Intervention Review

Prophylactic cranial irradiation for preventing brain metastases in patients undergoing radical treatment for non-small cell lung cancer

  1. Nita Patel1,*,
  2. Jason F Lester2,
  3. Bernadette Coles3,
  4. Fergus Macbeth4

Editorial Group: Cochrane Lung Cancer Group

Published Online: 20 APR 2005

Assessed as up-to-date: 7 JUL 2009

DOI: 10.1002/14651858.CD005221


How to Cite

Patel N, Lester JF, Coles B, Macbeth F. Prophylactic cranial irradiation for preventing brain metastases in patients undergoing radical treatment for non-small cell lung cancer. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD005221. DOI: 10.1002/14651858.CD005221.

Author Information

  1. 1

    St Thomas' Hospital, Clinical Oncology, London, UK

  2. 2

    Velindre Hospital NHS Trust, Oncology Department, Cardiff, South Glamorgan, UK

  3. 3

    Cardiff University, Cancer Research Wales Library, Cardiff, UK

  4. 4

    National Institute for Health and Clinical Excellence, Centre for Clinical Practice, London, UK

*Nita Patel, Clinical Oncology, St Thomas' Hospital, London, UK. Nita.Patel@uclh.nhs.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 20 APR 2005

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

In non-small cell lung cancer (NSCLC), there is a relatively high incidence of brain metastases following radical treatment. At present, the role of prophylactic cranial irradiation (PCI) in this group of patients is not clear. This is an update of the original review published in 2005.

Objectives

To investigate whether PCI has a role in the management of patients with NSCLC treated with radical intent.

Search methods

The electronic databases MEDLINE, EMBASE, CENTRAL (The Cochrane library) and LILACS, along with handsearching of journals, relevant books, and review articles used to identify potentially eligible trials.

Selection criteria

Randomised controlled trials (RCTs) comparing PCI with no PCI in NSCLC patients treated with radical intent.

Data collection and analysis

Two authors independently performed study selection, data extraction and assessment of risk of bias.

Due to the small patient numbers, and variations in radiotherapy (RT) dose, no meta-analysis was attempted.

Main results

Four RCTs have been included in this review. No further trials were found to be eligible in this update. Only one new trial investigating the role of PCI has been carried out since the original review and is only published in the abstract form (RTOG 0214) . PCI may reduce the incidence of brain metastases, but there is no evidence of a survival benefit. There is no evidence that any regimen is superior, and the effect of PCI on quality of life (QOL) is not known.

Authors' conclusions

This update of the review published in 2005 does not contain any new trials published in full. One new trial that has only been published as an abstract, does not show any benefit in overall survival in patients receiving prophylactic cranial irradiation. There is insufficient evidence to support the use of PCI in clinical practice. Where possible, patients should be offered entry into a clinical trial.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

There is no evidence to recommend that patients with non-small cell lung cancer receive prophylactic radiotherapy to the brain following potentially curative treatment with surgery or radiotherapy

Patients with non-small cell lung cancer have a significant risk of developing tumour spread (metastases) to the brain after potentially curative treatment. To date, four research trials have been published in full; they included different groups of patients who had different doses of radiotherapy, and different outcomes were measured. None of the trials showed that patients who had received prophylactic radiotherapy to the brain lived longer than those who had not, although fewer of them developed brain metastases. A fifth trial (RTOG 0214) has not yet been published in full and is discussed in the results section.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

評估非小細胞肺癌病人接受根治療法後使用預防性腦部放射線治療的預防腦轉移效果

非小細胞肺癌病人接受根治療法之後有相當高的機率發生腦部轉移,而預防性腦部放射線治療的角色仍不明確

目標

評估非小細胞肺癌病人接受根治療法後,預防性腦部放射線治療的地位

搜尋策略

電子資料庫,包括MEDLINE, EMBASE和Cancerlit,的搜尋以及人工搜尋期刊、相關書籍和回顧性文章來找到合乎條件的臨床試驗

選擇標準

非小細胞肺癌病人接受根治療法後,有無 接受預防性腦部放射線治療之隨機對照試驗

資料收集與分析

回顧了四個隨機對照試驗,由於病人數太少以及放射線治療的劑量差異,所以沒有考慮作統合分析

主要結論

預防性腦部放射線治療可能減少腦部轉移,但是沒有證據支持對存活有幫助或哪一種放療處方較佳,對於生活品質的影響也未知

作者結論

沒有足夠的證據支持在臨床應用上給予預防性腦部放射線治療。如果可能,應該提供病人進入臨床試驗

翻譯人

本摘要由臺北榮民總醫院馮嘉毅翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有證據建議非小細胞肺癌病人在接受治癒性手術或放射線治療之後再去接受預防性腦部放射線治療。 非小細胞肺癌病人在接受治癒性的治療之後有很高危險性會發生腦部轉移。到目前為止,有四個試驗包括不同組別的病人接受不同的放射線治療劑量和不同的結果評估發表,結果顯示雖然預防性腦部放射線治療可以減少將來發生轉移的機會,但沒有一個試驗顯示接受預防性腦部放射線治療的病人活的比沒有接受的病人久,所以需要更多病人加入試驗。