The Role of Prophylactic Cranial Irradiation in Patients With Extensive Stage Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Maeng, Chi Hoon; Song, Jae-Uk; Shim, Sung Ryul; Lee, Jong Hoo

doi:10.1016/j.jtho.2018.02.024

Cited by 22 publications

(20 citation statements)

References 39 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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“…Two meta-analysis regarding this topic were published this year. Maeng et al [40] focused on the role of PCI in patients with ES-SCLC. The aim of their study was to perform a systematic review and meta-analysis to determine the role of PCI in patients with ES-SCLC who received PCI.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic cranial irradiation in small cell lung cancer: a systematic review and meta-analysis

et al. 2019

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BackgroundThe efficacy of prophylactic cranial irradiation (PCI) in treating patients with small cell lung cancer (SCLC) has not been clear, and recent randomized studies have demonstrated conflicting results from previously published findings. The purpose of this study was to reevaluate the efficacy of PCI in patients with SCLC and to assess factors associated with its efficacy.MethodsWe conducted a quantitative meta-analysis to explore the efficacy of PCI in patients with SCLC. A literature search was performed using EMBASE, MEDLINE, Cochrane and ClinicalTrials.gov databases. We pooled the data and compared overall survival (OS) and brain metastasis (BM) between patients treated with PCI (PCI group) and patients without PCI treatment (observation group).ResultsOf the 1074 studies identified in our analysis, we selected seven studies including 2114 patients for the current meta-analysis. Our results showed that the PCI group showed decreased BM (HR = 0.45, 95% CI: 0.38–0.55, P < 0.001) and prolonged OS (HR = 0.81, 95% CI: 0.67–0.99, P < 0.001). However, in terms of OS, the pooled analysis showed a high heterogeneity (I2 = 74.1%, P = 0.001). In subgroup analyses of OS, we found that the heterogeneity mainly came from patients with brain imaging after initial chemoradiotherapy (HR = 0.94, 95% CI: 0.74–1.18, P = 0.59).ConclusionsThe results of this study showed that PCI has a significant effect on decreasing BM but little benefit in prolonging OS when brain imaging was introduced to confirm lack of BM after initial chemoradiotherapy and before irradiation.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-5251-3) contains supplementary material, which is available to authorized users.

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“…Recently, there was a meta-analysis [ 27 ] evaluating the impact of PCI in extensive-stage SCLC. They included five studies comprising 984 cases.…”

Section: Discussionmentioning

confidence: 99%

“…This was in accordance with our findings. However, their results showed PCI did not statistically prolong OS when compared to control (HR = 0.82; 95% CI: 0.60–1.11; p = 0.19), and the PCI group had a better 1-year survival (37.1% versus 27.1%; RR = 0.87; p = 0.002) compared to the control group [ 27 ]. In contrast, our analysis shows a statistical advantage of PCI on OS (HR = 0.57; 95%CI: 0.47, 0.69; p < 0.00001).…”

Section: Discussionmentioning

confidence: 99%

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

Yan

et al. 2018

Radiat Oncol

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BackgroundA 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.MethodsPubMed, 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.ResultsA 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.ConclusionPCI improves overall survival in extensive-stage SCLC. More randomized controlled trials are needed to verify our findings.Electronic supplementary materialThe online version of this article (10.1186/s13014-018-1101-3) contains supplementary material, which is available to authorized users.

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The Role of Prophylactic Cranial Irradiation in Patients With Extensive Stage Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Abstract: Our findings suggest that PCI in patients with extensive stage small cell lung cancer may lead to a significant benefit in 1-year survival, progression-free survival, and the risk of brain metastasis, despite the lack of a significant advantage in OS.

Cited by 22 publications

References 39 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

Prophylactic cranial irradiation in small cell lung cancer: a systematic review and meta-analysis

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

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