Whole Brain Radiotherapy Plus Concurrent Chemotherapy in Non-Small Cell Lung Cancer Patients with Brain Metastases: A Meta-Analysis

Abstract

ObjectiveThe aim of the present meta-analysis is to evaluate the response rate, median survival time (MST) and toxicity in patients with brain metastases (BM) originating from non-small cell lung cancer (NSCLC) and who were treated using either whole brain radiotherapy (WBRT) plus concurrent chemotherapy or WBRT alone.MethodsPubMed, EMBASE, Web of Science, The Cochrane Library, clinical trials and current controlled trials were searched to identify any relevant publications. After screening the literature and undertaking quality assessment and data extraction, the meta-analysis was performed using Stata11.0 software.ResultsIn total, six randomized controlled trials (RCT) involving 910 participants were included in the meta-analysis. The results of the analysis indicate that WBRT plus concurrent chemotherapy was more effective at improving response rate (RR = 2.06, 95% CI [1.13, 3.77]; P = 0.019) than WBRT alone. However, WBRT plus concurrent chemotherapy did not improve median survival time (MST) (HR = 1.09, 95%CI [0.94, 1.26]; P = 0.233) or time of neurological progression (CNS-TTP) (HR = 0.93, 95%CI [0.75, 1.16]; P = 0.543), and increased adverse events (Grade≥3) (RR = 2.59, 95% CI [1.88, 3.58]; P = 0.000). There were no significant differences in Grade 3–5 neurological or hematological toxicity between two patient groups (RR = 1.08, 95%CI [0.23, 5.1]; P = 0.92).ConclusionThe combination of chemotherapy plus WBRT in patients with BM originating from NSCLC may increase treatment response rates of brain metastases with limited toxicity. Although the therapy schedule did not prolong MST or CNS-TTP, further assessment is warranted.

Quality of life and efficacy of temozolomide combined with whole-brain radiotherapy in patients with brain metastases from non-small-cell lung cancer

“…A phase 3 trial reported that the combination of TMZ or erlotinib with RT did not improve OS in NSCLC patients with BM. The trial also demonstrated that the OS of erlotinib compared with that of TMZ in combination with RT did not differ significantly (23). Another phase 2 study reported no differences in TTP and OS between the TMZ + RT and the RT alone groups (24), and a phase 3 trial reported that adding TMZ or erlotinib to RT conferred no OS benefit to patients with BM from NSCLC (8).…”

Concurrent Whole Brain Irradiation With or Without Temozolomide in Treatment of Brain Metastases From Breast Cancer.

“…Several studies were for TMZ plus RT with median overall survival of 12 months and a satisfactory level for the quality of life (7,(16)(17)(18). However, individually, only one out of 7 randomized controlled trials RCTs included in this meta-analysis showed a some survival improvement following the addition of temozolomide to radiotherapy, with median survival times of 7and 8.6 months in the RT arm and TMZ plus RT arm, respectively (15).…”

Management of lung cancer brain metastasis: An overview

“…Since most of the studies included in the meta-analysis were retrospective or single arm-study and limited randomized controlled trials, the role of CT in LCBM remains controversial with no proven survival benefit. [49] The most extensively studied chemotherapeutic drugs with WBRT are temozolomide (TMZ) and the radiation sensitizer, motexafin gadolinium. Recent studies have raised concerns of worse outcomes with the combination of TMZ and WBRT in NSCLC patients.…”