Prophylactic Cranial Irradiation in Patients With Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Prophylactic Cranial Irradiation in Patients With Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
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DOI：
10.3389/fonc.2018.00115
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发表时间：
2018
影响因子：
4.7
通讯作者：
Geara FB
中科院分区：
文献类型：
--
作者：
Al Feghali KA;Ballout RA;Khamis AM;Akl EA;Geara FB
我们系统地回顾了关于预防性颅照射（PCI）治疗非小细胞肺癌（NSCLC）患者疗效的试验文献。比较接受根治性治疗的NSCLC患者的PCI与非PCI的随机对照试验（RCT）符合入选条件。我们检索了1946年至2016年7月期间的EMBASE、MEDLINE、PubMed和CENTRAL。截至2017年9月，我们还收到了来自PubMed的持续检索警报。检索词包括“非小细胞肺癌”、“颅照射”和“随机对照试验”。我们使用随机效应模型对脑转移发生率、总生存期（OS）和无病生存期（DFS）治疗效果的相对指标进行荟萃分析。当RCT中没有明确说明时，我们使用Parmar的方法来推导风险比（HR）。我们叙述性地综合了PCI对生活质量（QoL）和神经认知功能（NCF）影响的数据。我们使用推荐分级、评估、开发和评价方法来评估证据的质量。在检索策略捕获的3，548篇引文中，我们保留了8篇论文和1篇摘要，报告了6项合格试验。与未接受PCI的患者相比，接受PCI的患者发生脑转移的风险显著降低[相对风险（RR）= 0.37; 95%置信区间（CI）：0.26-0.52;中等质量证据]。但是，没有OS获益（HR = 1.08，95% CI：0.90-1.31;中等质量证据）。排除较早研究的敏感性分析未显示实质性不同的结果。最近的两项试验报告了DFS，这些试验仅包括III期患者。经皮冠状动脉介入治疗后DFS显著改善（HR = 0.67; 95% CI：0.46-0.98;高质量证据）。两项报告QoL的研究报告无统计学显著差异。除了通过霍普金斯言语学习测试评估的即时和延迟回忆外，在唯一一项报道这一结果的研究中，NCF下降没有显著差异。有中等质量的证据表明，在NSCLC患者中使用PCI可降低脑转移的风险，但不提供OS获益。然而，仅限于III期患者的数据表明，PCI可改善DFS，对QoL无影响。
We systematically reviewed the literature for trials addressing the efficacy of prophylactic cranial irradiation (PCI) in patients with non-small-cell lung cancer (NSCLC) treated with a curative intent. Randomized controlled trials (RCT) comparing PCI to no PCI in patients with NSCLC treated with a curative intent were eligible for inclusion. We searched EMBASE, MEDLINE, PubMed, and CENTRAL between 1946 and July 2016. We also received continual search alerts from PubMed through September 2017. Search terms included “non-small-cell lung carcinoma,” “cranial irradiation,” and “randomized controlled trials.” We conducted meta-analyses using random-effects models for relative measures of treatment effect for the incidence of brain metastasis, overall survival (OS), and disease-free survival (DFS). We used Parmar’s methodology to derive hazard ratios (HR) when not explicitly stated in RCTs. We narratively synthesized data for the impact of PCI on quality of life (QoL) and neurocognitive function (NCF). We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. Out of 3,548 citations captured by the search strategy, we retained 8 papers and 1 abstract, reporting on 6 eligible trials. Patients who received PCI had a significant reduction in the risk of developing brain metastases as compared with patients who did not [relative risk (RR) = 0.37; 95% confidence interval (CI): 0.26–0.52; moderate quality evidence]. However, there was no OS benefit (HR = 1.08, 95% CI: 0.90–1.31; moderate quality evidence). Sensitivity analysis excluding older studies did not show substantively different findings. DFS was reported in the two most recent trials that included only stage III patients. There was significant improvement in DFS with PCI (HR = 0.67; 95% CI: 0.46–0.98; high quality evidence). Two studies that reported on QoL reported no statistically significant differences. There was no significant difference in NCF decline in the only study that reported on this outcome, except in immediate and delayed recall, as assessed by the Hopkins Verbal Learning Test. There is moderate quality evidence that the use of PCI in patients with NSCLC decreases the risk of brain metastases, but does not provide an OS benefit. However, data limited to stage III patients suggests that PCI improves DFS, with no effect on QoL.
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影响因子：
7.2
作者：
Guyatt, Gordon H.;Oxman, Andrew D.;Schuenemann, Holger J.
通讯作者：
Schuenemann, Holger J.
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GREEN, MR
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158.5
作者：
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通讯作者：
Aisner, J
影响因子：
45.3
作者：
Govindan, Ramaswamy;Page, Nathan;Piccirillo, Jay
通讯作者：
Piccirillo, Jay