligible for inclusion in the present study. The principal characteristics of those RCTs are summarized in Table 1.…”

“…A total of 7 studies (894 patients) (4,5,7,11,15) evaluated the role of PCI in patients who had a complete response after induction chemotherapy. A total of 5 studies (6,9,(12)(13)(14) evaluated the role of PCI administered at the start of induction chemotherapy in patients considered free of brain metastases. A total of 7 studies (894 patients) (4,5,7,11,15) evaluated the role of PCI in patients who received it during induction chemotherapy.…”

“…A total of 10 studies (4)(5)(6)11,12,14,15) included patients regardless of their disease stage (limited or extensive). (6)(7)(8)(9)13) In contrast, 6 studies included only patients with limited disease, whereas 1 study included only those with extensive disease. (16) …”

“…On the basis of the abovementioned data, several randomized clinical trials (RCTs) have investigated the role of prophylactic cranial irradiation (PCI) in patients with extensive or limited SCLC. (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) A meta-analysis published in 1999 and including 7 RCTs involving 987 patients with SCLC and complete response to chemotherapy showed a 5.4% increase in the three-year survival of those undergoing PCI. (20) However, ever since that meta-analysis was published, several RCTs have been published, and uncertainties still remain regarding the indications for PCI use in patients with extensive disease and in those with limited disease and an incomplete response to chemotherapy.…”

Prophylactic cranial irradiation in high-risk non-small cell lung cancer patients

“…Previously overlooked, we know now that the brain is the most common site of dissemination for this disease, reaching a metastasis rate of more than 50% at 2 years. In the early 1970s, prophylactic cranial irradiation (PCI) was proposed to be included in the treatment strategy for SCLC and since then several randomised trials were conducted [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] to evaluate this treatment. Until recent years, it was thought that PCI was only effective in decreasing the brain metastasis rate, but without a significant effect on overall survival.…”