Prophylactic Cranial Irradiation in Patients With Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Feghali, Karine A. Al; Ballout, Rami A.; Khamis, Assem M.; Akl, Elie A.; Geara, Fady

doi:10.3389/fonc.2018.00115

Cited by 16 publications

(16 citation statements)

References 82 publications

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“…Second, in the aspect of systematic treatment, appropriate treatment lines of anticancer drugs can be moved forward for highrisk patients to prevent BM, especially in HER2-positive breast cancer, due to the excellent efficacy of novel targeted drugs. Third, in the aspect of local treatment, prophylactic cranial irradiation (PCI) is currently recommended for patients with small-cell lung cancer due to the significant rate of occult BM, resulting in reduced incidence of BM and improved survival outcomes (41)(42)(43). Although no guidelines recommended PCI for breast cancer to prevent BM currently, future randomized clinical trials of PCI for BM prevention might be undertaken in selected patients since high-risk groups can be identified by our nomogram.…”

Section: Discussionmentioning

confidence: 99%

A nomogram for predicting brain metastasis in patients with de novo stage IV breast cancer

Sun¹,

Liu²,

Ye³

et al. 2021

Ann Transl Med

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Background: Brain metastasis (BM) is a very serious event in patients with breast cancer. The aim of this study was to establish a nomogram to predict the risk of BM in patients with de novo stage IV breast cancer. Methods: We gathered female patients diagnosed with de novo stage IV breast cancer between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. After randomly allocating the patients to the training set and verification set, we used univariate and multivariate logistic regression to analyze the relationship between BM and clinicopathological features. Finally, we developed a nomogram which was validated by the analysis of calibration curve and receiver operating characteristic curve. Results: Of 7,154 patients with de novo stage IV breast cancer, 422 developed BM. Age, tumor size, subtype, and the degree of lung involvement were significantly correlated with BM. The nomogram had discriminatory ability with an area under curve (AUC) of 0.640 [95% confidence interval (CI): 0.607 to 0.673] in the training set, and 0.644 (95% CI: 0.595 to 0.693) in the validation set. Conclusions: Our study developed a nomogram to predict BM for de novo stage IV breast cancer, thus helping clinicians to identify patients at high-risk of BM and implement early preventive interventions to improve their prognoses.

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Section: Discussionmentioning

confidence: 99%

A nomogram for predicting brain metastasis in patients with de novo stage IV breast cancer

Sun¹,

Liu²,

Ye³

et al. 2021

Ann Transl Med

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“…To the best of our knowledge, this is the most recent meta-analysis with all available updated data from randomized controlled trials regarding the role of PCI for NSCLC. Previously, four meta-analyses (21)(22)(23)(24) have been carried out to evaluate the efficacy of PCI for NSCLC with inconsistent results. Published reviews demonstrated the effect of PCI in the prevention of BM in NSCLC which are in line with our findings.…”

Section: Discussionmentioning

confidence: 99%

“…However, with regard to effect of PCI on OS, previous reviews drew discordant conclusions. In the meta-analysis of Al Feghali and Lester (21,22), PCI failed to prolong survival for NSCLC while Xie et al (24) reported a detrimental effect on survival with PCI over observation. The meta-analysis by Xie et al (24) included the RCT of Pottgen et al (12), which was judged by our reviewers impossible to evaluate the effect of PCI on BM due to the study design that local treatment between the two arms was different.…”

Section: Discussionmentioning

confidence: 99%

The Role of Prophylactic Cranial Irradiation in Patients With Non-small Cell Lung Cancer: An Updated Systematic Review and Meta-Analysis

et al. 2020

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Background: The purpose of this study was to reevaluate the efficacy of prophylactic cranial irradiation (PCI) in non-small cell lung cancer (NSCLC) with the most recent published data and to identify subgroups who may be more likely to gain benefit from PCI. Methods: We searched PubMed, Embase, and Cochrane databases for randomized trials comparing PCI with non-PCI in NSCLC patients. We pooled the data of randomized controlled trials and compared brain metastasis (BM) and overall survival (OS) between PCI group and non-PCI group. Results: Seven studies including 1,462 patients were eligible for the current meta-analysis. Compared to non-PCI group, PCI group achieved decreased BM (RR = 0.37, 95% CI: 0.26-0.52) but similar OS (HR = 1.01, 95% CI: 0.87-1.22). In subgroup analyses of BM, PCI decreased BM for subgroups by pathology (squamous cell carcinoma or non-squamous cell carcinoma) and local treatment modality (surgery or no surgery). However, PCI failed to reduce BM for patients with poor performance status (WHO 2-3). The incidence of PCI related toxicities was low and PCI was well-tolerated by the majority of NSCLC. Low grade neurocognitive function (NCF) decline was reported in NAVLT study and greater deterioration in immediate and delayed recall was reported in RTOG 0214. No significant difference in quality of life (QOL) after PCI was reported. Conclusion: PCI reduces the incidence of BM except for patients with poor performance status. However, PCI fails to prolong OS significantly for NSCLC. An individual patient data meta-analysis may identify patients that could achieve OS prolongation with PCI.

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“…Three randomized studies have looked at the role of PCI in unselected Stage III NSCLC patients in the modern era treated in a multi-institutional setting with all three having slower than expected accrual and showing variable benefits [23], [24], [25]. A systematic review and meta-analysis including the two older studies as well as four additional trials from an earlier era also suggested that PCI decreases the risk of developing BM without an improvement in OS [26]. None of these studies included follow-up brain imaging unless symptoms suggestive of BM were present.…”

Section: Discussionmentioning

confidence: 99%

EGFR mutant locally advanced non-small cell lung cancer is at increased risk of brain metastasis

Mitra

Chen

et al. 2019

Clinical and Translational Radiation Oncology

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a b s t r a c tBackground and purpose: Small studies of primarily metastatic non-small cell lung cancer (NSCLC) have suggested an association between EGFR mutation (EGFR+) and likelihood of brain metastasis. However, these studies are confounded by follow-up time bias. We performed a competing risk analysis of brain metastasis in a more uniform locally advanced NSCLC (LA-NSCLC) cohort with known tumor genotype. Materials and methods: Between 2002 and 2014, 255 patients with LA-NSCLC underwent tumor genotyping for EGFR, ALK and/or KRAS (180 patients had follow-up brain imaging). Cumulative incidence and Fine-Gray regression were performed on clinical variables including genotype and risk of brain metastasis, with death as a competing event.Results: The proportion of tumors with aberrations in EGFR, ALK and KRAS were 17%, 4% and 28%, respectively. The median follow-up was 68 months. On multivariate analysis, EGFR+ was significantly associated with risk of brain metastasis in the full patient cohort (HR 2.04, 95% CI 1.22-3.39, p = 0.006) as well as in the subset of patients with brain follow-up imaging (HR 1.91. 95% CI 1.17-3.13, p = 0.01). This translated to a higher cumulative incidence of brain metastasis in EGFR+ patients at 3 and 5 years (33.3% vs. 23.2 and 43.8% vs. 24.2%, p = 0.006). Conclusion: Patients with EGFR+ LA-NSCLC have a significantly higher likelihood of developing brain metastasis after standard combined modality therapy, independent of their longer overall survival. This high-risk genotypic subgroup may benefit from routine surveillance with brain MRI to allow early salvage with targeted systemic-and/or radiation-therapies.

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Prophylactic Cranial Irradiation in Patients With Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cited by 16 publications

References 82 publications

A nomogram for predicting brain metastasis in patients with de novo stage IV breast cancer

A nomogram for predicting brain metastasis in patients with de novo stage IV breast cancer

The Role of Prophylactic Cranial Irradiation in Patients With Non-small Cell Lung Cancer: An Updated Systematic Review and Meta-Analysis

EGFR mutant locally advanced non-small cell lung cancer is at increased risk of brain metastasis

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