The Prevention of Brain Metastases in Non-Small Cell Lung Cancer by Prophylactic Cranial Irradiation

Frontiers in Oncology

Bram L. T. Ramaekers¹  Willem J. A. Witlox¹  Anne-Marie C. Dingemans²  Lizza E. L. Hendriks²  Judith G. M. van Loon³  Daniëlle B. P. Eekers³  Jaap D. Zindler³  Dirk K. M. De Ruysscher⁴ 

[1]Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands

[2]Department of Pulmonology, Maastricht University Medical Centre, GROW School of Oncology and Developmental Biology, Maastricht, Netherlands

[3]Department of Radiation Oncology (Maastro Clinic), Maastricht University Medical Centre, GROW School of Oncology and Developmental Biology, Maastricht, Netherlands

[4]Radiation Oncology, KU Leuven, Leuven, Belgium

关键词: non-small cell lung cancer;    prophylactic cranial irradiation;    brain metastases;    toxicity;    survival;    quality of life;   

DOI  :  10.3389/fonc.2018.00241

来源: DOAJ

【 摘 要 】

BackgroundNon-small cell lung cancer (NSCLC) patients frequently develop brain metastases (BM), even though the initial imaging with brain CT or MRI was negative. Stage III patients have the highest risk to develop BM, with an incidence of approximately 30%. BM can lead to neurocognitive disorders, loss of quality of life (QoL), and they are the most important factors influencing patient’s overall survival (OS). Although a radical local treatment of BM may be possible with primary radiosurgery or after resection, the prognosis often remains poor. Preventing the development of BM through prophylactic cranial irradiation (PCI) may improve the outcome of these patients.MethodsData from published randomized trials comparing PCI with non-PCI were sought using electronic database (PubMed) searching, hand searching, and by contacting experts. Trials were included if they considered a randomized comparison of PCI and non-PCI, enrolled NSCLC patients, excluded patients with recurrent or metastatic disease, and reported results on BM occurrence. Each randomized controlled trial (RCT) was assessed for methodological quality using the Cochrane collaboration’s tool for the assessment of risk of bias. Study estimates were pooled using a fixed effects sample-weighted meta-analysis approach to calculate an overall estimate and 95% confidence interval (CI). Results on PCI-related toxicity, QoL, and OS were only reported descriptively.ResultsSeven RCTs were included in the meta-analysis. In total, 1,462 patients were analyzed, including 717 patients who received PCI and 745 patients who did not. The risk of developing BM was significantly decreased through PCI (13% reduction, RR 0.33; 95% CI 0.22–0.45). PCI-related toxicity and QoL data were limited. Acute toxicity mostly included fatigue, skin-related toxicity, and nausea or vomiting. Late toxicities such as headache, dyspnea, lethargy, and low grade cognitive impairments were also reported in some of the included RCTs. Results on OS were inconclusive.ConclusionThe risk of developing BM was reduced in patients who received PCI compared to patients who did not. To implement PCI as the standard treatment for patients with NSCLC, the impact of PCI-related toxicity on QoL should be further investigated, as well as long-term OS. A future individual patient data meta-analysis could produce definitive answers to this clinical question.

【 授权许可】

Unknown