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Review
. 2001:1:5.
doi: 10.1186/1471-2407-1-5. Epub 2001 Jun 19.

Prophylactic cranial irradiation in small cell lung cancer: a systematic review of the literature with meta-analysis

A P Meert  1 , M Paesmans, T Berghmans, B Martin, C Mascaux, F Vallot, J M Verdebout, J J Lafitte, J P Sculier
Affiliations
Review

Prophylactic cranial irradiation in small cell lung cancer: a systematic review of the literature with meta-analysis

A P Meert et al. BMC Cancer. 2001.

Abstract

Purpose: A systematic review of the literature was carried out to determine the role of prophylactic cranial irradiation (PCI) in small cell lung cancer (SCLC).

Methods: To be eligible, full published trials needed to deal with SCLC and to have randomly assigned patients to receive PCI or not. Trials quality was assessed by two scores (Chalmers and ELCWP).

Results: Twelve randomised trials (1547 patients) were found to be eligible. Five evaluated the role of PCI in SCLC patients who had complete response (CR) after chemotherapy. Brain CT scan was done in the work-up in five studies and brain scintigraphy in six. Chalmers and ELCWP scores are well correlated (p < 0.001), with respective median scores of 32.6 and 38.8 %. This meta-analysis based on the available published data reveals a decrease of brain metastases incidence (hazard ratio (HR): 0.48; 95 % confidence interval (CI): 0.39 - 0.60) for all the studies and an improvement of survival (HR: 0.82; 95 % CI: 0.71 - 0.96) in patients in CR in favour of the PCI arm. Unfortunately, long-term neurotoxicity was not adequately described.

Conclusions: PCI decreases brain metastases incidence and improves survival in CR SCLC patients but these effects were obtained in patients who had no systematic neuropsychological and brain imagery assessments. The long-term toxicity has not been prospectively evaluated. If PCI can be recommended in patients with SCLC and CR documented by a work-up including brain CT scan, data are lacking to generalise its use to any CR situations.

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Figures

Figure 1
Figure 1
Results of the meta-analysis of the studies evaluating the role of PCI on time to relapse in the brain assessing brain metastases incidence : HR : 0.48 (95% CI : 0.39-0.60) NB: the centre of the lozenge gives the combined HR of the meta-analysis and its extremities the 95% confidence interval.
Figure 2
Figure 2
Results of the meta-analysis of the studies evaluating the role of PCI on time to relapse in the brain assessing brain metastases incidence when patients are in complete response : HR : 0.49 (95% CI : 0.39-0.62)
Figure 3
Figure 3
Results of the meta-analysis of the studies evaluating the role of PCI on survival : HR : 0.94 (95 % CI : 0.87-1.02)
Figure 4
Figure 4
Results of the meta-analysis of the studies evaluating the role of PCI on survival when patients are in CR : HR : 0.82 (95% CI : 0.71-0.96)
See this image and copyright information in PMC

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