The effects of prophylactic cranial irradiation versus control on survival of patients with extensive-stage small-cell lung cancer: a meta-analysis of 14 trials

Wei Ge, Huilin Xu, Yafei Yan, Dedong Cao, Wei Ge, Huilin Xu, Yafei Yan, Dedong Cao

Abstract

Background: A recent Japanese study suggested prophylactic cranial irradiation (PCI) failed to improve survival of extensive-stage small-cell lung cancer (SCLC). However, previous studies showed that PCI was beneficial in reducing the rate of mortality for extensive-stage SCLC. In this study, we aimed to evaluate the impact of PCI on the survival of patients diagnosed with extensive-stage SCLC by meta-analysis.

Methods: PubMed, Embase, the Cochrane library and Chinese Biomedical Literature database (CBM) were systematically searched to identify eligible clinical studies assessing the efficacy of PCI in extensive-stage SCLC patients. After extracting survival data, brain metastasis, and response rates, the pooled estimates were calculated.

Results: A total of 14 clinical studies were included, involving 1221 cases in the PCI group and 5074 in the control group. The results showed that PCI significantly improved overall survival (Hazard ratio (HR) = 0.57; 95% confidence interval (CI): 0.47, 0.69; p < 0.001) and brain metastasis (risk ratio (RR) =0.47, 95%CI: 0.33, 0.69; p < 0.01). Subgroup analysis along with sensitivity analysis suggested that PCI effects on overall survival were independent of region, pre-PCI brain metastasis status and PCI administration timing.

Conclusion: PCI improves overall survival in extensive-stage SCLC. More randomized controlled trials are needed to verify our findings.

Keywords: Brain metastasis; Evidence-based medicine; Meta-analysis; Prophylactic cranial irradiation; Small-cell lung cancer; Survival.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no conflicts of interests.

Publisher’s Note

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Figures

Fig. 1
Fig. 1
Flow-chart of identifying eligible studies
Fig. 2
Fig. 2
Combined effects of PCI versus control with regard to OS, PFS, and risk of brain metastasis. a, Forest plot showing the synthesized HR of PCI vs. control for OS in extensive-stage SCLC; b, Forest plot showing the synthesized HR of PCI vs. control for PFS in extensive-stage SCLC; c, PCI reduces the risk of brain metastasis in extensive-stage SCLC
Fig. 3
Fig. 3
Forest plot of subgroup analysis and funnel plot on OS. a, subgroup analysis of study type; b, subgroup analysis of the region
Fig. 4
Fig. 4
Subgroup analysis of PCI timing in extensive-stage SCLC

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Source: PubMed

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