The overall survival impact of prophylactic cranial irradiation in limited-stage small-cell lung cancer: A systematic review and meta-analysis.
| Autor: | Tomassen ML; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands., Pomp J; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands., van der Stap J; Department of Pulmonology, University Medical Center Utrecht, the Netherlands., van Lindert ASR; Department of Pulmonology, University Medical Center Utrecht, the Netherlands., Peters M; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands., Belderbos JSA; Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek Hospital, Amsterdam, the Netherlands., De Ruysscher DKM; Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands., Lin SH; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston (TX), United States of America., Verhoeff JJC; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands., van Rossum PSN; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands. |
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| Jazyk: | angličtina |
| Zdroj: | Clinical and translational radiation oncology [Clin Transl Radiat Oncol] 2022 Feb 17; Vol. 33, pp. 145-152. Date of Electronic Publication: 2022 Feb 17 (Print Publication: 2022). |
| DOI: | 10.1016/j.ctro.2022.02.002 |
| Abstrakt: | Background: Prophylactic cranial irradiation (PCI) for limited-stage small-cell lung cancer (LS-SCLC) patients has become more controversial. Since the publication of the systematic review by Aupérin et al. in 1999, no randomized controlled trials regarding PCI in LS-SCLC have been completed. The aim of this study was to systematically review and meta-analyze the effect of PCI on overall survival (OS) in patients with LS-SCLC. Methods: A systematic search was conducted in the databases of MEDLINE (PubMed), Embase and the Cochrane library. Only studies that reported an adjusted hazard ratio (aHR), indicating the effect of PCI versus no PCI on OS (adjusted for confounders) in patients with LS-SCLC were included for critical appraisal and meta-analysis. A pooled aHR estimate was calculated using a random-effects model. Results: Pooling of 28 retrospective studies including a total of 18,575 patients demonstrated a significant beneficial effect of PCI versus no PCI on OS with a pooled aHR of 0.62 (95% CI: 0.57-0.69). Substantial heterogeneity of reported aHRs among studies was observed (I 2 = 65.9%). Subgroup analyses revealed that this heterogeneity could partly be explained by study sample size. The pooled aHR among 7 versus 21 studies with a sample size of > 300 versus ≤ 300 patients was 0.79 (95% CI: 0.64-0.97) versus 0.56 (95% CI: 0.46-0.69; p < 0.001), respectively. Conclusions: This meta-analysis demonstrates a significant beneficial effect of PCI on OS in patients with LS-SCLC. Larger studies reported a milder beneficial effect, possibly due to a decreased risk of model overfitting. Serious risk of selection and confounding bias were of concern due to the lack of prospective trials. These results support the role of PCI in standard clinical practice in patients with LS-SCLC while awaiting results of prospective trials on alternative strategies. Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (© 2022 The Author(s).) |
| Databáze: | MEDLINE |
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