Prophylactic cranial irradiation for non-small cell lung cancer: a systematic review

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Author:
BAI Ge(Department of Oncology , First Affiliated Hospital, Xinjiang Medical University , Urumqi 830011, China)
GULIBIYE·Shabier(Department of Oncology , First Affiliated Hospital, Xinjiang Medical University , Urumqi 830011, China)
ZHANG Jian-qing(Department of Oncology , First Affiliated Hospital, Xinjiang Medical University , Urumqi 830011, China)
YANG Mei(Department of Oncology , First Affiliated Hospital, Xinjiang Medical University , Urumqi 830011, China)
BAO Yong-xing(Department of Oncology , First Affiliated Hospital, Xinjiang Medical University , Urumqi 830011, China)
ZHANG Li()
Journal Title:
Chinese Journal of Radiation Oncology
Issue:
Volume 21, Issue 05, 2012
DOI:
10.3760/cma.j.issn.1004-4221.2012.05.011
Key Word:
Carcinoma, non-small cell lung;Prophylactic cranial irradiation;Systematic review;Meta-analysis

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 ( x2 =1.98,P =0.000 ) ; but there is no evidence of 1-year overall survival (OS) benefit ( x2 =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.

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