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

Viani, Gustavo Arruda; Boin, André Campiolo; Ikeda, Veridiana Yuri; Vianna, Bruno Silveira; Silva, Rondinelli Salvador; Santanella, Fernando

doi:10.1590/s1806-37132012000300013

Cited by 25 publications

(9 citation statements)

References 16 publications

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“…Several systematic reviews and meta-analyses [10, 38–41] regarding the role of PCI for SCLC survival outcomes have been published. Compared with earlier meta-analyses [23, 38, 39], we set more strict inclusion criteria and excluded trials that didn’t report PCI. Besides, we included several recent trials in our analysis.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic cranial irradiation in small cell lung cancer: a systematic review and meta-analysis

et al. 2019

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BackgroundThe efficacy of prophylactic cranial irradiation (PCI) in treating patients with small cell lung cancer (SCLC) has not been clear, and recent randomized studies have demonstrated conflicting results from previously published findings. The purpose of this study was to reevaluate the efficacy of PCI in patients with SCLC and to assess factors associated with its efficacy.MethodsWe conducted a quantitative meta-analysis to explore the efficacy of PCI in patients with SCLC. A literature search was performed using EMBASE, MEDLINE, Cochrane and ClinicalTrials.gov databases. We pooled the data and compared overall survival (OS) and brain metastasis (BM) between patients treated with PCI (PCI group) and patients without PCI treatment (observation group).ResultsOf the 1074 studies identified in our analysis, we selected seven studies including 2114 patients for the current meta-analysis. Our results showed that the PCI group showed decreased BM (HR = 0.45, 95% CI: 0.38–0.55, P < 0.001) and prolonged OS (HR = 0.81, 95% CI: 0.67–0.99, P < 0.001). However, in terms of OS, the pooled analysis showed a high heterogeneity (I2 = 74.1%, P = 0.001). In subgroup analyses of OS, we found that the heterogeneity mainly came from patients with brain imaging after initial chemoradiotherapy (HR = 0.94, 95% CI: 0.74–1.18, P = 0.59).ConclusionsThe results of this study showed that PCI has a significant effect on decreasing BM but little benefit in prolonging OS when brain imaging was introduced to confirm lack of BM after initial chemoradiotherapy and before irradiation.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-5251-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Prophylactic cranial irradiation in small cell lung cancer: a systematic review and meta-analysis

et al. 2019

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“…Several randomized controlled trials show that PCI decreases brain metastases and increases overall survival in patients with both limited - and extensive - stage small cell lung cancer in those who have a good response to initial chemotherapy (5, 7, 10), with an overall increase in survival at 1 - year from 13 to 27% (7). Meta - analyses have shown a significant decrease in the incidence of brain metastases with a hazard ratio (HR) of 0.48 (95% confidence interval [CI] 0.39 – 0.60) (11), and a decrease in overall mortality by 4.4% in patients treated with PCI (4). Of note, there is one contemporary randomized control trial, which questions the utility of PCI in those with extensive disease; in that trial, there was no survival benefit between groups (12).…”

Section: Discussionmentioning

confidence: 99%

“…There has been growing enthusiasm for prophylactic cranial irradiation (PCI) for those patients who demonstrate a response to initial chemotherapy to decrease the risk of intracranial metastases. Although evidence for this approach is limited in small cell bladder cancer, there is strong evidence supporting its use in patients with small cell lung cancer, 40 – 80% of whom develop brain metastases within 2 years of diagnosis (4-6). Use of PCI in limited stage small cell lung cancer has been well established since the early 1990s.…”

Section: Introductionmentioning

confidence: 99%

Small cell bladder cancer: should we consider prophylactic cranial irradiation?

et al. 2019

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Purpose: To describe the clinical characteristics, treatment patterns, and outcomes in patients with small cell bladder cancer at our institution, including those who received prophylactic cranial irradiation (PCI) for the prevention of intracranial recurrence. Materials and Methods: Patients with small cell bladder cancer treated at a single institution between January 1990 and August 2015 were identified and analyzed retrospectively for demographics, tumor stage, treatment, and overall survival. Results: Of 44 patients diagnosed with small cell bladder cancer, 11 (25%) had metastatic disease at the time of presentation. Treatment included systemic chemotherapy (70%), radical surgery (59%), and local radiation (39%). Six patients (14%) received PCI. Median overall survival was 10 months (IQR 4 – 41). Patients with extensive disease had worse overall survival than those with organ confined disease (8 months vs. 36 months, respectively, p = 0.04). Among those who received PCI, 33% achieved 5 - year survival. Conclusion: Outcomes for patients with small cell bladder cancer remain poor. Further research is indicated to determine if PCI increases overall survival in small call bladder cancer patients, especially those with extensive disease who respond to chemotherapy.

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“…PCI for SCLC offers limited benefit, with some reduction in the incidence of brain metastases but with questionable effects on quality of life and overall survival [89–91]. Otherwise effective strategies for primary prevention remain lacking despite the considerable morbidity and mortality of malignant CNS involvement.…”

Section: Discussion and Therapeutic Implicationsmentioning

confidence: 99%

Breaking and entering into the CNS: clues from solid tumor and nonmalignant models with relevance to hematopoietic malignancies

Basu

Remick

Monga

et al. 2013

Clin Exp Metastasis

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Various malignancies invade the CNS sanctuary site, accounting for the vast majority of CNS neoplastic foci and contributing to significant morbidity as well as mortality. The blood–brain barrier (BBB) exhibits considerable impermeability to chemotherapeutic agents, severely limiting therapeutic options available for patients developing metastatic CNS involvement, accounting for poor outcomes. The mechanisms by which malignant cells breach the highly exclusive BBB and subsequently survive in this unique anatomical site remain poorly understood, with most of the current knowledge stemming from non-malignant and solid malignancy models. While solid and hematologic malignancies may face different challenges once within the CNS (e.g., solid tumor parenchymal metastasis compared to masses/nodules/leptomeningeal disease in hematologic malignancies), commonality exists in the process of migrating across the BBB from the circulation. Specifically considering this last point, this review aims to survey the current mechanistic knowledge regarding malignant migration across the BBB, necessarily emphasizing the better studied solid tumor and nonmalignant models with the intention of highlighting both the current knowledge gap and additional work required to effectively consider how hematopoietic malignancies breach the CNS.

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

Cited by 25 publications

References 16 publications

Prophylactic cranial irradiation in small cell lung cancer: a systematic review and meta-analysis

Prophylactic cranial irradiation in small cell lung cancer: a systematic review and meta-analysis

Small cell bladder cancer: should we consider prophylactic cranial irradiation?

Breaking and entering into the CNS: clues from solid tumor and nonmalignant models with relevance to hematopoietic malignancies

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