Prophylactic cranial irradiation in patients with non-small-cell lung cancer : systematic review and meta-analysis of randomized controlled trials -

Abstract

Background: Brain has been reported across multiple studies as first site of failure after curative treatment in 14-28percent of patients with NSCLC. Although prophylactic cranial irradiation (PCI) is recommended in the management of small cell lung cancer (SCLC) patients and has been demonstrated to confer a survival advantage over observation in those who achieved a complete remission after curative treatment, it is still not routinely recommended in the management of NSCLC. Objectives: To systematically review the benefits and harms of PCI in patients with NSCLC treated with a curative intent.W e sought to examine the impact of prophylactic cranial irradiation on: (1) the incidence of brain metastases in patients with NSCLC, (2) overall survival and disease-free survival rates and (3) impact of PCI on patients’ quality of life (QOL) and neurocognitive function (NCF), with emphasis on patients with the highest risk of developing brain metastases. Materials and Methods: 1) Data sources: We selected all randomized controlled trials comparing PCI to no PCI in patients with NSCLC treated with a curative intent. We searched EMBASE, MEDLINE, PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) with search dates between 1946 and February 2016. We did not apply any limits for language. Search terms included “non-small-cell lung carcinoma”, “cranial irradiation” and “randomized controlled trials”. We reviewed the Cochrane Database for Systematic Reviews, and clinical trials registers and consulted experts in the field for information on potential unpublished data. 2) Study selection: Two independent reviewers screened all papers identified by our search strategy for eligibility. 3) Data collection: A data abstraction form was used independently by the two reviewers. All the data extraction was performed in duplicate and independent manner, and disagreements between the two reviewers were resolved by discussion. Trial authors were contacted, when needed, in orde