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Meta-Analysis
. 2014 Jul 29;9(7):e103431.
doi: 10.1371/journal.pone.0103431. eCollection 2014.

Prophylactic cranial irradiation may impose a detrimental effect on overall survival of patients with nonsmall cell lung cancer: a systematic review and meta-analysis

Shuan-shuan Xie  1 , Ming Li  1 , Cai-cun Zhou  2 , Xiao-lian Song  1 , Chang-hui Wang  1
Affiliations
Meta-Analysis

Prophylactic cranial irradiation may impose a detrimental effect on overall survival of patients with nonsmall cell lung cancer: a systematic review and meta-analysis

Shuan-shuan Xie et al. PLoS One. .

Abstract

Purpose: To determine the role of brain metastases (BM) and overall survival (OS) in patients with non-small cell lung cancer (NSCLC) by performing a meta-analysis of the RCTs (randomized controlled clinical trials) and non-RCTs (non-randomized controlled clinical trials) published in the literature.

Methods: A meta-analysis was performed using trials identified through PubMed, EMBASE and Cochrane databases. Two investigators independently assessed the quality of the trials and extracted data. The outcomes included BM, OS, median survival (MS), response rate (RR), Hazard ratios (HRs) and odds ratios (ORs), and their 95% confidence intervals (CIs) were pooled using ReMan software.

Results: Twelve trials (6 RCTs and 6 non-RCTs) involving 1,718 NSCLC patients met the inclusion criteria. They were grouped on the basis of study design for separate Meta-analyses. The results showed that prophylactic cranial irradiation (PCI) reduced the risk of BM as compared with non-PCI in NSCLC patients (OR = 0.30, 95% [CI]: 0.21-0.43, p<0.00001). However, HRs for OS favored non-PCI (HR = 1.19, 95% [CI]: 1.06-1.33, p = 0.004), without evidence of heterogeneity between the studies.

Conclusion: Our results suggest that although PCI decreased the risk of BM, it may impose a detrimental effect on OS of NSCLC patients.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Procedures used for trial selection.
Abbreviations: RCT,randomized controlled trial; Non-RCT, non-randomized controlled trial.
Figure 2
Figure 2. Results of the meta-analysis on studies evaluating the effect of PCI on brain metastases: OR: 0.30 (95% CI: 0.21–0.43).
Figure 3
Figure 3. Results of the meta-analysis on studies evaluating the effect of PCI on overall survival: HR: 1.19 (95% CI: 1.06–1.33).
Figure 4
Figure 4. Results of the funnel plot of the studies evaluating the effect of PCI on brain metastases: OR, Odds ratio.
Figure 5
Figure 5. Results of the funnel plot of studies evaluating the effect of PCI on overall survival: HR, Hazard ratio.
See this image and copyright information in PMC

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