Prophylactic cranial irradiation for non-small cell lung cancer:a systematic review
BAI Ge*, GULIBIYE·Shabier, ZHANG Jian-qing, YANG Mei, BAO Yong-xing, ZHANG Li
*Department of Oncology, First Affiliated Hospital, Xinjiang Medical University, Urumqi 830011, China Corresponding author:ZHANG Li,Department of Internal Medicine,First Affiliated Hospital,Xinjiang Medical Universty, Urumqi 830011,China;Email:zhangli9514@126.com
Abstract：Objective To determine whether prophylactic cranial irradiation (PCI) has a role in the management of patients with non-small cell lung carcinoma (NSCLC) treated with radical intent. Methods We searched The Cochrane Library, MEDLINE, EMbase, CBM, CNKI and VIP. The quality of the included studies was critically evaluated. Data analyses were performed using the Cochrane Collaboration′s RevMan 5.1 software. Results Four randomized controlled trials involving 905 patients met the inclusion criteria. The results meta-analyses showed the incidence of brain metastases was lower in PCI group compared with the observation group (χ2=1.98,P=0.000);but there is no evidence of 1-year overall survival (OS) benefit (χ2=1.12,P=0.880).Only RTOG 2009 provides prospective data:There were no significant differences in global cognitive function (P=0.600) or ADL (P=0.880) after PCI, but there was a significant decline in immediate recall (P=0.030) and delayed recall (P=0.008) at 1 year. At 1 year, there was no significant differences in QOL after PCI (P=0.050). Conclusions This systematic review show significantly decreases the risk of BM without improving 1-year OS in NSCLC patient receiving prophylactic cranial irradiation. There is insufficient evidence to support the use of PCI in clinical practice. Where possible, patients should be offered entry into a clinical trial.
BAI Ge*,GULIBIYE·Shabier,ZHANG Jian-qing et al. Prophylactic cranial irradiation for non-small cell lung cancer:a systematic review[J]. Chinese Journal of Radiation Oncology, 2012, 21(5): 432-434.
[1] Higgins JPT, Altman DG. Assessing risk of bias in included studies//Higgins JPT,Green S. Cochrane handbook for systematic reviews of intervention. Version 5.0.1 [2011-12-10].http://www.cochrane-handbook.org. [2] Cox JD, Stanley K, Petrovich Z, et al. Cranial rradiation in cancer of the lung of all cell types. JAMA,1981,245:469-472. [3] Umsawasdi T, Valdivieso M, Barkley HT, et al. Combined chemoradiotherapy in limited-disease inoperable non-small cell lung cancer. Int J Radiat Oncol Biol and Phys,1987,14:43-48. [4] Miller TP, Crowley JJ. Mira J, et al. A randomized trial of chemotherapy and radiotherapy for stage Ⅲ non-small cell lung cancer. Cancer Therapeutics,1998,4:229-236. [5] Russell AH, Pajak TE, Selim HM, et al. Prophylactic cranial irradiation for lung cancer patients at high risk for development of cerebral metastasis:results of a prospective randomised trial conduced by the radiation therapy oncology group. Int J Radiat Oncol Biol Phys,1991,21:637-643. [6] Ptgen C, Eberhardt W, Grannass A, et al. Prophylactic cranial irradiation in operable stage Ⅲa non-small cell lung cancer treated with neoadjuvant chemoradiotherapy:results from a german mulitcenter randomised trial. J Clin Oncol,2007,25:4987-4992. [7] Gore EM, Bae K, Wong SJ, et al. Phase Ⅲ comparison of prophylactic cranial irradiation versus observation in patients with locally advanced non-small-cell lung cancer:primary analysis of radiation therapy oncology group study RTOG 0214. J Clin Oncol,2011,29:272-278. [8] Sun A, Bae K, Gore EM, et al. Phase Ⅲ trial of prophylactic cranial irradiation compared with observation in patients with locally advanced non-small-cell lung cancer:neurocognitive and quality of life analysis. J Clin Oncol,2011,29:279-286. [9] Aupérin A, Arriagada R, Pignon JP,et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. N Engl J Med,1999,341:476-484. [10] Chen G, Liu X, Wang Z, et al. Vascular endothelial growth factor C:the predictor of early recurrence in patients with N2 non-small cell lung cancer. Eur J Cardiothorac Surg,2010,37:546-551. [11] Dimitropoulos C, Hillas G, Nikolakopoulou S, et al. Prophylactic cranial irradiation in non-small cell lung cancer patients:who might be the candidates? Cancer Manag Res,2011,3:287-294. [12] Arriagada R, Le Chevalier T, Borie F, et al. Prophylactic cranial irradiation for patients with small cell lung cancer in complete remission. J Natl Cancer Inst,1995,87:183-190. [13] Gregor A, Cull A, Stephens RJ, et al. Prophylactic cranial irradiation is indicated following complete response to induction therapy in small cell lung cancer:results of a multicentre randomized trial. Eur J Cancer,1997,33:1752-1758. [14] Slotman B, Mauer ME, Bottomley A, et al. Prophylactic cranial irradiation in extensive disease small-cell lung cancer:short-term health-related quality of life and patient reported symptoms-results of an international phase Ⅲ randomized controlled trial by the EORTC radiation oncology and lung cancer groups. J Clin Oncol,2009,27:78-84. [15] Slotman B, Faivre-Finn C,Kramer G, et al. Prophylactic cranialirradiation in extensive small-cell lung cancer. N Engl J Med,
2007,357:664-672. [16] Le Péchoux C, Dunant A, Senan S,et al. Standard-dose versus higher-dose prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer in complete remission after chemotherapy and thoracic radiotherapy (PCI 99-01, EORTC 22003-08004, RTOG 0212, and IFCT 99-01):a randomised clinical trial. Lancet Oncol,2009,10:467-474.
2012, Vol. 21 
